title: Subjective and objective sleep disturbance and longitudinal risk of depression in a cohort of older women.
abstract: OBJECTIVE
  To investigate the longitudinal relationship between subjective and objective sleep disturbance and depressive symptoms.
  
  
  METHODS
  Longitudinal.
  
  
  METHODS
  Three US clinical centers.
  
  
  METHODS
  Nine hundred fifty-two community-dwelling older women (70 y or older).
  
  
  METHODS
  At baseline, subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measures were assessed with wrist actigraphy. Depressive symptoms were assessed with the Geriatric Depression Scale (GDS) at baseline and approximately 5 y later. The analysis was restricted to women with few (GDS 0-2) depressive symptoms at baseline.
  
  
  RESULTS
  There was an independent association between greater PSQI score (per standard deviation increase, indicating worse subjective sleep quality) at baseline and greater odds of worsening depressive symptoms (≥ 2-point increase in GDS) (Multivariate Odds Ratio [MOR] 1.19, confidence interval [CI] 1.01-1.40, P = 0.036). Higher scores specifically on the sleep quality (MOR 1.41, CI 1.13-1.77, P < 0.003) and sleep latency (MOR 1.21, CI 1.03-1.41, P = 0.018) PSQI subscales were also associated with greater odds for worsening depressive symptoms. Objective assessments revealed an association between baseline prolonged wake after sleep onset (WASO ≥ 60 min) and worsening depressive symptoms at follow-up (MOR 1.36, CI 1.01-1.84, P = 0.046). There were no associations between other objectively assessed sleep measures and worsening depressive symptoms.
  
  
  CONCLUSIONS
  In older women with few or no depressive symptoms at baseline, those with more subjectively reported sleep disturbance and more objectively assessed fragmentation of sleep at baseline had greater odds of worsening depressive symptoms 5 y later. Future studies investigating this relationship in more detail are indicated.
  
  
  BACKGROUND
  Maglione JE, Ancoli-Israel S, Peters KW, Paudel ML, Yaffe K, Ensrud KE, Stone KL, Study of Osteoporotic Fractures Research Group. Subjective and objective sleep disturbance and longitudinal risk of depression in a cohort of older women.
authors: Department of Psychiatry, University of California, San Diego, La Jolla, CA.
authors: Jeanne E
authors: JE
authors: Maglione
authors: Department of Psychiatry, University of California, San Diego, La Jolla, CA ; Department of Medicine, University of California, San Diego, La Jolla, CA.
authors: Sonia
authors: S
authors: Ancoli-Israel
authors: California Pacific Medical Center Research Institute, San Francisco, CA.
authors: Katherine W
authors: KW
authors: Peters
authors: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis MN.
authors: Misti L
authors: ML
authors: Paudel
authors: Departments of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, CA.
authors: Kristine
authors: K
authors: Yaffe
authors: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis MN ; Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN ; Department of Medicine, University of Minnesota, Minneapolis, MN.
authors: Kristine E
authors: KE
authors: Ensrud
authors: California Pacific Medical Center Research Institute, San Francisco, CA.
authors: Katie L
authors: KL
authors: Stone
mesh_terms: D056044:Actigraphy; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016017:Odds Ratio; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D014481:United States
keywords: actigraphy; age; depression; elderly; sleep