title: Insomnia and objectively measured sleep disturbances predict treatment outcome in depressed patients treated with psychotherapy or psychotherapy-pharmacotherapy combinations.
abstract: OBJECTIVE
  Insomnia and objectively measured sleep disturbances predict poor treatment outcomes in patients with major depressive disorder (MDD). However, prior research has utilized individual clinical trials with relatively small sample sizes and has focused on insomnia symptoms or objective measures, but not both. The present study is a secondary analysis that examines the degree to which insomnia, objective sleep disturbances, or their combination predicts depression remission following pharmacotherapy and/or psychotherapy treatment.
  
  
  METHODS
  Participants were 711 depressed (DSM criteria) patients drawn from 6 clinical trials. Remission status, defined as a score of ≤ 7 on the Hamilton Depression Rating Scale (HDRS) over 2 consecutive months, served as the primary outcome. Insomnia was assessed via the 3 sleep items on the HDRS. Objectively measured short sleep duration (total sleep time ≤ 6 hours) and prolonged sleep latency (> 30 minutes) or wakefulness after sleep onset (> 30 minutes) were derived from in-laboratory polysomnographic sleep studies. Logistic regression predicted the odds of nonremission according to insomnia, each of the objective sleep disturbances, or their combination, after adjusting for age, sex, treatment modality, and baseline depressive symptoms.
  
  
  RESULTS
  Prolonged sleep latency alone (OR = 3.53; 95% CI, 1.28-9.73) or in combination with insomnia (OR = 2.11; 95% CI, 1.13-3.95) predicted increased risk of nonremission. In addition, insomnia and sleep duration individually and in combination were each associated with a significantly increased risk of nonremission (P values < .05).
  
  
  CONCLUSIONS
  Findings suggest that objectively measured prolonged sleep latency and short sleep duration independently or in conjunction with insomnia are risk factors for poor depression treatment outcome.
authors.affiliation: Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15213, USA. troxelw@upmc.edu
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Troxel
authors.forename: David J
authors.initials: DJ
authors.lastname: Kupfer
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Jean M
authors.initials: JM
authors.lastname: Miewald
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017286:Polysomnography; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000523:psychology; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents