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Use of Selective Serotonin Reuptake Inhibitors and Sleep Disturbances in Community-Dwelling Older Women

Authors

  • Kristine E. Ensrud MD, MPH,

    1. From the *Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotaDepartment of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, MinnesotaCalifornia Pacific Medical Center Research Institute, San Francisco, California§Department of Psychiatry, University of California at San Diego, San Diego, California; Departments of Pediatrics, Medicine, and #Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; and Departments of **Psychiatry, ††Neurology, and ‡‡Epidemiology and Biostatistics, and §§Pulmonary and Critical Care Division, University of California at San Francisco, San Francisco, California.
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  • Terri L. Blackwell MA,

    1. From the *Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotaDepartment of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, MinnesotaCalifornia Pacific Medical Center Research Institute, San Francisco, California§Department of Psychiatry, University of California at San Diego, San Diego, California; Departments of Pediatrics, Medicine, and #Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; and Departments of **Psychiatry, ††Neurology, and ‡‡Epidemiology and Biostatistics, and §§Pulmonary and Critical Care Division, University of California at San Francisco, San Francisco, California.
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  • Sonia Ancoli-Israel PhD,

    1. From the *Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotaDepartment of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, MinnesotaCalifornia Pacific Medical Center Research Institute, San Francisco, California§Department of Psychiatry, University of California at San Diego, San Diego, California; Departments of Pediatrics, Medicine, and #Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; and Departments of **Psychiatry, ††Neurology, and ‡‡Epidemiology and Biostatistics, and §§Pulmonary and Critical Care Division, University of California at San Francisco, San Francisco, California.
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  • Susan Redline MD,

    1. From the *Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotaDepartment of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, MinnesotaCalifornia Pacific Medical Center Research Institute, San Francisco, California§Department of Psychiatry, University of California at San Diego, San Diego, California; Departments of Pediatrics, Medicine, and #Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; and Departments of **Psychiatry, ††Neurology, and ‡‡Epidemiology and Biostatistics, and §§Pulmonary and Critical Care Division, University of California at San Francisco, San Francisco, California.
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  • Kristine Yaffe MD,

    1. From the *Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotaDepartment of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, MinnesotaCalifornia Pacific Medical Center Research Institute, San Francisco, California§Department of Psychiatry, University of California at San Diego, San Diego, California; Departments of Pediatrics, Medicine, and #Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; and Departments of **Psychiatry, ††Neurology, and ‡‡Epidemiology and Biostatistics, and §§Pulmonary and Critical Care Division, University of California at San Francisco, San Francisco, California.
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  • Susan Diem MD, MPH,

    1. From the *Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotaDepartment of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, MinnesotaCalifornia Pacific Medical Center Research Institute, San Francisco, California§Department of Psychiatry, University of California at San Diego, San Diego, California; Departments of Pediatrics, Medicine, and #Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; and Departments of **Psychiatry, ††Neurology, and ‡‡Epidemiology and Biostatistics, and §§Pulmonary and Critical Care Division, University of California at San Francisco, San Francisco, California.
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  • David Claman MD,

    1. From the *Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotaDepartment of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, MinnesotaCalifornia Pacific Medical Center Research Institute, San Francisco, California§Department of Psychiatry, University of California at San Diego, San Diego, California; Departments of Pediatrics, Medicine, and #Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; and Departments of **Psychiatry, ††Neurology, and ‡‡Epidemiology and Biostatistics, and §§Pulmonary and Critical Care Division, University of California at San Francisco, San Francisco, California.
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  • Katie L. Stone PhD,

    1. From the *Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotaDepartment of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, MinnesotaCalifornia Pacific Medical Center Research Institute, San Francisco, California§Department of Psychiatry, University of California at San Diego, San Diego, California; Departments of Pediatrics, Medicine, and #Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; and Departments of **Psychiatry, ††Neurology, and ‡‡Epidemiology and Biostatistics, and §§Pulmonary and Critical Care Division, University of California at San Francisco, San Francisco, California.
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  • for the Study of Osteoporotic Fractures Research Group

    1. From the *Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotaDepartment of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, MinnesotaCalifornia Pacific Medical Center Research Institute, San Francisco, California§Department of Psychiatry, University of California at San Diego, San Diego, California; Departments of Pediatrics, Medicine, and #Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; and Departments of **Psychiatry, ††Neurology, and ‡‡Epidemiology and Biostatistics, and §§Pulmonary and Critical Care Division, University of California at San Francisco, San Francisco, California.
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Address correspondence to Kristine E. Ensrud, MD, MPH, Department of Medicine (111–0), One Veterans Drive, Minneapolis, MN 55417. E-mail: ensru001@.umn.edu

Abstract

OBJECTIVES: To determine the association between use of selective serotonin reuptake inhibitors (SSRIs) and objective measures of sleep disturbances in older community-dwelling women, including women without evidence of depression.

DESIGN: Cross-sectional study.

SETTING: Four U.S. clinical centers.

PARTICIPANTS: Two thousand eight hundred fifty-three women aged 71 and older (2,630 nonusers of antidepressants and 223 taking SSRIs alone, not in combination with other antidepressants).

MEASUREMENTS: Medication use, assessed using an interviewer-administered questionnaire with verification of use from medication containers and computerized dictionary used to categorize type of medication; evidence of depression assessed using self-report or a score of 6 or higher on the Geriatric Depression Scale; and sleep parameters measured using a wrist actigraph, with data collected for an average of four consecutive 24-hour periods.

RESULTS: Of the overall cohort of 2,853 women and of 2,337 women without evidence of depression, sleep disturbances were more common in women taking SSRIs than in those not taking antidepressants. After excluding women with evidence of depression and adjusting for multiple potential confounders, women taking SSRIs were more likely to have a sleep duration of 5 hours or less (multivariate odds ratio (MOR)=2.15, 95% confidence interval (CI)=1.04–4.47), sleep efficiency less than 70% (MOR=2.37, 95% CI=1.32–4.25), sleep latency of 1 hour or more (MOR=3.99, 95% CI=2.29–6.96) and eight or more long wake episodes (MOR=1.75, 95% CI=0.99–3.10).

CONCLUSION: SSRI use by older women, including those without evidence of depression, is associated with a greater likelihood of sleep disturbances, including poorer sleep efficiency, longer sleep latency, and sleep fragmentation, manifested by multiple long wake episodes. These results add to the uncertainty regarding risks and benefits of SSRI use in aged populations.

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