Sleep Duration and Insomnia with Comorbid Depression and Anxiety Symptoms in Chinese Adults: A Cross-Sectional Study

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Abstract

Purpose

Depression and anxiety are two highly prevalent mental disorders that commonly coexist. However, little is known about the association between sleep and comorbid depressive and anxiety symptoms (CDAS). Therefore, this study aims to explore the relationship between sleep duration, insomnia and CDAS.

Methods

This is a cross-sectional study of 22,004 community adults who participated in the China Multi-Ethnic Cohort (CMEC) study. Chinese version of Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 were used to screen CDAS in community adults. A positive score on each scale was considered indicative of CDAS. All participants received face-to-face interviews, medical examinations, and biochemical examinations to assess sleep duration and insomnia and collect covariates. The self-reported sleep duration was divided into three groups: <7 hr, 7–9 hr and >9 hr groups. Logistic regression was used to analyze the association between sleep duration, insomnia and CDAS. A restricted cubic spline (RCS) was used to explore the dose–response relationship between sleep duration and CDAS. Stratified analysis based on gender and age was conducted.

Results

Overall, 2.8% (95% CI 2.6%~3.0%) of participants reported having CDAS. After adjusting the potential covariates, sleep duration <7 hr (OR=1.635, 95% CI=1.335~2.004) was significantly associated with CDAS, compared with sleep 7–9 hr. After RCS analysis, there was a nonlinear relationship between sleep duration and CDAS. The increase in the number of types of insomnia, the greater the likelihood of CDAS ( p for trend<0.05). In sensitivity analysis, it was found that the results were consistent with those of the main analysis. After stratification by gender and age, the association between sleep duration and CDAS was only observed in female and young and middle-aged adults, not in men and older adults.

Conclusion

Both insufficient sleep duration and insomnia are associated with a higher prevalence of CDAS in Chinese adults.

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Most cited references 32

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Association of sleep time with diabetes mellitus and impaired glucose tolerance.

Daniel Gottlieb, Naresh M. Punjabi, Ann B. Newman … (2005)

Experimental sleep restriction causes impaired glucose tolerance (IGT); however, little is known about the metabolic effects of habitual sleep restriction. We assessed the cross-sectional relation of usual sleep time to diabetes mellitus (DM) and IGT among participants in the Sleep Heart Health Study, a community-based prospective study of the cardiovascular consequences of sleep-disordered breathing. Participants were 722 men and 764 women, aged 53 to 93 years. Usual sleep time was obtained by standardized questionnaire. Diabetes mellitus was defined as a serum glucose level of 126 mg/dL or more (> or =7.0 mmol/L) fasting or 200 mg/dL or more (> or =11.1 mmol/L) 2 hours following standard oral glucose challenge or medication use for DM. Impaired glucose tolerance was defined as a 2-hour postchallenge glucose level of 140 mg/dL or more (> or =7.8 mmol/L) and less than 200 mg/dL. The relation of sleep time to DM and IGT was examined using categorical logistic regression with adjustment for age, sex, race, body habitus, and apnea-hypopnea index. The median sleep time was 7 hours per night, with 27.1% of subjects sleeping 6 hours or less per night. Compared with those sleeping 7 to 8 hours per night, subjects sleeping 5 hours or less and 6 hours per night had adjusted odds ratios for DM of 2.51 (95% confidence interval, 1.57-4.02) and 1.66 (95% confidence interval, 1.15-2.39), respectively. Adjusted odds ratios for IGT were 1.33 (95% confidence interval, 0.83-2.15) and 1.58 (95% confidence interval, 1.15-2.18), respectively. Subjects sleeping 9 hours or more per night also had increased odds ratios for DM and IGT. These associations persisted when subjects with insomnia symptoms were excluded. A sleep duration of 6 hours or less or 9 hours or more is associated with increased prevalence of DM and IGT. Because this effect was present in subjects without insomnia, voluntary sleep restriction may contribute to the large public health burden of DM.

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Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity.

