Aug 2026· Journal of Sleep Research· pp.
e70431
· 0 citations· 30 references
Medicine
TL;DR
While sleep fragmentation was associated with depressive symptoms, insomnia symptoms appear to be a key factor in assessing insomnia in depression and vice versa and addressing these conditions, may be useful for reducing symptom burden.
Abstract
Sleep and sleep disturbances, such as sleep apnoea and insomnia, are linked to mental health, particularly, depressive symptoms. It remains unclear however, if sleep fragmentation or hypoxia is primarily linked to depressive symptoms and how insomnia symptoms affect this relationship in samples free of clinical referral bias. We analysed cross-sectional data from two harmonised, population-based cohorts: the Sleep and HEalth in women (SHE) study and the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study (ntotal = 1238; 68% males, 57 ± 12 years, BMI 28.0 ± 4.2 kg/m2). Objective measures of OSA (apnoea-hypopnoea index; AHI, oxygen desaturation index; ODI) and sleep fragmentation variables (sleep efficiency; SE% and wake after sleep onset; WASO) were measured, along with subjective data on insomnia symptoms and depressive symptoms. Logistic regression models were used to assess associations while adjusting for age, sex, BMI, alcohol and physical activity. Pathway analyses further explored potential mediating relationships. Depressive symptoms were present in 17% of the sample. We did not find a link between intermittent hypoxia variables (AHI, ODI) and depressive symptoms. In contrast, reduced SE% (OR 0.84; 0.72-0.98) and increased WASO (1.26; 1.06-1.51) were significantly related to depressive symptoms. When including adjustment for insomnia in the model, these associations were no longer significant. While sleep fragmentation was associated with depressive symptoms, insomnia symptoms appear to be a key factor. Assessing insomnia in depression and vice versa and addressing these conditions, may be useful for reducing symptom burden.
Nocturia is associated with sleep disturbance and depressive symptoms, but the role of daytime sleepiness in this relationship remains unclear. This study examined the relationships among nocturia, sleep duration, daytime sleepiness, and depressive symptoms, with particular attention to the indirect associations through sleep duration and daytime sleepiness. Data from the 2015 to 2023 National Health and Nutrition Examination Survey were analyzed. Depressive symptoms were assessed using the Patient Health Questionnaire-9 and categorized as none or minimal, mild, moderate, moderately severe, or severe. Survey-weighted logistic regression was used to examine factors associated with nocturia. Interaction and direct and indirect association analyses were performed using linear regression and structural equation modeling with bootstrap confidence intervals. Among 17,731 participants, 6479 (36.5%) reported nocturia. Analyses involving daytime sleepiness included 12,634 participants. Nocturia frequency and daytime sleepiness were associated with higher Patient Health Questionnaire-9 scores, and a significant interaction was observed between them (β = 0.12, P < .001). The indirect association through sleep duration was not statistically significant (P = .083). The indirect association through daytime sleepiness was β = 0.136 (P < .001), representing 21.15% of the total association between nocturia and depressive symptoms. Nocturia was associated with depressive symptoms, and an indirect association through daytime sleepiness was observed. The temporal relationship among nocturia, daytime sleepiness, and depressive symptoms remains to be determined.
Targeting insomnia may yield the greatest improvements in sleep quality in this population of community-dwelling older adults in Jordan and is driven primarily by insomnia severity rather than demographic or health factors.
Sleeping difficulties are prevalent among adults with pulmonary hypertension (PH), with most individuals studied to date reporting poor sleep. However, research investigating the impact of sleep on psychological distress and health‐related quality of life (HRQoL) in PH remains limited. This study aimed to identify the nature of common sleep difficulties in PH and the associated psychosocial impact using multiple self‐reported measures. A cross‐sectional survey was conducted with 111 adults with PH recruited from PH associations globally. Most identified as White (91%) and female (82%). Participants completed measures of overall sleep quality (Pittsburgh Sleep Quality Index), insomnia (Insomnia Severity Scale), daytime sleepiness (Epworth Sleepiness Scale), anxiety (Generalised Anxiety Disorder‐7), depression (Patient Health Questionnaire‐9) and HRQoL (emPHasis‐10). Regression analyses were used to inspect relationships between measures and other PH variables. A total of 79.8% of participants were identified as having poor sleep quality. The most prevalent sleep‐related difficulties were sleep disturbance and sleep latency issues. Insomnia and daytime sleepiness rates were also elevated (35% and 33.6%, respectively) and often co‐occurred. In addition, 40% and 29% of participants had clinical levels of depression and anxiety, respectively. All types of sleep difficulties were associated with lower HRQoL. A series of parallel mediation analyses suggested that this association was partially mediated by depressive symptoms. The findings indicate the need to routinely screen for both sleep difficulties and mood disturbance in this population. Further work is needed to understand whether existing brief sleep interventions are effective for use in PH, where multiple factors are influencing sleep quality.
