title: Depression is associated with worse objectively and subjectively measured sleep, but not more frequent awakenings, in women with vasomotor symptoms.
abstract: OBJECTIVE
  Depression occurs more commonly during the menopausal transition in women with vasomotor symptoms (VMS) than in those without, but most women with VMS do not develop depression. It has been hypothesized that VMS are associated with depression because VMS lead to repeated awakenings, which impair daytime well-being. We aimed to determine if objectively measured sleep and perceived sleep quality are worse in depressed women with VMS than in nondepressed women with VMS.
  
  
  METHODS
  Objectively and subjectively measured sleep parameters were compared between 52 depressed women with VMS and 51 nondepressed controls with VMS. Actigraphic measures of objective sleep conducted in the home environment and subjective measures of sleep quality (Pittsburgh Sleep Questionnaire Index) were compared using linear regression models.
  
  
  RESULTS
  On objective assessments, depressed women with VMS spent less time in bed (by 64.8 min; P < 0.001) and had shorter total sleep time (by 47.7 min; P = 0.008), longer sleep-onset latency (by 13.8 min; P = 0.03), and lower sleep efficiency (by 3.2 percentage points; P = 0.09), but did not awaken more or spend more time awake after sleep onset than nondepressed controls with VMS. Depressed women also reported worse sleep quality (mean Pittsburgh Sleep Questionnaire Index 12.0 vs 8.3; P < 0.001). Adjustment for VMS frequency and important demographic characteristics did not alter these associations.
  
  
  CONCLUSIONS
  Sleep quality and selected parameters of objectively measured sleep, but not sleep interruption, are worse in depressed than in nondepressed women with VMS. The type of sleep disturbance seen in depressed participants was not consistent with the etiology of depression secondary to VMS-associated awakenings.
authors.affiliation: Perinatal and Reproductive Psychiatry Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. hjoffe@partners.org
authors.forename: Hadine
authors.initials: H
authors.lastname: Joffe
authors.forename: Claudio N
authors.initials: CN
authors.lastname: Soares
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
authors.forename: David P
authors.initials: DP
authors.lastname: White
authors.forename: Lee S
authors.initials: LS
authors.lastname: Cohen
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hall
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000503:physiopathology / Q000628:therapy; D003863:Depression / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D019584:Hot Flashes / Q000150:complications*; D006801:Humans; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000503:physiopathology
chemical_list: D005640:Follicle Stimulating Hormone