SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science IX. Psychiatric and Behavioral Disorders and Sleep
Methods: Participants were 77 healthy individuals (36.4% male) who
met DSM-IV criteria for MDD and insomnia disorder and did not meet
criteria for other primary psychiatric diagnoses. Participants underwent
ambulatory screening polysomnography (PSG) and were not taking
hypnotic, antidepressant or other medications that affect sleep or mood.
The mean age was 48 (SD=11); 6.5% were Hispanic; 74% Caucasian;
40% were married or cohabitating. Insomnia and depression severity
were measured using the Insomnia Severity Index (ISI) and the Hamilton
Rating Scale for Depression (HRSD), respectively.
Results: The mean (SD) HRSD was 22.3 (4.1) and the mean ISI was
22.8 (3.5). PSG data revealed mean (SD) sleep onset latency 31 minutes
(69); wakefulness after sleep onset 85 minutes (60); Apnea Hypopnea
Index (AHI) 9 events/hour (11). AHI≥15 was present in 18.2% of the
sample and AHI≥10 was present in 27.3% of the sample. AHI was not
significantly correlated with HRSD or ISI (p-values > .77). As expected,
male gender was associated with greater likelihood of AHI>15 (one
tailed p=.036).
Conclusion: The frequency of OSA with an AHI ≥15 in this sample
of depressed individuals with insomnia was higher than observed in a
large-scale epidemiological study in the United States, which found 9%
of men and 4% of women (age 30-60) had an AHI ≥15. Our results may
underestimate the true prevalence of OSA in patients with MDD and
insomnia, as individuals with an existing diagnosis of OSA and those
with probable OSA were excluded.
Support (If Any): Research supported by NIH grants R01 MH78924 &
R01 HL096492 and by a gift form Philips-Respironics.
0748
CO-EXISTING MOOD AND ANXIETY DISORDERS ARE
ASSOCIATED WITH AN ELEVATED PREVALENCE OF
INSOMNIA SYMPTOMS IN THE NATIONAL COMORBIDITY
SURVEY-REPLICATION
Soehner A, Harvey AG
Psychology, University of California, Berkeley, Berkeley, CA, USA
Introduction: Insomnia symptoms are highly prevalent in mood and
anxiety disorders, yet little is known about rates of insomnia symptoms
in co-existing mood and anxiety disorders. In this study, we examined
the association between insomnia symptoms and co-existing mood and
anxiety disorders in the National Comorbidity Survey - Replication
(NCS-R).
Methods: The NCS-R is a nationally representative survey of the U.S.
population (ages 18+) conducted between 2001 and 2003. Difficulty
initiating sleep (DIS), difficulty maintaining sleep (DMS), and early
morning awakening (EMA) in the past year were assessed as dichotomous
variables. A variable (ANY) was created to signify the presence
of at least one insomnia symptom (DIS, DMS or EMA). Mood
disorders (major depressive disorder, dysthymia, bipolar disorder) and
anxiety disorders (panic disorder, agoraphobia, specific phobia, social
phobia, generalized anxiety disorder, posttraumatic stress disorder) occurring
in the past year were assessed using DSM-IV criteria. A sample
of 5692 respondents was divided into four groups: no mood or anxiety
disorder (N=3711), mood disorder only (N=327), anxiety disorder only
(N=1137), and co-existing mood and anxiety disorder (N=517). Prevalence
estimates, and odds ratios adjusted for demographic and clinical
variables in logistic regression analyses, were corrected for the complex
survey design.
Results: Respondents with co-existing mood and anxiety disorders
had significantly higher rates of at least one insomnia symptom
(ANY=62.8%), as well as specific insomnia symptoms (DIS=45.4%;
DMS=48.4%; EMA=40.1%), compared to the other three groups.
Insomnia symptom prevalence in the mood disorder only group
(ANY=45.6%; DIS=31.2%; DMS=36.2%; EMA=24.5%) did not significantly
differ from the anxiety disorder only group (ANY=46.5%;
DIS=25.2%; DMS=31.7%; EMA=27.5%); however, both groups more
frequently endorsed insomnia symptoms compared to respondents
with no such diagnosis (ANY= 23.3%; DIS=12.4%; DMS=15.3%;
EMA=12.9%). This pattern of findings remained significant after controlling
for clinical and demographic factors.
Conclusion: Co-existing mood and anxiety disorders are associated
with high rates of insomnia symptoms.
Support (If Any): R34MH080958
0749
CHANGE IN QUALITY OF LIFE AFTER BRIEF
BEHAVIORAL THERAPY FOR REFRACTORY INSOMNIA IN
RESIDUAL DEPRESSION: A RANDOMIZED CONTROLLED
TRIAL
Watanabe N 1 , Furukawa TA 2 , Shimodera S 3 , Morokuma I 3 , Katsuki F 4 ,
Fujita H 3 , Sasaki M 5 , Kawamura C 3 , Perlis ML 6
1
Psychiatry and Cognitive-Behavioral Medicine, Nagoya City
University Graduate School of Medical Sciences, Nagoya, Japan,
2
Health Promotion and Human Behavior (Cognitive-Behavioral
Medicine), Kyoto University Graduate School of Medicine / School of
Public Health, Kyoto, Japan, 3 Neuropsychiatry, Kochi Medical School,
Kochi, Japan, 4 Psychiatric and Mental Health Nursing, Nagoya City
University School of Nursing, Nagoya, Japan, 5 Center for Education
and Research on the Science of Preventive Education, Naruto
University of Education, Tokushima, Japan, 6 Psychiatry, University of
Pennsylvania, Philadelphia, PA, USA
Introduction: Insomnia concurrent with depression is not only a major
subjectively distressing factor for patients, but also exacerbates daytime
fatigue and somnolence, which leads to deterioration in quality of life
in patients. Moreover, insomnia often persists despite pharmacotherapy
in depression and represents an obstacle to its full remission. The added
value of brief Behavioural Therapy for insomnia (bBTi) over treatment
as usual (TAU) has been confirmed for residual depression and refractory
insomnia in terms of the severity both of insomnia and depression (in
press), but to date the impact of bBTi on Quality of Life (QoL) have not
been appropriately evaluated. The study aimed to examine what aspects
of QoL changed among patients with residual depression and refractory
insomnia treated with bBTi.
Methods: Thirty-seven outpatients (average age of 50.5 years) were
randomly assigned to TAU alone or TAU plus bBTi, consisting of 4
weekly 1-hour individual sessions. QoL was evaluated using the Short
Form 36 at baseline and the 8-week follow-up. Each of the eight QoL
domains was quantified. Analysis of covariance was used to test group
effects while controlling for the baseline scores.
Results: The mean scores of all the domains increased in the bBTi plus
TAU group at the 8-week follow-up, while those in four domains decreased
in the TAU alone group. bBTi plus TAU resulted in significantly
lower scores in terms of the physical functioning (P=.006), the social
functioning (P=.002) and the mental health (P=.041) domains than TAU
alone at 8 weeks. No significant differences were observed in the other
domains.
Conclusion: In patients with residual depression and treatment refractory
insomnia, adding bBTi to usual clinical care produced statistically
significant and clinically substantive added benefits in terms of some
aspects in QoL.
Support (If Any): This study was funded by a Grant-in-Aid for Scientific
Research (No. 19230201) from the Ministry of Health, Labor and
Welfare, Japan.
A257
SLEEP, Volume 34, Abstract Supplement, 2011