The Characteristic Of Subjective And Objective Sleep Disorders And The Impact Of Subjective Sleep Disorders On Effectiveness In Depression

Background:To our knowledge there was a little evidence in the literature about therelationship between subjective sleep estimation and objective sleep variables indepression, and a few research of the impact of sleep disorders on effectiveness.Objective:The present study was carried out to investigate the correlation between the objectiveand subjective sleep measures in depressed patients, and the impact of subjectivesleep disturbances on effectiveness after4-week anti-depressant treatment.Method:34inpatients with major depression in the department of psychology of NanjingBrain Hospital were investigated over the course of4-week treatment of depression.We used laboratory polysomnography at baseline with extensive assessments ofsubjective sleep by using Pittsburgh Sleep Quality Index (PSQI) the morning aftersleep recording to estimate the relationship between subjective sleep estimation andobjective sleep variables, and the day after antidepressant treatment four weeks later,PSQI was assessed again. The24-item Hamilton Depression Rating Scale (HAMD-24)was used to evaluate the severity of depression at pre-and post-treatment. Results:Section1:1) There was a discrepancy between subjective and objective sleep in depressedpatients. The subjective total sleep time and sleep efficiency showed asignificant lower than the objective indictors.2) At baseline,the score of PSQI was correlated positively with awakeningtime(Spearman rho=0.352,p=0.041),and the factor of sleep latency wascorrelated with awakening time(Spearman rho=0.429， p=0.011),sleepefficiency significantly correlated with awakening time, total sleep time,actual sleep time,and objective sleep efficiency(Spearman rho=0.444，p=0.009， Spearman rho=-0.374，p=0.044，Spearman rho=-0.377，p=0.028，Spearman rho=-0.427，p=0.012).And first REM latency was correlated withthe factor of sleep time and sleep efficiency in PSQI(Spearman r=-0.398，p=0.020，Spearman r=-0.422，p=0.013).Section2:1) Objective sleep variables had a influence on subjective sleep estimation,Awakening time in depression-serious sleep disturbance group was longer,AT/TST%was higher, sleep efficiency and sleep maintenance were lowerthan those in depression-light sleep disturbance group.2) Before the treatment, the scores of sleep factor in HAMD was correlatedpositively with the score of HAMD(r=0.572,P=0.001),and was also correlatedsignificantly with the scores of HAMD which excluded the sleepfactor(r=0.378,P=0.033), the score of HAMD excluded sleep factor indepression-serious sleep disturbance group was higher than it in the light one[(26.211±4.22)vs.(22.571±5.30)](P=0.036),hopelessness factor in depression-serious sleep disturbance group was higher than the one in light sleepdisturbance group[(4.895±1.97)vs.(3.286±1.20)](P=0.011).3) After the treatment, the severity of depression between the two group was the same.The subjective evaluation at baseline had no influence on the severity ofdepression after treatment.Conclusions:1) There was a difference and relationship between subjective and objectivesleep disorders.2) The subjective feeling of sleep had a negative influence on the severity ofdepression, and the improvement of subjective sleep quality was a part ofantidepressant treatment, but had no influence on the severity of depressionafter treatment.