Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA.
J Psychiatr Res. 2022 Dec;156:114-121. doi: 10.1016/j.jpsychires.2022.10.019. Epub 2022 Oct 10.
Sleep and circadian rhythm disruptions are symptoms of, and hypothesized underlying mechanisms in, seasonal depression. Discrepant observational findings and mixed responses to sleep/circadian-based treatments suggest heterogenous sleep and circadian disruptions in seasonal depression, despite these disruptions historically conceptualized as delayed circadian phase and hypersomnia. This study used a data-driven cluster analysis to characterize sleep/circadian profiles in seasonal depression to identify treatment targets for future interventions. Biobehavioral measures of sleep and circadian rhythms were assessed during the winter in individuals with Seasonal Affective Disorder (SAD), subsyndromal-SAD (S-SAD), or nonseasonal, never depressed controls (total sample N = 103). The following variables were used in the cluster analysis: circadian phase (from dim light melatonin onset), midsleep timing, total sleep time, sleep efficiency, regularity of midsleep timing, and nap duration (all from wrist actigraphy). Sleep and circadian variables were compared across clusters and controls. Despite limited sleep/circadian differences between diagnostic groups, there were two reliable (Jaccard Coefficients >0.75) sleep/circadian profiles in SAD/S-SAD individuals: a 'Disrupted sleep' cluster, characterized by irregular and fragmented sleep and an 'Advanced' cluster, characterized by early sleep and circadian timing and longer total sleep times (>7.5 h). Clusters did not differ by depression severity. Midsleep correlated with DLMO (r = 0.56), irregularity (r = 0.3), and total sleep time (r = -0.27). Sleep and circadian disruptions in seasonal depression are not uniformly characterized by hypersomnia and circadian phase delay. Presence of distinct sleep and circadian subgroups in seasonal depression may predict successful treatment response. Prospective assessment and tailoring of individual sleep and circadian disruptions may reduce treatment failures.
睡眠和昼夜节律紊乱是季节性抑郁的症状和假设的潜在机制。观察到的不一致结果以及对睡眠/昼夜节律为基础的治疗的混合反应表明，季节性抑郁的睡眠和昼夜节律紊乱存在异质性，尽管这些紊乱历史上被概念化为昼夜相位延迟和嗜睡。本研究使用数据驱动的聚类分析来描述季节性抑郁的睡眠/昼夜节律特征，以确定未来干预的治疗靶点。在个体冬季期间评估了睡眠和昼夜节律的生物行为测量，这些个体患有季节性情感障碍（SAD）、亚综合征-SAD（S-SAD）或非季节性、从未抑郁的对照者（总样本 N=103）。聚类分析中使用了以下变量：昼夜相位（从微光褪黑素开始）、午夜睡眠时间、总睡眠时间、睡眠效率、午夜睡眠时间规律和午睡时间（均来自腕动仪）。比较了睡眠和昼夜节律变量在聚类和对照组之间的差异。尽管诊断组之间的睡眠/昼夜节律差异有限，但 SAD/S-SAD 个体中存在两个可靠的（Jaccard 系数>0.75）睡眠/昼夜节律特征：一个“睡眠紊乱”聚类，其特征是不规则和碎片化的睡眠和一个“提前”聚类，其特征是早期的睡眠和昼夜节律时间以及更长的总睡眠时间（>7.5 小时）。聚类在抑郁严重程度上没有差异。午夜睡眠与 DLMO（r=0.56）、不规则性（r=0.3）和总睡眠时间（r=-0.27）相关。季节性抑郁的睡眠和昼夜节律紊乱并非统一表现为嗜睡和昼夜相位延迟。季节性抑郁中存在不同的睡眠和昼夜节律亚群可能预示着治疗反应成功。对个体睡眠和昼夜节律紊乱的前瞻性评估和定制可能会减少治疗失败。
