SLEEP ARCHITECTURE CHANGES IN DEPRESSION AND SLEEP-RELATED DISORDERS
Authors: Wang *Huangchi , Hsu Wenyu , Chang Tinggang , Chang Chengchen , Chu Siyu 
Published: February 2025

Abstract

Background
Depression is a prevalent mental health concern, impacting nearly 3.8% of the global population. The strong link between depression and sleep-related disorders has been widely acknowledged. Persistent sleep-related issues not only increase the relapse and recurrence of depression but also necessitate adjustments in medication regimens. However, the sleep architecture changes in depression and sleep- related disorders are seldom discussed. Some shared neurobiological factors between these conditions pose a challenge. This study bridges the gap by examining sleep architectures in obstructive sleep apnea (OSA), restless leg syndrome (RLS), and periodic limb movement disorder (PLMD) comorbid with depression to discern the differences.

Aims & Objectives
This study explores the associations of sleep architectures between depression and the presentation of OSA, RLS, and PLMD.

Methods
In this study, we collected data from patients referred to a sleep center in Lutong Hospital, Central Taiwan, between January 2012 and June 2013. Patients were diagnosed with depression and sleep disorders based on clinical evaluations and chart records. Demographic data, physical measurements, and subjective and objective sleep measures were collected. Statistical analysis was performed to examine the relationships and differences between these variables.

Results
The study involved 715 patients, with 210 (19.6%) diagnosed with depression. Various demographic and physical measurements showed significant differences between depressed and non-depressed patients. Depressed patients had different sleep patterns, including higher rates of initial and middle insomnia, lower Epworth Sleepiness Scale (ESS) scores, and differences in objective sleep measures like Apnea- Hypopnea Index (AHI) and periodic leg movement index (PLMI).

Discussion & Conclusion
This study examines the effects of three sleep-related disorders— OSA, RLS and PLMD— on the sleep architecture of individuals with comorbid depression. OSA has previously shown alterations in sleep patterns, such as reduced deep sleep and REM sleep. While our study found no significant sleep architecture differences between OSA patients with and without depression, a noteworthy exception was observed in REM sleep, where OSA patients with severe depression had a higher percentage of REM sleep. OSA patients with depression also experienced higher initial insomnia prevalence.
For RLS patients, our study revealed altered sleep patterns in those with comorbid depression, including decreased REM sleep and increased REM latency. RLS patients, especially those with depression, displayed higher middle insomnia rates and were more likely to experience depression.
In PLMD, we found that PLMD patients with depression exhibited increased light sleep and reduced deep sleep. Surprisingly, they also experienced less REM sleep. Initial insomnia was more pronounced among PLMD patients with depression.
In conclusion, this study consolidates findings regarding alterations in sleep architectures in patients with various sleep disorders and comorbid depression. It underscores the significance of further research to validate and expand upon these findings, as they contribute to our understanding of the intricate relationships between these conditions. This comprehensive investigation opens the door to more in- depth exploration and potential advancements in the field.

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