title: Depressive symptoms and subjective and objective sleep in community-dwelling older women.
abstract: OBJECTIVE
  To examine the relationship between depressive symptoms and subjective and objective sleep in older women.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Four U.S. clinical centers.
  
  
  METHODS
  Three thousand forty-five community-dwelling women aged 70 and older.
  
  
  METHODS
  Depressive symptoms were assessed using the Geriatric Depression Scale, categorizing participants as normal (0-2, reference), some depressive symptoms (3-5), or depressed (≥ 6). Subjective sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Objective sleep measures were assessed using wrist actigraphy.
  
  
  RESULTS
  In multivariable-adjusted models, there were graded associations between greater level of depressive symptoms and worse subjective sleep quality and more subjective daytime sleepiness (P-trends < .001). Women with some depressive symptoms (odds ratio (OR) = 1.82, 95% confidence interval (CI) = 1.48-2.24) and depressed (OR = 2.84, 95% CI = 2.08-3.86) women had greater odds of reporting poor sleep (PSQI>5). Women with some depressive symptoms (OR = 1.97, 95% CI = 1.47-2.64) and depressed women (OR = 1.70, 95% CI = 1.12-2.58) had greater odds of reporting excessive daytime sleepiness (ESS>10). There were also graded associations between greater level of depressive symptoms and objectively measured wake after sleep onset (WASO) (P-trend = .03) and wake episodes longer than 5 minutes (P-trend = .006). Depressed women had modestly higher odds of WASO of 1 hour or longer (OR = 1.37, 95% CI = 1.03-1.83). Women with some depressive symptoms (OR = 1.49, 95% CI = 1.19-1.86) and depressed women (OR = 2.04, 95% CI = 1.52-2.74) had greater odds of being in the highest quartile for number of nap episodes longer than 5 minutes. No associations between depressive symptom level and prolonged sleep latency, poor sleep efficiency, or short or long total sleep time were found.
  
  
  CONCLUSIONS
  Greater depressive symptom levels were associated with more subjective sleep disturbance and objective evidence of sleep fragmentation and napping.
authors.affiliation: Department of Psychiatry, University of California at San Diego, La Jolla, California, USA. jmaglione@ucsd.edu
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Maglione
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Peters
authors.forename: Misti L
authors.initials: ML
authors.lastname: Paudel
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: Katie L
authors.initials: KL
authors.lastname: Stone
mesh_terms: D056044:Actigraphy; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014481:United States / Q000453:epidemiology