Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Psychol Med. 2023 Mar;53(4):1418-1425. doi: 10.1017/S003329172100297X. Epub 2021 Aug 11.
In older populations disturbed 24-h activity rhythms, poor sleep, and depressive symptoms are often lingering and co-morbid, making treatment difficult. To improve insights into these commonly co-occurring problems, we assessed the bidirectional association of sleep and 24-h activity rhythms with depressive symptoms in middle-aged and elderly persons.
In 1734 participants (mean age: 62.3 ± 9.3 years, 55% women) from the prospective Rotterdam Study, 24-h activity rhythms and sleep were estimated with actigraphy (mean duration: 146 ± 19.6 h), sleep quality with the Pittsburgh Sleep Quality Index, and depressive symptoms with the Center for Epidemiological Studies Depression scale. Repeated measures were available for 947 participants (54%) over a median follow-up of 6 years (interquartile range = 5.6-6.3). Linear-mixed models were used to assess temporal associations of 24-h activity rhythms and sleep with depressive symptoms in both directions.
High 24-h activity rhythm fragmentation (IV) ( = 1.002, 95% confidence interval (CI) = 0.641-1.363), long time in bed (TIB) ( = 0.111, 95% CI = 0.053-0.169), low sleep efficiency (SE) ( = -0.015, 95% CI = -0.020 to -0.009), long sleep onset latency (SOL) ( = 0.009, 95% CI = 0.006-0.012), and low self-rated sleep quality ( = 0.112, 95% CI = 0.0992-0.124) at baseline were associated with increasing depressive symptoms over time. Conversely, more depressive symptoms at baseline were associated with an increasing 24-h activity rhythm fragmentation ( = 0.002, 95% CI = 0.001-0.003) and TIB ( = 0.009, 95% CI = 0.004-0.015), and a decreasing SE ( = -0.140, 95% CI = -0.196 to -0.084), SOL ( = 0.013, 95% CI = 0.008-0.018), and self-rated sleep quality ( = 0.193, 95% CI = 0.171-0.215) over time.
This study demonstrates a bidirectional association of 24-h activity rhythms, actigraphy-estimated sleep, and self-rated sleep quality with depressive symptoms over a time frame of multiple years in middle-aged and elderly persons.
在老年人中，昼夜节律紊乱、睡眠质量差和抑郁症状常常同时存在且相互影响，这使得治疗变得困难。为了更深入地了解这些常见的共病问题，我们评估了中年和老年人的睡眠和 24 小时活动节律与抑郁症状之间的双向关联。
在前瞻性的鹿特丹研究中，共有 1734 名参与者（平均年龄：62.3 ± 9.3 岁，55%为女性），使用活动记录仪（平均持续时间：146 ± 19.6 小时）来评估 24 小时活动节律和睡眠质量，使用匹兹堡睡眠质量指数来评估睡眠质量，使用流行病学研究中心抑郁量表来评估抑郁症状。对于 947 名（54%）参与者，中位随访时间为 6 年（四分位距 = 5.6-6.3），可获得重复测量数据。使用线性混合模型在两个方向上评估 24 小时活动节律和睡眠与抑郁症状之间的时间关联。
基线时高 24 小时活动节律碎片化（IV）（ = 1.002，95%置信区间（CI）= 0.641-1.363）、长卧床时间（TIB）（ = 0.111，95% CI = 0.053-0.169）、低睡眠效率（SE）（ = -0.015，95% CI = -0.020 至 -0.009）、长睡眠潜伏期（SOL）（ = 0.009，95% CI = 0.006-0.012）和低自我报告睡眠质量（ = 0.112，95% CI = 0.0992-0.124）与随时间推移抑郁症状的增加有关。相反，基线时更多的抑郁症状与 24 小时活动节律碎片化的增加（ = 0.002，95% CI = 0.001-0.003）和 TIB 的增加（ = 0.009，95% CI = 0.004-0.015）、SE 的减少（ = -0.140，95% CI = -0.196 至 -0.084）、SOL 的减少（ = 0.013，95% CI = 0.008-0.018）和自我报告的睡眠质量的减少（ = 0.193，95% CI = 0.171-0.215）有关。
本研究表明，在中年和老年人中，24 小时活动节律、活动记录仪估计的睡眠和自我报告的睡眠质量与抑郁症状之间存在双向关联，这种关联可以持续多年。
