Abstract

BackgroundDepression is common in older people and is associated with underlying brain change increasing the risk of dementia. Sleep disturbance is frequently reported by those with lifetime depression, however whether circadian misalignment also exists is unclear. We aimed to examine circadian rhythms and sleep associations in older patients with and without lifetime depression.MethodsThirty-four older people meeting DSM-IV criteria for lifetime major depression (mean age = 63.9 years), and 30 healthy controls (mean age = 65.7 years) were recruited. Participants underwent 2-weeks of actigraphy followed by a 3-night protocol including dim light melatonin onset (DLMO) assessment and overnight polysomnography (PSG) for sleep architecture. DLMO and phase angle of entrainment were computed.ResultsCompared to controls, participants with depression had a significantly longer phase angle of entrainment (6.82 h ± 1.45 vs. 5.87 h ± 1.60, p = 0.02, Cohens-d = 0.62). A small to moderate yet non-significant difference in DLMO times, with earlier DLMO (34 ± 27 min) observed in depression (20:36 ± 1:48 vs. 21:10 ± 1:48, p = 0.22, Cohens-d = 0.32). Individuals with depression had longer sleep latency and latency to rapid eye movement sleep than controls (all p < 0.05).ConclusionCircadian advancement and alterations to the timing of sleep and REM onset are evident in older people with lifetime major depression, despite having only mild residual symptoms. Further research examining the prognostic significance of these changes is warranted as well as chronotherapeutic treatment studies.

Highlights

  • Depression is common in older people and is associated with underlying brain change increasing the risk of dementia

  • The significance of sleep-wake functions for mood and cognition is underscored by a number of clinical, epidemiological and longitudinal studies showing that sleep-wake disturbance is a prodromal feature of depressive symptom onset, that it may persist in the remitted state and that it may perpetuate the illness [10,11,12,13]

  • We aimed to examine circadian rhythms in older patients with depression, with the primary outcomes of interest being dim light melatonin onset and phase angle of entrainment

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Summary

Introduction

Depression is common in older people and is associated with underlying brain change increasing the risk of dementia. Within the increasing ageing population, depression in older people will continue to be a predominant health care problem. This syndrome is associated with significant disease burden, disability, functional decline and premature death [1]. The significance of sleep-wake functions for mood and cognition is underscored by a number of clinical, epidemiological and longitudinal studies showing that sleep-wake disturbance is a prodromal feature of depressive symptom onset, that it may persist in the remitted state and that it may perpetuate the illness [10,11,12,13]. In older people with depression, insomnia is the most commonly reported sleep disturbance; with complaints of early morning wakefulness being common [15, 16]. The presence of this feature has considerable clinical and prognostic significance

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