Whether insomnia, a known correlate of depression, predicts depression longitudinally warrants elucidation. The authors examined 555 Wisconsin Sleep Cohort Study participants aged 33-71 years without baseline depression or antidepressant use who completed baseline and follow-up overnight polysomnography and had complete questionnaire-based data on insomnia and depression for 1998-2006. Using Poisson regression, they estimated relative risks for depression (Zung scale score > or =50) at 4-year (average) follow-up according to baseline insomnia symptoms and polysomnographic markers. Twenty-six participants (4.7%) developed depression by follow-up. Having 3-4 insomnia symptoms versus none predicted depression risk (age-, sex-, and comorbidity-adjusted relative risk (RR) = 3.2, 95% confidence interval: 1.1, 9.6). After multiple adjustments, frequent difficulty falling asleep (RR = 5.3, 95% confidence interval: 1.1, 27.9) and polysomnographically assessed (upper or lower quartiles) sleep latency, continuity, and duration (RRs = 2.2-4.7; P's < or = 0.05) predicted depression. Graded trends (P-trend < or = 0.05) were observed with increasing number of symptoms, difficulty falling asleep, and difficulty returning to sleep. Given the small number of events using Zung > or =50 (depression cutpoint), a limitation that may bias multivariable estimates, continuous depression scores were analyzed; mean values were largely consistent with dichotomous findings. Insomnia symptoms or markers increased depression risk 2.2- to 5.3-fold. These results support prior findings based on self-reported insomnia and may extend similar conclusions to objective markers. Heightened recognition and treatment of insomnia may prevent subsequent depression.

Insufficient sleep is a risk factor for depression, suicidality, and substance use, yet little is known about gender, ethnic, and community-level differences in sleep and its associated outcomes, especially during adolescence. Further, much of the prior work has compared groups of teens getting plenty as opposed to insufficient amounts of sleep rather than examine sleep hours continuously. The present study examined adolescent weekday self-reported sleep duration and its links with hopelessness, suicidality, and substance use in a suburban community with very early high school start times. We utilized a large (N = 27,939, 51.2% female) and ethnically diverse sample of adolescents from the 2009 Fairfax County (Virginia) Youth Survey, an anonymous, self-report, population-level survey administered to all 8th, 10th and 12th grade students in public schools in the county. High-school students reported an average 6.5 h of sleep per school night, with 20% obtaining ≤5 h, and only 3% reporting the recommended 9 h/night. Females and minority youth obtained even less sleep on average, and the reduction in sleep in the transition from middle school to high school was more pronounced for females and for Asian students. Hierarchical, multivariate, logistic regression analyses, controlling for background variables, indicated that just 1 h less of weekday sleep was associated with significantly greater odds of feeling hopeless, seriously considering suicide, suicide attempts, and substance use. Relationships between sleep duration and suicidality were stronger for male teens, and sleep duration was more associated with hopelessness for white students compared to most ethnic minority groups. Implications for intervention at multiple levels are discussed.

Our longitudinal findings of a dose-response increase in development of systolic nondipping of BP with severity of SDB at baseline in a population-based sample provide evidence consistent with a causal link. Nocturnal systolic nondipping may be a mechanism by which SDB contributes to increased cardiovascular disease.

