Integrated 24-Hour Time Use Patterns to Mediate Depression and Cardiovascular Disease Comorbidity: A Shared Lifestyle...

Area of Science:

• Chronobiology and Public Health
• Behavioral Medicine
• Cardiovascular Epidemiology

Background:

• Cardiovascular disease (CVD) and depression are leading causes of morbidity and mortality globally.
• The interplay between daily time use behaviors (sleep, work, physical activity) and these conditions is not fully understood.
• Understanding these integrated patterns may reveal novel targets for prevention and treatment.

Purpose of the Study:

• To examine associations between integrated sleep-work-activity patterns and health outcomes, including cardiovascular disease (CVD) and depression.
• To investigate the mediating role of these time use patterns in the depression-CVD comorbidity.

Main Methods:

• Analysis of National Health and Nutrition Examination Survey (NHANES) data (2005-2018) using cross-sectional and prospective cohort designs.
• Application of a novel time use optimization algorithm to define 27 distinct sleep-work-activity behavioral patterns.
• Assessment of associations with mortality, major adverse cardiovascular events, CVD risk factors, and depression using Cox regression and generalized linear models, with mediation analysis.

Main Results:

• Six favorable sleep-work-activity patterns were linked to halved risks of all-cause mortality and depression compared to moderate patterns.
• Three unfavorable patterns, such as unemployment with sleep dysregulation, were associated with doubled mortality and depression risks.
• These integrated behavioral patterns mediated a substantial proportion (44.4%-44.6%) of the association between depression and major adverse cardiovascular events.

Conclusions:

• Integrated sleep-work-activity patterns within a 24-hour period are strongly associated with cardiometabolic and mental health.
• These patterns significantly mediate the comorbidity between depression and CVD.
• Personalized time use recommendations represent a promising strategy for the joint prevention of these conditions.