Subjective sleep characteristics associated with anxiety and depression in older adults: a population-based study

Abstract

At the moment, population-based data on the subjective sleep characteristics related to anxiety disorders in older adults are scarce and the few results do not agree with the view proposed by the DSM concerning sleep difficulties related to anxiety. This study examines the subjective sleep characteristics specific to anxiety and depression in older adults. The sample comprises a random population-based sample of 2393 individuals aged 65 years or older. Anxiety and depression were identified by a structured interview and categorized using DSM-5 criteria for phobias, panic disorder, generalized anxiety disorder, unspecified anxiety disorder, major depressive episode (MDE) and depressive episode with insufficient symptoms (DEIS). Subjective sleep characteristics were measured using the Pittsburgh Sleep Quality Index (PSQI). The association between subjective sleep characteristics and anxiety/depression were assessed using logistic regression adjusted for age, education level, cognitive functioning, subjective health, anxiolytic/sedative/hypnotic use, antidepressants use, cardiovascular conditions, and the number of chronic diseases. The prevalence of poor sleep (PSQI > 5) was 64% in participants with anxiety disorder (Adjusted odds ratio: 2.16, 95% CI: 1.30–3.60) and 55% in participants with unspecified anxiety disorders (1.59, 1.12–2.26) compared to 37% in those without anxiety. Nearly all PSQI subscales were significantly associated with anxiety, but these subscales shared variance and only short sleep duration, sleep disturbance and daytime functioning subscales were independently related to anxiety. Within these significant subscales, the main specific sleep complaints associated with anxiety were daytime sleepiness and sleep disturbances related to breathing, coughing/snoring, feeling hot or cold, pain, and bad dreams. The prevalence of poor sleep was 54% in participants with MDE (1.07, 0.70–1.64) and 58% in participants with DEIS (1.70, 1.22–2.36) compared to 36% in those without depression. The use of sleeping medication was the only specific sleep characteristic associated with depression. These results suggest that in older adults, symptoms of short sleep duration, daytime sleepiness and sleep disturbances are specific related to anxiety while the use of sleep medication is associated to depression. This study was supported by research grants from the Canadian Institutes of Health Research (CIHR) and the Fonds de recherche en santé du Québec. Olivier Potvin is supported by a fellowship award from the CIHR.