title: Poor sleep quality is associated with depressive symptoms in patients with heart disease.
abstract: BACKGROUND
  Depression in cardiac patients has gained importance due to increased mortality. Although sleep disturbances are a core symptom of depression, the prevalence and patterns of sleep disturbances in heart disease have hardly been examined regarding depression.
  
  
  OBJECTIVE
  This cross-sectional study aims to examine sleep disturbances and depressive symptoms in consecutively admitted cardiac patients and depressed patients.
  
  
  METHODS
  Two hundred four inpatients (113 male, 91 female) were examined: 94 cardiac inpatients (mean age 49.3 ± 14.3 years) with different heart diseases and 110 psychiatric inpatients (mean age 41.6 ± 13.0 years) with depressive disorders (DP). A depressive episode according to International Classification of Diseases (ICD)-10 was also diagnosed in 14 of the cardiac patients (DCP). The Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) were used to assess subjective sleep quality and severity of depressive symptoms.
  
  
  RESULTS
  Poor sleep quality (PSQI > 5) was reported in all comorbid DCP (PSQI 12.00 ± 3.53, BDI 17.86 ± 4.28), in 60% of the 80 non-DCP (PSQI 5.59 ± 3.73, BDI 4.47 ± 3.07), and in 86.4% of the DP (PSQI 11.76 ± 4.77, BDI 27.11 ± 10.54). The cardiac inpatients showed a significant correlation between increased depressive symptoms and the PSQI components subjective sleep quality (r = 0.40) and daytime dysfunction (r = 0.34). Both sleep components were significant predictors of self-rated depression (R² = 0.404).
  
  
  CONCLUSIONS
  Most cardiac patients experience poor sleep quality. Self-reported sleep disturbances in heart disease could serve as predictors of clinical or subclinical comorbid depression outside of a psychiatric setting in cardiology and other fields, and such patients should be referred to consultation-liaison psychiatry or polysomnography where sleep disorders like sleep apnea are suspected.
authors: Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, Bochum, Germany. Christine.Norra@rub.de
authors: Christine
authors: C
authors: Norra
authors: Julia
authors: J
authors: Kummer
authors: Maren
authors: M
authors: Boecker
authors: Erik
authors: E
authors: Skobel
authors: Patrick
authors: P
authors: Schauerte
authors: Markus
authors: M
authors: Wirtz
authors: Siegfried
authors: S
authors: Gauggel
authors: Thomas
authors: T
authors: Forkmann
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D017286:Polysomnography; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology