This pilot study provides evidence that augmenting an antidepressant medication with a brief, symptom focused, cognitive-behavioral therapy for insomnia is promising for individuals with MDD and comorbid insomnia in terms of alleviating both depression and insomnia.

Clinicaltrials.gov, www.clinicaltrials.gov, NCT00186654.

Objective-Disturbances in sleep continuity are common among individuals with major depressive disorder (MDD) and can impact the course of depression and response to treatment. Several studies have examined depressive symptom severity among sleep disordered patients with obstructive sleep apnea (OSA). In contrast little is known about OSA in patients with MDD. The goal of this study was to examine the frequency and predictors of OSA in a sample of individuals with comorbid MDD and insomnia.Method-Participants were 51 individuals who enrolled in a treatment study on insomnia and depression, met criteria for MDD and comorbid insomnia, and underwent an overnight polysomnography evaluation. An Apnea Hypopnea Index (AHI) ≥15 events per hour was used as a cut-off score for OSA. Regression analyses were conducted to examine clinical and demographic predictors of OSA severity as measured by the AHI. Results-The results revealed that 39% of the sample met criteria for OSA. The OSA group had significantly higher Body-Mass Index (BMI) scores and a significantly greater proportion of men. Regression analysis revealed that male gender, older age, and higher BMI were significant predictors of OSA severity. Neither depression severity nor insomnia severity were significant predictors.Conclusion-These findings indicate that the frequency of OSA is higher among individuals with comorbid MDD and insomnia than was previously found among people with either MDD or insomnia alone. In addition, previously identified predictors of OSA (male gender, older age, and high BMI) also apply to this population.

The current study explored the relationship between maternal subjective sleep quality and two factors that have been independently linked to maternal sleep: infant caretaking at night and maternal depressive symptom severity. Participants were a follow-up cohort of 94 women (mean age 33.3, SD=4.4), who were depressed during pregnancy and part of a larger randomised controlled trial. Participants were evaluated 10 weeks after delivery, using the Edinburgh Postnatal Depression Scale and daily sleep logs for one week. On average, women woke to attend to the infant 2.2 times (SD=1.1) and spent 47.3 min (SD=33.0) awake to attend to the infant. Regression analysis revealed that the number of times a woman's sleep was disrupted by attending to her infant was a significant predictor of her perceived subjective sleep quality; however, the total amount of time she spent attending to her infant and her depressive symptom severity were not predictors. The findings of this study suggest that during the third postpartum month, sleep fragmentation appears more detrimental to maternal subjective sleep quality than amount of time awake during the night. This finding is relevant to the implementation of clinical interventions for improving maternal subjective sleep quality during the early postpartum period.

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