Abstract
Sleep disorders and changes in the profile of the cortisol awakening response (CAR) are potential predictive factors for the incidence of major depressive disorder (MDD). However, these parameters usually are evaluated separately, lacking information regarding the simultaneous association of sleep disorders and CAR, mainly throughout the MDD severity. This study addressed the relationship between sleep quality and CAR in patients with initial/mild depression (MD, n = 30) versus advanced/treatment-resistant (TRD, n = 28), compared with a group of healthy controls (CG, n = 49), aiming to point out in a clinical perspective which alterations in sleep and CAR have been observed along major depression severity stages. TRD patients presented a blunted CAR and poorer sleep quality comparing MD and CG groups. Additionally, MD patients showed worse sleep quality and larger CAR than CG. Taken together, both sleep quality and CAR were correlated with MDD symptoms and predictors of MDD severity, with a greater classification power for sleep quality. From sleep quality, specifically, the use of sleep medication and sleep efficiency predicted depression severity, discriminating mild and treatment-resistant depression. These results show the importance of assessing sleep quality and CAR in patients with major depression when there is a need for evaluation of the disorder’s severity in a clinical context. CAR and sleep quality can be useful complementary tools to help in the clinical identification of major depression severity and the understanding of their impact on MDD may support further studies that aim to improve intervention strategies to increase the effectiveness of treatments.
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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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We would like to thank Kedma Valnice Freire Oliveira for contributing to the data collection.
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NG-C, FP-F, BL-S, ML-M, and DA conducted the clinical trial. AM and RA performed the dosing of biomarkers. GS and AM carried out the statistical analyses. LT and YM wrote the first version of the manuscript. All authors drafted and edited the manuscript.
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The study was approved by the Hospital Universitário Onofre Lopes (HUOL) Medical Research Ethics Committee (Registration number 579.479), and the Human Research Ethics Committee of the Federal University Rio Grande do Norte (UFRN) (Registration number 2.628.202). All volunteers signed a consent form in which they state that they are aware of the study methods, and that guarantees that they have complete freedom to interrupt their participation in the study, without any harm being done. Moreover, this study fulfills the ethical standards of the relevant national and institutional committees for human experimentation and with the Declaration of Helsinki of 1975, revised in 2008.
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Torres, L.H.S.F., Medeiros, Y.K.M., de Sousa, G.M. et al. Use of sleep quality questionary and cortisol awakening response as complementary tools for the evaluation of major depression progression. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-05786-z
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DOI: https://doi.org/10.1007/s12144-024-05786-z