title: Sleep Disturbances and Depression in the Multi-Ethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  We examined the association of objectively and subjectively measured sleep disturbances with depression, and explored if race/ethnicity, socioeconomic status, and sex modified these associations.
  
  
  METHODS
  We used data from the cross-sectional Multi-Ethnic Study of Atherosclerosis Sleep Study. Participants included 1,784 adults (ages 54-93 y), 36.8% non-Hispanic Whites, 28.0% African Americans, 23.7% Hispanics, 11.5% Chinese, and 46.0% males. Sleep was assessed with actigraphy, polysomnography, and self-report. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. We used relative risk regression to evaluate the association of sleep measures and depression (CES-D score ≥ 16) adjusting for site, sociodemographics, and behavioral and medical risk factors.
  
  
  RESULTS
  Overall, 14.5% had depression, 29.3% had insomnia symptoms, 14.1% had excessive daytime sleepiness (EDS), 15.1% had apnea-hypopnea index (AHI) ≥ 30, and 30.4% experienced short sleep (< 6 h). Depression was associated with short sleep duration (adjusted prevalence ratio [PR] = 1.47, 95% confidence interval [CI] = 1.11, 1.94), < 10% rapid eye movement [REM] sleep (PR = 1.57, 95% CI = 1.08, 2.27), ≥ 25% REM sleep (PR = 1.42, 95% CI = 1.03, 1.95), insomnia (PR = 1.83, 95% CI = 1.39, 2.40), excessive daytime sleepiness (EDS) (PR = 1.61, 95% CI = 1.19, 2.18), and AHI > 15 + EDS (PR = 1.55, 95% CI = 1.01, 2.39). Short sleep duration was associated with depression among those with high school education or beyond, but not among those with less education. Insomnia was more strongly associated with depression among men than women.
  
  
  CONCLUSIONS
  Sleep disturbances are associated with depression among middle-aged and older adults; these associations may be modified by education and sex. Future research should further test these hypotheses, evaluate whether early detection or treatment of sleep disturbances ameliorate depression, and explore subpopulation differences.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY.|Social Work, Columbia University School of Social Work, New York, NY.
authors.forename: Carmela
authors.initials: C
authors.lastname: Alcántara
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Biggs
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY.|New York Presbyterian Hospital, New York, NY.
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Delaney
authors.affiliation: Harvard Medical School, Boston, MA.
authors.forename: Chandra L
authors.initials: CL
authors.lastname: Jackson
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Zee
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Steven J C
authors.initials: SJ
authors.lastname: Shea
authors.affiliation: Department of Medicine,Harvard Medical School; Brigham and Women's Hospital and Beth Israel Deaconess Medical School, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D056044:Actigraphy; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000208:ethnology* / Q000503:physiopathology / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000208:ethnology; D004522:Educational Status; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D044469:Racial Groups / Q000523:psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D057566:Self Report; D012727:Sex Characteristics; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000208:ethnology; D012894:Sleep Stages; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000208:ethnology*
keywords: actigraphy; polysomnography; psychosocial; race/ethnicity; socioeconomic factors