Sleep architecture and the incidence of depressive symptoms in middle-aged and older adults: A community-based study

Background: Rapid eye movement (REM) sleep and three stages of non-REM (NREM) sleep comprise the full sleep cycle. The changes in sleep have been linked to depression risk. This study aimed to explore the association between sleep architecture and depressive symptoms. Methods: A total of 3247 participants from the Sleep Heart Health Study (SHHS) were included in this cohort study. REM and NREM sleep were monitored by in-home polysomnography at SHHS visit 1. Depressive symptoms was reported as the first occurrence between SHHS visits 1 and 2 (mean follow-up of 5.3 years). Multivariable logistic regression was used to investigate the relationship between sleep stages and depressive symptoms. Results: In total, 225 cases of depressive symptoms (6.9 %) were observed between SHHS visits 1 and 2. A significant linear association between NREM Stage 1 and depressive symptoms was found after adjusting for potential covariates. Multivariable logistic regression analysis showed that percentage in NREM Stage 1 was associated with the incidence of depressive symptoms (odds ratio [OR], 1.06; 95 % confidence interval [CI], 1.02–1.10; P = 0.001), as were time in NREM Stage 1 and depressive symptoms (OR, 1.02; 95 % CI, 1.01–1.03; P = 0.001). However, no significant association with depressive symptoms was found for other sleep stage. Limitations: The specific follow-up time for depressive symptoms diagnosis was missing. Conclusions: Increased time or percentage in NREM Stage 1 was associated with a higher risk of developing depressive symptoms. The early change in sleep architecture were important for incidence of depressive symptoms and warrants constant concerns.