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Review
. 2025 May 1:376:139-148.
doi: 10.1016/j.jad.2025.02.010. Epub 2025 Feb 6.

Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

Elena Condominas  1 , Albert Sanchez-Niubo  2 , Joan Domènech-Abella  3 , Josep Maria Haro  4 , Raquel Bailon  5 , Iago Giné-Vázquez  3 , Gemma Riquelme  6 , Faith Matcham  7 , Femke Lamers  8 , Spyridon Kontaxis  9 , Estela Laporta  9 , Esther Garcia  10 , Maria Teresa Peñarrubia Maria  11 , Katie M White  12 , Carolin Oetzmann  12 , Peter Annas  13 , Matthew Hotopf  12 , Brenda W J H Penninx  8 , Vaibhav A Narayan  14 , Amos Folarin  12 , Daniel Leightley  15 , Nicholas Cummins  12 , Yathart Ranjan  12 , Giovanni de Girolamo  16 , Antonio Preti  17 , Sara Simblett  12 , Til Wykes  18 , Inez Myin-Germeys  19 , Richard Dobson  12 , Sara Siddi  20 ; RADAR-CNS consortium. Electronic address: https://radar-cns.org/
Affiliations
Free article
Review

Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

Elena Condominas et al. J Affect Disord. .
Free article

Abstract

Background: Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity.

Methods: This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions.

Results: Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR.

Conclusions: Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

Keywords: Anxiety; Depression; Mobile health (mHealth); Night resting heart rate; Real-world monitoring; Sleep disturbance.

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Conflict of interest statement

Declaration of competing interest Vaibhav A Narayan is employee of Janssen Research and Development LLC. Peter Annas is employed by the pharmaceutical company H. Lundbeck A/S. Josep Maria Haro has received economic compensation for participating in advisory boards or giving educational lectures from Eli Lilly & Co, Sanofi, Lundbeck, and Otsuka. No other authors have competing interests to declare.