Dama Manish H, Martin Josh, Tassone Vanessa K, Lin Qiaowei, Lou Wendy, Bhat Venkat
Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada.
School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Republic of Ireland.
Can J Psychiatry. 2025 Mar 24:7067437251328308. doi: 10.1177/07067437251328308.
ObjectivesDelayed sleep-wake phase disorder (DSWPD) most commonly affects young individuals (adolescents and young adults), but it is often undetected in clinical practice. Despite several reports suggesting a link between DSWPD and depression, no systematic review has investigated this association. The aim of this systematic review was to determine whether DSWPD is associated with depression among young individuals.MethodsMEDLINE, EMBASE, PsycINFO, and CINAHL Plus were searched up to 29 July 2024. Primary studies investigating DSWPD and depression among young individuals were eligible. Methodological quality and risk of bias was assessed with the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Common-effect models were conducted to examine the relationship between DSWPD status (categorical variable: yes or no) and depression severity (continuous variable). PROSPERO ID: CRD42023458889.ResultsSixteen studies were included with 766 participants being evaluated against the diagnostic criteria for DSWPD from the International Classification of Sleep Disorders. Thirteen out of 15 studies demonstrated that young individuals with DSWPD had a significantly greater severity of depressive symptoms than young individuals without DSWPD. NIH quality assessment scores ranged between 5 and 9 (out of a total of 11). DSWPD status had a significantly large effect on depression severity in the common-effect model (: 16 estimates, 693 participants, Cohen's = 0.92, 95% confidence interval (95% CI) [0.76-1.08]). The subgroup analysis also demonstrated significant findings with the common-effect model that only utilized data from studies that controlled for psychiatric disorders (: 12 estimates, 535 participants, Cohen's = 0.88, 95% CI [0.70-1.06]).ConclusionsDSWPD is associated with a greater severity of depressive symptoms among young individuals. Although more research is required to understand this association, it may be useful to consider the presence of DSWPD when managing young individuals who present with persistent sleep disturbances (e.g., sleep-onset insomnia) and depressive symptoms.
目的
延迟睡眠-觉醒相位障碍（DSWPD）最常影响年轻人（青少年和青年成年人），但在临床实践中往往未被发现。尽管有几份报告表明DSWPD与抑郁症之间存在联系，但尚未有系统评价对这种关联进行研究。本系统评价的目的是确定DSWPD在年轻人中是否与抑郁症相关。
方法
检索截至2024年7月29日的MEDLINE、EMBASE、PsycINFO和CINAHL Plus数据库。纳入调查年轻人中DSWPD和抑郁症的原始研究。采用美国国立卫生研究院（NIH）观察性队列和横断面研究质量评估工具评估方法学质量和偏倚风险。采用固定效应模型检验DSWPD状态（分类变量：是或否）与抑郁严重程度（连续变量）之间的关系。国际前瞻性系统评价注册库（PROSPERO）标识符：CRD42023458889。
结果
纳入16项研究，共766名参与者根据《国际睡眠障碍分类》的DSWPD诊断标准进行评估。15项研究中的13项表明，患有DSWPD的年轻人比未患有DSWPD的年轻人抑郁症状严重程度显著更高。NIH质量评估得分在5至9分之间（满分11分）。在固定效应模型中，DSWPD状态对抑郁严重程度有显著的较大影响（：16项估计，693名参与者，科恩效应量=0.92，95%置信区间[0.76 - 1.08]）。亚组分析也显示，仅使用控制了精神疾病的研究数据的固定效应模型有显著结果（：12项估计，535名参与者，科恩效应量=0.88，95%置信区间[0.70 - 1.06]）。
结论
DSWPD与年轻人中更严重的抑郁症状相关。尽管需要更多研究来理解这种关联，但在管理出现持续睡眠障碍（如入睡性失眠）和抑郁症状的年轻人时，考虑DSWPD的存在可能会有所帮助。
