Sex differences in associations between sleep architecture and CBC-derived immune cell indices in MDD with comorbid insomnia
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Updated: Oct 31, 2026
Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder
Published on: April 26, 2024
Qi Wang1, Manli Deng1, Yixu Wang1
1The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, 214151, China.
Background:
Insomnia symptoms and alterations in sleep architecture are core pathophysiological features of Major Depressive Disorder (MDD). While sex differences in MDD prevalence and symptomatology are well documented, the specific interplay between sleep architecture and complete blood count (CBC)-derived immune cell indices, metabolic markers, and thyroid-related parameters remains under-characterized with respect to sex.
Methods:
This study included 126 patients with MDD and comorbid insomnia (43 males, 83 females). All participants underwent overnight polysomnography (PSG) and fasting blood biochemical analysis. Sex-specific associations between objective sleep parameters and peripheral biomarkers were analyzed using age-adjusted partial Spearman correlation and multiple linear regression models with interaction terms.
Results:
Female patients had longer REM sleep latency and N2 sleep duration, whereas male patients had a higher apnea-hypopnea index. Females had higher HDL-C levels, while males had higher monocyte counts. In age-adjusted FDR-corrected correlation analyses, significant associations involving CBC-derived immune cell counts were observed primarily in male patients, where lymphocyte count was associated with TST, REM sleep duration, N1%, and N2 sleep duration; no significant CBC-derived immune cell count correlations remained in female patients. In multivariable interaction analyses with FDR correction, sex × lymphocyte interaction terms remained significant for TMA, REM sleep duration, and REM sleep duration relative to TST.
Conclusion:
These findings suggest that sex may shape both the subjective-objective expression of sleep disturbance and lymphocyte-related sleep regulation in patients with MDD and comorbid insomnia. The pattern of poorer subjective sleep quality despite relatively favorable selected PSG characteristics in females, together with sex-dependent lymphocyte associations involving REM sleep and arousal measures, warrants further validation in larger longitudinal studies.
Clinical Trial Number:
Not applicable.
