Kalmbach David A, Arnedt J Todd, Swanson Leslie M, Rapier Jesica L, Ciesla Jeffrey A
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
Sleep Med. 2017 May;33:6-12. doi: 10.1016/j.sleep.2016.03.014. Epub 2016 May 12.
The objective of this study was to characterize the day-to-day associations among sleep disturbance, depression, and anxiety in a sample of young adult women.
One hundred and seventy-one women (20.1 ± 3.3 years) completed in-laboratory baseline assessment followed by daily online surveys across a two-week period. Daily measures included the Mood and Anxiety Symptom Questionnaire-Short Form to assess shared and disorder-specific symptoms of depression and anxiety (general distress, anhedonic depression, and anxious arousal), as well as self-reported total sleep time (TST), sleep-onset latency (SOL), and sleep quality (SQ).
Findings supported bidirectional day-to-day relationships between sleep and affective symptoms. When women felt greater general distress (shared features of anxiety and depression), they experienced longer SOL and worse SQ at night. Specificity among depression, anxiety, and sleep disturbance was observed such that higher levels of depression-specific anhedonia presaged longer SOL, shorter TST, and poorer SQ. In the other direction, when women had poor-quality sleep, they later experienced greater anhedonic depression and anxious arousal. The influence of TST on anhedonia was complex such that a single night of short sleep led to less anhedonic depression the next day, whereas women who obtained shorter sleep across the two-week period reported greater anhedonia.
Reciprocal dynamics between nightly sleep disturbance and daily experiences of depression and anxiety may serve as a process by which insomnia, depression, and anxiety develop into comorbid clinical states over time in women. The associations of anhedonic depression with nightly sleep disturbance and chronic short sleep were especially toxic, offering insight into daily mechanisms driving the most prevalent phenotype of comorbid insomnia.
本研究的目的是描述年轻成年女性样本中睡眠障碍、抑郁和焦虑之间的日常关联。
171名女性（20.1±3.3岁）完成了实验室基线评估，随后在两周内进行每日在线调查。每日测量包括情绪和焦虑症状问卷简表，以评估抑郁和焦虑的共同症状及特定症状（一般困扰、快感缺失性抑郁和焦虑性觉醒），以及自我报告的总睡眠时间（TST）、入睡潜伏期（SOL）和睡眠质量（SQ）。
研究结果支持睡眠与情感症状之间的双向日常关系。当女性感到更大的一般困扰（焦虑和抑郁的共同特征）时，她们夜间的入睡潜伏期更长，睡眠质量更差。观察到抑郁、焦虑和睡眠障碍之间的特异性，即更高水平的抑郁特异性快感缺失预示着更长的入睡潜伏期、更短的总睡眠时间和更差的睡眠质量。在另一个方向上，当女性睡眠质量差时，她们随后会经历更大的快感缺失性抑郁和焦虑性觉醒。总睡眠时间对快感缺失的影响很复杂，即一晚的短睡眠会导致第二天的快感缺失性抑郁减轻，而在两周内睡眠时间较短的女性报告有更大的快感缺失。
夜间睡眠障碍与抑郁和焦虑的日常经历之间的相互作用可能是随着时间的推移，失眠、抑郁和焦虑在女性中发展为共病临床状态的一个过程。快感缺失性抑郁与夜间睡眠障碍和慢性短睡眠的关联尤其有害，这为驱动共病失眠最普遍表型的日常机制提供了见解。
