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. 2017 Jan 15:208:309-315.
doi: 10.1016/j.jad.2016.08.050. Epub 2016 Oct 14.

Sleep architecture parameters as a putative biomarker of suicidal ideation in treatment-resistant depression

Rebecca A Bernert  1 , David A Luckenbaugh  2 , Wallace C Duncan  2 , Naomi G Iwata  3 , Elizabeth D Ballard  2 , Carlos A Zarate  2
Affiliations

Sleep architecture parameters as a putative biomarker of suicidal ideation in treatment-resistant depression

Rebecca A Bernert et al. J Affect Disord. .

Abstract

Background: Disturbed sleep may confer risk for suicidal behaviors. Polysomnographic (PSG) sleep parameters have not been systematically evaluated in association with suicidal ideation (SI) among individuals with treatment-resistant depression (TRD).

Methods: This secondary data analysis included 54 TRD individuals (N=30 with major depressive disorder (MDD) and N=24 with bipolar depression (BD)). PSG sleep parameters included Sleep Efficiency (SE), Total Sleep Time (TST), Wakefulness After Sleep Onset (WASO), REM percent/latency, and non-REM (NREM) Sleep Stages 1-4. The Hamilton Depression Rating Scale (HAM-D) was used to group participants according to presence or absence of SI. Sleep abnormalities were hypothesized among those with current SI. ANOVA analyses were conducted before (Model 1) and after adjusting for depression (Model 2) and diagnostic variables (Model 3).

Results: Significant differences in PSG parameters were observed in Model 1; those with SI had less NREM Stage 4 sleep (p<.05). After adjusting for central covariates, Models 2 and 3 revealed significantly less NREM Stage 4 sleep, lower SE (P<.05), and higher WASO (P<.05) among those with SI. BD participants with SI also had less NREM Stage 4 and more NREM Stage 1 sleep.

Limitations: 1) a predominantly white sample; 2) exclusion of imminent suicide risk; 3) concomitant mood stabilizer use among BD patients; and 4) single-item SI assessment.

Conclusions: Independent of depression severity, SI was associated with less NREM Stage 4 sleep, and higher nocturnal wakefulness across diagnostic groups. Sleep may warrant further investigation in the pathogenesis of suicide risk, particularly in TRD, where risk may be heightened.

Trial registration: ClinicalTrials.gov NCT00088699.

Keywords: Bipolar disorder; Depression; Sleep architecture; Suicide risk; Treatment-resistance.

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Figures

Figure 1
Figure 1
Stage 4 Interaction. Interaction for non rapid eye movement (NREM) Stage 4 sleep in minutes (min) according to presence of current suicidal ideation (SI) or absence of suicidal ideation symptoms (non-SI) among patients with bipolar disorder (BD) or major depressive disorder (MDD).
See this image and copyright information in PMC

References

    1. Agargun MY, Cartwright R. REM sleep, dream variables and suicidality in depressed patients. Psychiatr Res. 2003;119:33–39. - PubMed
    1. Ahmadpanah M, Haghighi M, Jahangard L, Borzoei S, Heshmati S, Bajoghli H, Holsboer-Trachsler E, Brand S. No evidence for metabolic syndrome and lipid profile differences in patients suffering from bipolar I disorder with and without suicide attempts. International journal of psychiatry in clinical practice. 2015;19:168–173. - PubMed
    1. Alexopoulos GS, Bruce ML, Hull J, Sirey J, Kakuma T. Clinical determinants of suicidal ideation and behavior in geriatric depression. Arch Gen Psychiatry. 1999;56:1048–1053. - PubMed
    1. Bernert R, Joiner TJ, Cukrowicz K, Schmidt N, Krakow B. Suicidality and sleep disturbances. Sleep. 2005a;28:1135–1141. - PubMed
    1. Bernert R, Turvey C, Conwell Y, Joiner T., Jr Association of poor subjective sleep quality with risk for death by suicide during a 10-year period: a longitudinal, population-based study of late life. JAMA Psychiatry. 2014;71:1129–1137. - PMC - PubMed

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