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Depression is associated with worse objectively and subjectively measured sleep, but not more frequent awakenings, in women with vasomotor symptoms

Joffe, Hadine MD, MSc1; Soares, Claudio N. MD, PhD1; Thurston, Rebecca C. PhD2; White, David P. MD3; Cohen, Lee S. MD1; Hall, Janet E. MD4

Menopause:
doi: 10.1097/gme.0b013e3181957377
Articles
Abstract

Objective: Depression occurs more commonly during the menopausal transition in women with vasomotor symptoms (VMS) than in those without, but most women with VMS do not develop depression. It has been hypothesized that VMS are associated with depression because VMS lead to repeated awakenings, which impair daytime well-being. We aimed to determine if objectively measured sleep and perceived sleep quality are worse in depressed women with VMS than in nondepressed women with VMS.

Methods: Objectively and subjectively measured sleep parameters were compared between 52 depressed women with VMS and 51 nondepressed controls with VMS. Actigraphic measures of objective sleep conducted in the home environment and subjective measures of sleep quality (Pittsburgh Sleep Questionnaire Index) were compared using linear regression models.

Results: On objective assessments, depressed women with VMS spent less time in bed (by 64.8 min; P < 0.001) and had shorter total sleep time (by 47.7 min; P = 0.008), longer sleep-onset latency (by 13.8 min; P = 0.03), and lower sleep efficiency (by 3.2 percentage points; P = 0.09), but did not awaken more or spend more time awake after sleep onset than nondepressed controls with VMS. Depressed women also reported worse sleep quality (mean Pittsburgh Sleep Questionnaire Index 12.0 vs 8.3; P < 0.001). Adjustment for VMS frequency and important demographic characteristics did not alter these associations.

Conclusions: Sleep quality and selected parameters of objectively measured sleep, but not sleep interruption, are worse in depressed than in nondepressed women with VMS. The type of sleep disturbance seen in depressed participants was not consistent with the etiology of depression secondary to VMS-associated awakenings.

In Brief

Sleep quality and selected parameters of objectively measured sleep, but not sleep interruption, are worse in depressed women with vasomotor symptoms (VMS) than in nondepressed controls with VMS. The type of sleep disturbance seen in these depressed women was not consistent with the etiology of depression secondary to VMS-associated awakenings.

Author Information

From the 1Perinatal and Reproductive Psychiatry Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; 2Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; 3Sleep Disorders Program, Department of Medicine, Brigham and Women's Hospital; and 4Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Received September 5, 2008; revised and accepted November 13, 2008.

Drs. Cohen and Hall contributed equally as senior authors.

Funding/support: This work was supported in part by National Institute of Mental Health grant K23 MH066978, a Susan G. Komen Breast Cancer Foundation Award, and GlaxoSmithKline.

Financial disclosure/conflicts of interest: See Appendix for financial disclosure information.

Address correspondence to: Hadine Joffe, MD, MSc, Perinatal and Reproductive Psychiatry Program, Massachusetts General Hospital, Simches Research Building, 185 Cambridge St, Suite 2000, Boston MA 02114. E-mail: hjoffe@partners.org

©2009The North American Menopause Society