Research paperInsomnia and hypersomnia in major depressive episode: Prevalence, sociodemographic characteristics and psychiatric comorbidity in a population-based study
Introduction
Major Depressive Disorder (MDD) is associated with considerable functional and social impairment (Ustün et al., 2004, Wittchen and Jacobi, 2005) and considered as being the most prevalent psychiatric disorder (Waraich et al., 2004). MDD is the second worldwide cause of disability and is associated with decreased quality of life and increased mortality (Ferrari et al., 2013, Hoertel et al., 2014, Whiteford et al., 2013). Sleep disturbances are observed in nearly 90% of individuals with major depressive episode (MDE) (Tsuno et al., 2005). The most characteristic sleep disturbances in MDE include delayed sleep onset, non-restful sleep, early-morning wakening, daytime fatigue, and blunting or reversal of the normal morning peaks in subjective energy and alertness (Hickie and Rogers, 2011). Sleep complaints are also frequently the last symptoms to resolve at the end of a MDE (Wichniak et al., 2012). Several clinical studies have linked sleep disturbances in patients with MDE to increased severity of depressive symptoms (O’Brien et al., 2011), poorer treatment response (Pigeon et al., 2008), and increased risk of suicidal ideation and suicide attempt (Li et al., 2012, Pigeon et al., 2012). Sleep complaints may also persist during MDE remission and are associated with greater risk of recurrence (Kaplan et al., 2011, Perlis et al., 1997, Sylvia et al., 2012), poorer overall functioning and quality of life, and increased risk of metabolic syndrome (Kaplan et al., 2011, Li et al., 2012, van Mill et al., 2010). Advancing our understanding of the mechanisms through which sleep disturbances impact on the prognosis of MDE may have important implications for the management of patients with MDE (Bellivier et al., 2015, Dallaspezia et al., 2015, Harvey et al., 2015).
Along the last decades, growing attention has been paid by clinicians and researchers to better characterize sleep disturbances associated with MDE. Several studies used subjective and objective measures based on actigraphy or polysomnography and showed a short rapid eye movement (REM) sleep latency, an increased REM sleep and a decreased slow wave sleep (Arfken et al., 2014, Berle et al., 2010, Korszun et al., 2002, Lopez et al., 2010, Pillai et al., 2011, Todder et al., 2006). Based on these findings, several chronobiological treatments have emerged to help relieve MDE symptoms, including bright light treatment, melatonin agonists, sleep deprivation, and specific cognitive and behavioural therapies (Al-Karawi and Jubair, 2016, Benedetti and Colombo, 2011, Dallaspezia et al., 2015, Hickie and Rogers, 2011). However, a better understanding of the heterogeneity of sleep complaints observed in individuals with MDE may help refine existing sleep treatments and develop personalized treatment of depression.
Research on insomnia and hypersomnia in MDE has predominantly focused on sleep complaints as distinct entities despite growing evidence indicating that insomnia and hypersomnia can co-occur (Soehner et al., 2014). In addition, it remains poorly known whether specific sociodemographic and psychiatric comorbidity may be associated with specific sleep complaints in MDE.
In a large sample of individuals with MDE, we sought to examine (i) the frequency of three sleep complaints (i.e., early wake-up, trouble falling asleep and hypersomnia) and their co-occurrence and (ii) the sociodemographic characteristics and psychiatric comorbidity associated with the different types of sleep complaints. By using a large, nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we aimed to obtain stable estimates that could be generalized beyond clinical samples.
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Participants
Data were drawn from the Wave 1 and Wave 2 NESARC, a nationally representative survey of the US adult population, conducted in 2001–2002 (Wave 1) and 2004–2005 (Wave 2) by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) and described in detail elsewhere (Grant et al., 2009). The target population included the civilian population, aged 18 years and older, residing in households and group quarters. Face-to-face interviews were conducted with 43,093 respondents. The overall survey
Prevalence of sleep complaints in participants with MDE
We found that 3573 participants (mean age = 44.0 years (SE = 0.3); age range at Wave 2: 20–90 years; median = 43 years; 1st quartile = 33 years; 3rd quartile = 54 years) had a DSM-IV-TR diagnosis of MDE between the two waves of the NESARC. Among these participants, 3299 (92.3%) reported at least one type of sleep complaints whereas 274 (7.7%) had no sleep problems. Among respondents with sleep complaints, 2809 (85.2%) had insomnia while 1566 (47.5%) reported hypersomnia. More specifically,
Discussion
Several important findings emerged from this study. First, in a nationally representative sample, we confirmed that almost all participants with MDE report sleep complaints. Second, while insomnia was the sleep complaint the most frequently reported by individuals with MDE, we found that hypersomnia was reported by about half of individuals with MDE. Third, we observed that up to one-third of participants with MDE reported both insomnia and hypersomnia. Lastly, we found that several
Funding/support
None.
Additional information
Original data set for the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is available from the National Institute on Alcohol Abuse and Alcoholism (http://www.niaaa.nih.gov).
Acknowledgments
The National Epidemiologic Survey on Alcohol and Related Conditions was sponsored by the National Institute on Alcohol Abuse and Alcoholism and funded, in part, by the Intramural Program, NIAAA, National Institutes of Health.
Pierre A. Geoffroy is a psychiatrist and sleep physician, and neuroscientist (MD, Ph.D.) in Fernand Widal Hospital, Department of Psychiatry, in Paris; and Assistant Professor in Paris Diderot University in France.
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Pierre A. Geoffroy is a psychiatrist and sleep physician, and neuroscientist (MD, Ph.D.) in Fernand Widal Hospital, Department of Psychiatry, in Paris; and Assistant Professor in Paris Diderot University in France.
Nicolas Hoertel is a psychiatrist and epidemiologist (MD, Ph.D.), specialized in elder, working in Corentin Celton Hospital, Department of Psychiatry, and in Paris Descartes University in France.
Bruno Etain is a psychiatrist (MD, Ph.D.) in Fernand Widal Hospital, Department of Psychiatry, in Paris; and Associate Professor in Paris Diderot University in France.
Frank Bellivier is a psychiatrist (MD, Ph.D.) in Fernand Widal Hospital, Department of Psychiatry and Addictology, in Paris; and Full Professor in Paris Diderot University in France.
Richard Delorme is a child psychiatrist (MD, Ph.D.) in Robert Debré Hospital, Department of Child and Adolescent Psychiatry, in Paris; and Full Professor in Paris Diderot University in France.
Frédéric Limosin is a psychiatrist and neuroscientist (MD, Ph.D.), specialized in elder, working in Corentin Celton Hospital, Department of Psychiatry, and Full Professor in Paris Descartes University in France.
Hugo Peyre is a child psychiatrist and epidemiologist (MD, Ph.D.) in Robert Debré Hospital, Department of Child and Adolescent Psychiatry, in Paris; and Associate Professor in Paris Diderot University in France.