title: Self-reported sleep disturbance is associated with elevated levels of PAI-1 in individuals with a recorded history of depressive symptoms.
abstract: BACKGROUND
  The majority of depressed individuals report insomnia. Self-reported symptoms of insomnia, in particular, more strongly predict adverse health effects than the actual measured sleep time. The physiological alterations in individuals with insomnia are complex, as both autonomic and endocrine dysfunctions are present. Plasminogen activator inhibitor (PAI)-1 is a stress-related acute-phase reactant that has also been suggested to regulate the circadian rhythm and sleep patterns. It has been suggested to contribute to both depressive symptoms and sleep disorders, although data on the relationships between these parameters are scarce.
  
  
  OBJECTIVE
  This study examined the role of self-reported sleep disturbance and its association with PAI-1 among individuals with a history of depressive symptoms.
  
  
  METHODS
  Differences in the serum levels of PAI-1 between two groups (group 1: moderate to very severe sleep disturbance, n=37; group 2: mild or no sleep disturbance, n = 90) were examined in a population-based sample of individuals with a recorded history of depressive symptoms.
  
  
  RESULTS
  Multivariate analysis controlling for potential confounding factors (age, sex, body mass index, depression severity) showed that each 1-unit increase in PAI-1 (μg/mL) increased the likelihood for belonging to the group with moderate to very severe sleep disturbance by 23% (OR = 1.23, C.I. 95% = 1.04-1.45, p = 0.016). This statistical significance remained after additional adjustments for regular smoking and the use of sleep or lipid-lowering medication.
  
  
  CONCLUSIONS
  Our observations may further clarify the physiological alterations related to sleep disturbance in depressive individuals. In the present study, self-reported sleep disturbance in individuals with a recorded history of depressive symptoms was associated with an elevation of PAI-1. This finding may illustrate the association of subjective sleep disturbance with sympathetic activation. Our study highlights the importance of effects of perceived sleep disturbance on individual homeostasis, and may provide potential directions for research on treatment options.
authors.affiliation: Department of Psychiatry, Kuopio University Hospital & University of Easterrn Finland, 70210 Kuopio, Finland. Electronic address: apelomaa@gmail.com.
authors.forename: Antti-Pekka
authors.initials: AP
authors.lastname: Elomaa
authors.forename: Heli
authors.initials: H
authors.lastname: Koivumaa-Honkanen
authors.forename: Leo
authors.initials: L
authors.lastname: Niskanen
authors.forename: Kirsi
authors.initials: K
authors.lastname: Honkalampi
authors.forename: Minna
authors.initials: M
authors.lastname: Valkonen-Korhonen
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Herzig
authors.forename: Heimo
authors.initials: H
authors.lastname: Viinamäki
authors.forename: Soili M
authors.initials: SM
authors.lastname: Lehto
mesh_terms: D015992:Body Mass Index; D003863:Depression / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D057566:Self Report; D012893:Sleep Wake Disorders / Q000097:blood / Q000209:etiology / Q000523:psychology
chemical_list: D017395:Plasminogen Activator Inhibitor 1
keywords: 15-dimensional questionnaire; 15D; BDI; BMI; Beck Depression Inventory; Depression; Inflammation; MDD; MetS; OSA; PAI-1; Sleep disturbance; body mass index; major depressive disorder; metabolic syndrome; obstructive sleep apnea; plasminogen activator inhibitor-1