Severe sleep disturbance is associated with executive function impairment in patients with first-episode, treatment-na\xefve major depressive disorders

Feihuan Cui,Qi Liu,Hongjun Tian,Yu Huang,Xin Yu,Gang Wang,Gang Zhu,Jing Wei,Xiaozhen Lv,Nan Zhang,Kerang Zhang,Xueyi Wang,Qiaoling Chen,Rainer Leonhart,Tianmei Si

doi:10.1186/s12888-021-03194-2

Abstract

BackgroundSleep disturbance and executive function impairment are common in patients with major depressive disorder (MDD), though the relationship between the two remains unclear. We investigated this association in first-episode, treatment-naïve patients with MDD.MethodsWe analyzed data from 242 patients with MDD. We divided the patients into 2 groups based on sleep disturbance severity and compared the executive function odds ratios between the groups.ResultsA total of 121 pairs of patients were matched (age 39.4 ± 10.1, 70.2% female). After propensity score matching, the odds ratios for cognitive impairment in patients with MDD and severe sleep disturbance were 1.922 (1.068–3.459, P = 0.029, q = 0.044) in executive functioning; 2.023 (1.211–3.379, P = 0.007, q = 0.021) in executive shifting.ConclusionsSleep disturbance is associated with executive functioning impairment in first-episode, treatment-naïve patients with MDD. Severe sleep disturbance can be a marker and aid in recognizing executive function impairment in patients with first-episode treatment-naïve MDD. Severe sleep disturbance can be a potential modifiable factor to improve executive function in MDD, as well as an effective measurement to improve cognition for sleep symptom management that should be enforced at initial treatment of first-episode MDD. Further study is required to confirm our results.Trial registrationClinicalTrials.gov: NCT02023567; registration date: December 2013.

Highlights

Sleep disturbance and executive function impairment are common in patients with major depressive disorder (MDD), though the relationship between the two remains unclear
Before matching, compared with the patients in Group 2, chi-square analysis revealed that patients in Group 1 had more impairment in executive functioning (32.2% vs 20.6%; P = 0.024, q = 0.036), and executive shifting (55.4% vs 40.0%; P = 0.009, q = 0.027), and executive inhibition (35.5% vs 23.4%, P = 0.036), respectively
In this study, we evaluated the effects of severe sleep disturbance on cognitive functioning in treatmentnaïve patients with first-episode MDD and found a link between severe sleep disturbance and impaired executive functioning

Summary

Introduction

Sleep disturbance and executive function impairment are common in patients with major depressive disorder (MDD), though the relationship between the two remains unclear. We investigated this association in firstepisode, treatment-naïve patients with MDD. Executive impairment has 3 dimensions including inhibition (defined as suppressing or avoiding an automatic response), shifting (defined as switching between task sets and response rules), and work memory (defined as actively maintaining or manipulating information across a short delay, which can be further divided into verbal and visuospatial components) [8], and has been identified as one of the main impaired cognitive domains in patients with MDD [8]. Deficits in executive functioning have been associated with pathophysiology in the prefrontal cortex-subcortical brain circuitry in MDD patients [9]

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Discussion

Conclusion