Michael Irwin, Mark Opp (2017)

Sleep disturbances including insomnia independently contribute to risk of inflammatory disorders and major depressive disorder. This review and overview provides an integrated understanding of the reciprocal relationships between sleep and the innate immune system and considers the role of sleep in the nocturnal regulation of the inflammatory biology dynamics; the impact of insomnia complaints, extremes of sleep duration, and experimental sleep deprivation on genomic, cellular, and systemic markers of inflammation; and the influence of sleep complaints and insomnia on inflammaging and molecular processes of cellular aging. Clinical implications of this research include discussion of the contribution of sleep disturbance to depression and especially inflammation-related depressive symptoms. Reciprocal action of inflammatory mediators on the homeostatic regulation of sleep continuity and sleep macrostructure, and the potential of interventions that target insomnia to reverse inflammation, are also reviewed. Together, interactions between sleep and inflammatory biology mechanisms underscore the implications of sleep disturbance for inflammatory disease risk, and provide a map to guide the development of treatments that modulate inflammation, improve sleep, and promote sleep health.

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Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future.

Michael Grandner, Lauren Hale, Melisa Moore … (2010)

This review of the scientific literature examines the widely observed relationship between sleep duration and mortality. As early as 1964, data have shown that 7-h sleepers experience the lowest risks for all-cause mortality, whereas those at the shortest and longest sleep durations have significantly higher mortality risks. Numerous follow-up studies from around the world (e.g., Japan, Israel, Sweden, Finland, the United Kingdom) show similar relationships. We discuss possible mechanisms, including cardiovascular disease, obesity, physiologic stress, immunity, and socioeconomic status. We put forth a social-ecological framework to explore five possible pathways for the relationship between sleep duration and mortality, and we conclude with a four-point agenda for future research. Copyright 2009 Elsevier Ltd. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Nat Sci Sleep

Journal ID (iso-abbrev): Nat Sci Sleep

Journal ID (publisher-id): nss

Title: Nature and Science of Sleep

Publisher: Dove

ISSN (Electronic): 1179-1608

Publication date (Electronic): 21 December 2023

Publication date Collection: 2023

Volume: 15

Pages: 1079-1091

Affiliations

[1 ]School of Public Health, Kunming Medical University , Kunming, Yunnan, People’s Republic of China

[2 ]Institute for Acute Communicable Disease Prevention and Control, Yunnan Provincial Center for Disease Control and Prevention , Kunming, Yunnan, People’s Republic of China

[3 ]Medical Department, The First Affiliated Hospital of Kunming Medical University , Kunming, Yunnan, People’s Republic of China

[4 ]Department of Hospital Infection, Wuhan Mental Health Center , Wuhan, Hubei, People’s Republic of China

[5 ]AIDS Care Center, Yunnan Provincial Hospital of Infectious Disease , Anning, Yunnan, People’s Republic of China

[6 ]Baoshan College of Traditional Chinese Medicine , Baoshan, Yunnan, People’s Republic of China

Author notes

Correspondence: Qiong Meng, School of Public Health, Kunming Medical University , 1168 West Chunrong Road, Yuhua Avenue, Chenggong District, Kunming, Yunnan, 650500, People’s Republic of China, Tel +8615559789771, Email mengqiong2006@163.com

Jianzhong Yin, Baoshan College of Traditional Chinese Medicine , Baoshan Longyang District Qingyang District Vocational Education Park, Baoshan, Yunnan, 678000, People’s Republic of China, Tel +8613987645337, Email yinjianzhong2005@sina.com

[*]

These authors contributed equally to this work

Author information

Qian Wang http://orcid.org/0009-0009-5004-9148

Yi Li http://orcid.org/0009-0005-4302-1340

Jianzhong Yin http://orcid.org/0000-0002-1876-387X

Article

Publisher ID: 440584

DOI: 10.2147/NSS.S440584

PMC ID: 10749553

PubMed ID: 38146513

SO-VID: 32f7b250-6a7a-4b4c-86d9-c78526fef6a2

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 16 September 2023

Date accepted : 13 December 2023

Page count

Figures: 3, Tables: 4, References: 32, Pages: 13

Funding

Funded by: the National Natural Science Foundation of China;

Funded by: Yunnan Applied Basic Research Projects-Kunming Medical University Union Foundation;

This study was funded by the National Natural Science Foundation of China (No. 81960617) and Yunnan Applied Basic Research Projects-Kunming Medical University Union Foundation (No. 202001AY070001-182). The study funder had no influence on the study design, collection, management, analysis, and interpretation of data, writing of the report, or decision to submit the report for publication.

Sleep Duration and Insomnia with Comorbid Depression and Anxiety Symptoms in Chinese Adults: A Cross-Sectional Study

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Abstract

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Conclusion

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Measurement of Glucocorticoid Receptor Signaling in Major Depression

Most cited references 32

Association of sleep time with diabetes mellitus and impaired glucose tolerance.

Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity.

Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future.

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