Summary Sleep disturbances are important correlates of depression, with epidemiologic research heretofore focused on insomnia and sleepiness. This epidemiologic study’s aim was to investigate, in a community sample, depression’s relationships to other sleep disturbances: sleep paralysis (SP), hypnagogic/hypnopompic hallucinations (HH), cataplexy – considered rapid eye movement‐related disturbances – and automatic behavior (AB). Although typical of narcolepsy, these disturbances are prevalent, albeit under‐studied, in the population. Cross‐sectional analyses (1998–2002), based on Wisconsin Sleep Cohort Study population‐based data from 866 participants (mean age 54, 53% male), examined: depression (Zung Self‐Rating Depression Scale), trait anxiety (Spielberger State‐Trait Anxiety Inventory, STAI‐T ≥ 75th percentile), and self‐reported sleep disturbances. Descriptive sleep data were obtained by overnight polysomnography. Adjusted logistic regression models estimated depression’s associations with each (>few times ever) outcome – SP, HH, AB, and cataplexy. Depression’s associations with self‐reported SP and cataplexy were not explained by anxiety. After anxiety adjustment, severe depression (Zung ≥55), vis‐à‐vis Zung <50, increased SP odds ∼500% (P = 0.0008). Depression (Zung ≥50), after stratification by anxiety given an interaction (P = 0.02), increased self‐reported cataplexy odds in non‐anxious (OR 8.9, P = 0.0008) but not anxious (OR 1.1, P = 0.82) participants. Insomnia and sleepiness seemed only partial mediators or confounders for depression’s associations with self‐reported cataplexy and SP. Anxiety (OR 1.9, P = 0.04) partially explained depression’s (Zung ≥55) association with HH (OR 2.2, P = 0.08). Anxiety (OR 1.6, P = 0.02) was also more related than depression to AB. Recognizing depression’s relationships to oft‐neglected sleep disturbances, most notably SP, might assist in better characterizing depression and the full range of its associated sleep problems in the population. Longitudinal studies are warranted to elucidate mediators and causality.

R esearch suggests that teens require more than 9 hours of sleep per night in order to function optimally. Insufficient sleep in teens is common 2 and could eventuate in excessive sleepiness 3 and such onerous consequences as academic difficulties, behavioral abnormalities, 4,5 mood disorders and perhaps even increased risk of suicidal ideation. 6 A potential critical consequence of insufficient sleep in teens is drowsy driving. Fall-asleep crashes tend to be severe, and, of these, 55% have been found to occur in individuals who are 25 years or younger. 7 For the years 2007 and 2008, individuals aged 16-20 years had the highest injury rate from motor vehicle crashes. 8 While individuals aged 15 to 20 years represented only 9% of the U.S. population and 6% of licensed drivers for 2007, 19% of all fatalities in the United States were related to young-driver crashes. 9 Early high school start times could contribute to insufficient sleep in teenagers 10 and increased motor vehicle crashes. One study found start time to be the main determinant of wake times in adolescents. 11 A recent study revealed that a 30-min delay in high school start time was associated with 45 min of additional sleep on weekday nights and reduced sleepiness. 12 Thus, later high school start times could result in more sleep and better synchronicity with the circadian phase delay found in teens. 3 Unfortunately, the relationship of high school start times to crash rates has rarely been investigated. One recent study by Danner and Phillips did demonstrate that delaying high school start times reduced vehicle crashes in teens. In Lexington Kentucky, a 1-h delay in high school start times was associated with a 16.5% decline in teen crashes in the ensuing 2 years. 13 Adjacent and demographically similar cities in Southeastern Virginia, Virginia Beach and Chesapeake offer a propitious opportunity to compare further school start times and teen crashes. These adjoining cities have markedly different public high school start times. Virginia Beach begins public high school Study Objectives: Early high school start times may contribute to insufficient sleep leading to increased teen crash rate. Virginia Beach (VB) and Chesapeake are adjacent, demographically similar cities. VB high schools start 75-80 minutes earlier than Chesapeake's. We hypothesized that VB teens would manifest a higher crash rate than Chesapeake teens. Methods: The Virginia Department of Motor Vehicles (DMV) provided de-identified, aggregate 2008 and 2007 data for weekday crashes and crash times in VB and Chesapeake for drivers aged 16-18 years ("teens"), and provided 2008 and 2007 crash data for all drivers. Data allowed comparisons of VB versus Chesapeake crash rates for teens (overall and hour-by-hour), and teens versus all other ages. We compared AM and PM traffic congestion (peak hours) in the two cities.