Depressive Symptoms and Subjective and Objective Sleep in Community-Dwelling Older Women

Authors

  • Jeanne E. Maglione MD, PhD,

    Corresponding author
    • Department of Psychiatry, University of California at San Diego, La Jolla, California
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  • Sonia Ancoli-Israel PhD,

    1. Department of Psychiatry, University of California at San Diego, La Jolla, California
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  • Katherine W. Peters MS,

    1. California Pacific Medical Center Research Institute, San Francisco, California
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  • Misti L. Paudel MPH,

    1. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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  • Kristine Yaffe MD,

    1. Department of Psychiatry, University of California at San Francisco, San Francisco, California
    2. Department of Neurology, University of California at San Francisco, San Francisco, California
    3. Department of Epidemiology, University of California at San Francisco, San Francisco, California
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  • Kristine E. Ensrud MD, MPH,

    1. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
    2. Department of Medicine, University of Minnesota, Minneapolis, Minnesota
    3. Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
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  • Katie L. Stone PhD

    1. California Pacific Medical Center Research Institute, San Francisco, California
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Address correspondence to Jeanne E. Maglione, Gillin Sleep and Chronobiology Research Center, 9500 Gilman Drive #0733, La Jolla, CA 92093. E-mail: jmaglione@ucsd.edu

Abstract

Objectives

To examine the relationship between depressive symptoms and subjective and objective sleep in older women.

Design

Cross-sectional.

Setting

Four U.S. clinical centers.

Participants

Three thousand forty-five community-dwelling women aged 70 and older.

Measurements

Depressive symptoms were assessed using the Geriatric Depression Scale, categorizing participants as normal (0–2, reference), some depressive symptoms (3–5), or depressed (≥6). Subjective sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Objective sleep measures were assessed using wrist actigraphy.

Results

In multivariable-adjusted models, there were graded associations between greater level of depressive symptoms and worse subjective sleep quality and more subjective daytime sleepiness (P-trends < .001). Women with some depressive symptoms (odds ratio (OR) = 1.82, 95% confidence interval (CI) = 1.48–2.24) and depressed (OR = 2.84, 95% CI = 2.08–3.86) women had greater odds of reporting poor sleep (PSQI>5). Women with some depressive symptoms (OR = 1.97, 95% CI = 1.47–2.64) and depressed women (OR = 1.70, 95% CI = 1.12–2.58) had greater odds of reporting excessive daytime sleepiness (ESS>10). There were also graded associations between greater level of depressive symptoms and objectively measured wake after sleep onset (WASO) (P-trend = .03) and wake episodes longer than 5 minutes (P-trend = .006). Depressed women had modestly higher odds of WASO of 1 hour or longer (OR = 1.37, 95% CI = 1.03–1.83). Women with some depressive symptoms (OR = 1.49, 95% CI = 1.19–1.86) and depressed women (OR = 2.04, 95% CI = 1.52–2.74) had greater odds of being in the highest quartile for number of nap episodes longer than 5 minutes. No associations between depressive symptom level and prolonged sleep latency, poor sleep efficiency, or short or long total sleep time were found.

Conclusion

Greater depressive symptom levels were associated with more subjective sleep disturbance and objective evidence of sleep fragmentation and napping.

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