Sleep Disturbances and Depression in the Multi-Ethnic Study of Atherosclerosis

We examined the association of objectively and subjectively measured sleep disturbances with depression, and explored if race/ethnicity, socioeconomic status, and sex modified these associations.

We used data from the cross-sectional Multi-Ethnic Study of Atherosclerosis Sleep Study. Participants included 1,784 adults (ages 54-93 y), 36.8% non-Hispanic Whites, 28.0% African Americans, 23.7% Hispanics, 11.5% Chinese, and 46.0% males. Sleep was assessed with actigraphy, polysomnography, and self-report. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. We used relative risk regression to evaluate the association of sleep measures and depression (CES-D score ≥ 16) adjusting for site, sociodemographics, and behavioral and medical risk factors.

Overall, 14.5% had depression, 29.3% had insomnia symptoms, 14.1% had excessive daytime sleepiness (EDS), 15.1% had apnea-hypopnea index (AHI) ≥ 30, and 30.4% experienced short sleep (< 6 h). Depression was associated with short sleep duration (adjusted prevalence ratio [PR] = 1.47, 95% confidence interval [CI] = 1.11, 1.94), < 10% rapid eye movement [REM] sleep (PR = 1.57, 95% CI = 1.08, 2.27), ≥ 25% REM sleep (PR = 1.42, 95% CI = 1.03, 1.95), insomnia (PR = 1.83, 95% CI = 1.39, 2.40), excessive daytime sleepiness (EDS) (PR = 1.61, 95% CI = 1.19, 2.18), and AHI > 15 + EDS (PR = 1.55, 95% CI = 1.01, 2.39). Short sleep duration was associated with depression among those with high school education or beyond, but not among those with less education. Insomnia was more strongly associated with depression among men than women.

Sleep disturbances are associated with depression among middle-aged and older adults; these associations may be modified by education and sex. Future research should further test these hypotheses, evaluate whether early detection or treatment of sleep disturbances ameliorate depression, and explore subpopulation differences.