Keller Lena Katharina, Grünewald Barbara, Vetter Céline, Roenneberg Till, Schulte-Körne Gerd
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Waltherstr. 23, 80337, Munich, Germany.
Institute for Medical Psychology, Human Chronobiology, Ludwig-Maximilians-University, Goethestr. 31, 80336, Munich, Germany.
Eur Child Adolesc Psychiatry. 2017 Oct;26(10):1233-1244. doi: 10.1007/s00787-017-0977-z. Epub 2017 Mar 29.
The relationship between sleep and adolescent depression is much discussed, but still not fully understood. One important sleep variable is self-selected sleep timing, which is also referred to as chronotype. Chronotype is mostly regulated by the circadian clock that synchronises the internal time of the body with the external light dark cycle. A late chronotype as well as a misalignment between internal time and external time such as social jetlag has been shown to be associated with depressive symptoms in adults. In this study, we investigated whether adolescents with remitted depression differ from healthy controls in terms of chronotype, social jetlag and other sleep-related variables. For this purpose, we assessed chronotype and social jetlag with the Munich ChronoType Questionnaire (MCTQ), subjective sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and used continuous wrist-actimetry over 31 consecutive days to determine objective sleep timing. Given the potentially mediating effect of light on chronotype and depressive symptoms, we measured light exposure with a light sensor on the actimeter. In our sample, adolescents with remitted depression showed similar chronotypes and similar amounts of social jetlag compared to controls. However, patients with remitted depression slept significantly longer on work-free days and reported a worse subjective sleep quality than controls. Additionally, light exposure in remitted patients was significantly higher, but this finding was mediated by living in a rural environment. These findings indicate that chronotype might be modified during remission, which should be further investigated in longitudinal studies.
睡眠与青少年抑郁症之间的关系已被广泛讨论，但仍未完全理解。一个重要的睡眠变量是自我选择的睡眠时间，也称为昼夜节律类型。昼夜节律类型主要由生物钟调节，生物钟使身体的内部时间与外部明暗周期同步。在成年人中，晚睡型以及内部时间与外部时间的不一致，如社交时差，已被证明与抑郁症状有关。在本研究中，我们调查了缓解期抑郁症青少年在昼夜节律类型、社交时差和其他与睡眠相关的变量方面是否与健康对照组不同。为此，我们使用慕尼黑昼夜节律类型问卷（MCTQ）评估昼夜节律类型和社交时差，使用匹兹堡睡眠质量指数（PSQI）评估主观睡眠质量，并连续31天使用连续腕部活动记录仪来确定客观睡眠时间。考虑到光照对昼夜节律类型和抑郁症状的潜在中介作用，我们在活动记录仪上使用光传感器测量光照暴露。在我们的样本中，缓解期抑郁症青少年与对照组相比，表现出相似的昼夜节律类型和相似的社交时差量。然而，缓解期抑郁症患者在休息日睡眠时间显著更长，并且报告的主观睡眠质量比对照组更差。此外，缓解期患者的光照暴露显著更高，但这一发现是由生活在农村环境所介导的。这些发现表明，昼夜节律类型可能在缓解期发生改变，这应在纵向研究中进一步调查。
