Objective measures of sleep duration and continuity in major depressive disorder with comorbid hypersomnolence: a primary investigation with contiguous systematic review and meta‐analysis

Abstract

SUMMARY Hypersomnolence plays an important role in the presentation, treatment, and course of mood disorders. However, there has been relatively little research that examines objective measures of sleep duration and continuity in patients with depression and hypersomnolence, despite the use of these factors in sleep medicine nosological systems. This study compared total sleep time and efficiency measured by naturalistic actigraphic recordings followed by ad libitum polysomnography (without prescribed wake time) in twenty-two patients with major depressive disorder and co-occurring hypersomnolence (MDD-HYP) against age- and sex-matched healthy sleeper controls (HC). MDD-HYP demonstrated significantly longer sleep duration compared to HC quantified by sleep diaries, actigraphy, and ad libitum polysomnography. No between-group differences in sleep efficiency, latency to sleep, or wake after sleep onset were observed when assessed using objective measures. To further contextualize these findings within the broader scientific literature, a systematic review was performed to identify other comparable investigations. Meta-analysis of pooled data demonstrated patients with mood disorders and co-occurring hypersomnolence have significantly greater sleep duration and similar sleep efficiency compared to healthy controls when assessed using ad libitum polysomnography. These results suggest current sleep medicine nosology that distinguishes hypersomnia associated with psychiatric disorders primarily as a construct characterized by low sleep efficiency and increased time in bed may not be accurate. Future studies that establish the biological bases hypersomnolence in mood disorders, as well as clarify the accuracy of nosological thresholds to define excessive sleep duration, are needed to refine the diagnosis and treatment of these disorders.

Sleepiness comorbid to musculoskeletal pain is associated with worse quality of life and mood symptoms in a general population sample

“…Regarding sleep pattern, our findings showed only HPS-mediated differences, represented by increased total sleep time, sleep efficiency and REM sleep stage, as well as a reduction in sleep onset latency in HPS groups compared to no-HPS groups. Longer sleep duration was found by Plante et al 40 in patients with major depressive disorder and co-occurring HPS, but not in controls versus HPS groups, contrary to our findings 40 . We observed a lack of differences in objective sleep parameters among the groups with and without MSK, differently from subjective sleep.…”

Distinct Relevance of Nightly Sleep Duration to Metabolic, Anthropometric, and Lifestyle Factors in Patients with Type 2 Diabetes

“…Another possible explanation is that some patients in group 3 may have psychological problems that cause a physically inactive lifestyle, as hypersomnolence and physical inactivity are common features of major depressive disorders ( 32 , 33 ). Depression increases the risk of cardiovascular morbidity and mortality, probably through an unfavorable lifestyle ( 34 ).…”

Utility of the Fitbit Flex to evaluate sleep in major depressive disorder: A comparison against polysomnography and wrist-worn actigraphy

“…Depression can be accompanied by a diverse range of sleep disturbances including insomnia (difficulty falling asleep, maintaining sleep, or waking up too early) and/or hypersomnolence (excessive daytime sleepiness and/or sleep duration (Soehner et al, 2014). Objective changes in sleep continuity and duration in MDD, as measured by polysomnography, are robust physiological indicators of sleep disturbance in the disorder (Benca et al, 1992; Steiger and Kimura, 2010; Pillai et al, 2011; Plante et al, 2017). Sleep disturbance is also associated with treatment resistance, symptomatic relapse, suicidality, and impaired daytime function, underscoring its importance in the course of affective illness (Baglioni et al, 2011; McCall et al, 2010; Nadorff et al, 2013; Perlis et al, 1997; Riemann and Voderholzer, 2003; Szklo-Coxe et al, 2010).…”