Jemma L. Green, V. Costin, Iain Armstrong et al.· Clinical Respiratory Journal· 0 citations
Investigation of cross-sectional associations between objective sleep features (sleep duration, duration variability, and onset time) and mental health outcomes in 1371 U.S. adolescents found objective sleep features were differentially associated with mental health outcomes.
S. Izabel, Orsolya Kiss, Adam J. Krause et al.· npj Mental Health Research· 0 citations
Background: Medical students are vulnerable to sleep disturbance and nocturnal eating behaviors that may jointly increase psychiatric and metabolic morbidity. Comprehensive sleep-eating evaluations in Turkish medical students remain limited. To determine the prevalence of poor sleep quality and night eating syndrome (NES) risk and to examine their cross-sectional associations with insomnia, anxiety, emotional eating, restless legs symptoms, chronotype, and lifestyle factors. Methods: This cross-sectional study, conducted from March to December 2023, included 265 medical students who completed validated instruments assessing sleep quality (Pittsburgh Sleep Quality Index [PSQI]), night eating syndrome (NES) risk (a score of ≥25 indicating high risk), insomnia severity, daytime sleepiness (Epworth Sleepiness Scale [ESS]), anxiety, emotional eating, Restless Legs Syndrome (RLS) symptoms, and chronotype. Group comparisons, Spearman’s correlation analyses, and multiple linear regression were conducted. Results: Poor sleep quality (PSQI > 5) affected 50.2% of participants, and high NES risk affected 14.7%. PSQI correlated with NEQ (r = 0.301; p < 0.001), insomnia severity (r = 0.538), anxiety, and emotional eating. Mean NEQ was higher in the poor-sleep group (18.67 ± 8.00 vs. 15.38 ± 6.36; p < 0.001; Cohen’s d = 0.455). Females had higher PSQI and ESS scores, anxiety, and emotional eating scores; high NES risk was numerically more frequent in males (18.6% vs. 11.8%; p = 0.175). RLS symptoms (score > 0) were present in 34.7% (mild 22.6%; moderate 7.9%; severe 4.2%). In the primary multivariable model (PSQI and sex), PSQI was the strongest independent correlate of NEQ (standardized β = 0.325; p < 0.001); sensitivity analyses showed stable PSQI estimates after additional covariate adjustment, whereas sex coefficients were non-significant and unstable across models. A secondary model excluding PSQI identified alcohol use as a significant lifestyle correlate (standardized β = 0.167; p = 0.014). R2 = 0.148 for the full covariate model and R2 = 0.108 for the primary model. Conclusions: Sleep disturbance and NES risk are prevalent and cross-sectionally associated in Turkish medical students. Poor sleep quality was the strongest independent correlate of night eating scores. Integrated campus screening targeting sleep, eating behavior, anxiety, and comorbid sleep symptoms may facilitate prevention and referral.
V. Tekin, Sümeyra Delibaş, Eyüp Sina Keten et al.· Healthcare· 0 citations
INTRODUCTION The bidirectional relationship between mental health and sleep represents a central clinical challenge in oncological care. In women with breast cancer, hypothalamic-pituitary-adrenal axis hyperactivation and increased pro-inflammatory cytokines from treatment impair sleep architecture and amplify anxiety and depressive symptoms. In Brazil, poor sleep quality prevalence ranges from 16.1% to 35.1% in the general population, while international oncology studies report rates of 67–90%. Despite this, national data on the joint prevalence of sleep disorders and mental health symptoms in outpatients remain scarce. METHOD Analytical cross-sectional study with 211 women in outpatient breast cancer treatment at state hospitals in the São Paulo metropolitan region. Three validated instruments were applied: PSQI-BR (sleep quality), Epworth Sleepiness Scale (daytime sleepiness) and HADS (anxiety and depression), alongside a clinical-sociodemographic form. Sample size by Wald method (n=208; 95% CI). Analyses in Stata 17.0: Pearson correlation, chi-square, multiple linear and logistic regression. CEP-FMABC: CAAE 90818825.2.0000.0082. RESULT Poor sleep quality (PSQI≥5): 78.7% (95% CI: 72.5–84.1). Excessive daytime sleepiness (ESS≥10): 23.2%. Anxiety symptoms in 38.9%; depressive in 25.6%. Anxiety was associated with poor sleep quality (χ²=10.70; p=0.001); depression with sleepiness (χ²=4.16; p=0.041). Logistic regression: anxiety was the only independent predictor of poor sleep quality (OR=1.157; 95% CI: 1.042–1.285; p=0.006; AUC=0.734). DISCUSSION Prevalence far exceeded that of the Brazilian general population, consistent with international oncology literature. Anxiety emerged as the main determinant, supporting the cognitive-emotional hyperarousal model. CONCLUSION Sleep disorders are strongly associated with anxiety in women with breast cancer, highlighting the need for systematic screening and integrated psychological management in outpatient oncological care.
Vitória Miranda do Amaral, Pedro Augusto Rodrigues Ribeiro, E. Fiss et al.· Procedings of the 51st Congr...· 0 citations