Rest-Activity Rhythm Characteristics Associated With Depression Symptoms in Stroke Survivors

Stahl, Sarah T.; Skidmore, Elizabeth R.; Kringle, Emily; Shih, Minmei; Baum, Carolyn; Hammel, Joy; Krafty, Robert T.; Covassin, Naima; Li, Jingen; Smagula, Stephen F.

doi:10.1016/j.apmr.2023.01.013

Cited by 7 publications

(6 citation statements)

References 35 publications

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“…Associations between sleep health and depressive symptoms were determined using two approaches. First, depressive symptoms were dichotomized as having no or minimal depressive symptoms (PHQ ≤ 4; coded 0) or having greater than minimal depressive symptoms (PHQ ≥ 5; coded 1), as in other studies (39,40). Multiple logistic regression analysis was performed to examine the association of individual sleep health dimensions and a composite sleep health score with the presence of depressive symptoms.…”

Section: Discussionmentioning

confidence: 99%

The Association of Multidimensional Sleep Health With HbA1c and Depressive Symptoms in African American Adults With Type 2 Diabetes

Woo,

Lehrer,

Tabibi

et al. 2024

Psychosom Med

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Objective Sleep is important for diabetes-related health outcomes. Using a multidimensional sleep health framework, we examined the association of individual sleep health dimensions and a composite sleep health score with hemoglobin A1c (HbA1c) and depressive symptoms among African American adults with type 2 diabetes. Methods Participants (N = 257; mean age = 62.5 years) were recruited through local churches. Wrist-worn actigraphy and sleep questionnaire data assessed multidimensional sleep health using the RuSATED framework (regularity, satisfaction, alertness, timing, efficiency, duration). Individual sleep dimensions were dichotomized into poor or good sleep health and summed into a composite score. HbA1c was assessed using the DCA Vantage™ Analyzer or A1CNow® Self Check. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Regression models examined the association of individual sleep dimensions and composite sleep health with HbA1c and depressive symptoms. Results Higher composite sleep health scores were associated with a lower likelihood of having greater than minimal depressive symptoms (PHQ-9 ≥ 5) (odds ratio [OR] = 0.578, 95% confidence interval [CI] = 0.461–0.725). Several individual sleep dimensions, including irregularity (OR = 1.013, CI = 1.005–1.021), poor satisfaction (OR = 3.130, CI = 2.095–4.678), and lower alertness (OR = 1.866, CI = 1.230–2.833) were associated with a greater likelihood of having depressive symptoms. Neither composite sleep health scores nor individual sleep dimensions were associated with HbA1c. Conclusions Better multidimensional sleep health is associated with lower depressive symptoms among African American adults with type 2 diabetes. Longitudinal research is needed to determine the causal association between multidimensional sleep health and depressive symptoms in this population. Trial Registry ClinicalTrials.gov identifier NCT04282395.

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Section: Discussionmentioning

confidence: 99%

The Association of Multidimensional Sleep Health With HbA1c and Depressive Symptoms in African American Adults With Type 2 Diabetes

Woo,

Lehrer,

Tabibi

et al. 2024

Psychosom Med

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“…Understanding these associations has significant clinical implications because RAR is exogenously modifiable 19 and thus a potential treatment target; clinical trials in dementia patients have shown that entraining circadian RAR leads to improved mood 20 and cognitive performance. 21 To our knowledge, only 1 study 22 has examined the association of RAR with depressive symptoms among stroke survivors, and none that has examined RAR correlates of poststroke cognitive functioning. The study conducted by Stahl et al 22 found that stroke survivors with more fragmented RAR were more likely to have depressive symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…21 To our knowledge, only 1 study 22 has examined the association of RAR with depressive symptoms among stroke survivors, and none that has examined RAR correlates of poststroke cognitive functioning. The study conducted by Stahl et al 22 found that stroke survivors with more fragmented RAR were more likely to have depressive symptoms. However, depressive symptoms were assessed using retrospective questionnaires, which require a summative recollection of past experiences and are thus subject to recall biases, particularly when episodic memory deficit is prevalent after stroke.…”

Section: Introductionmentioning

confidence: 99%

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Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study

Lau,

Connor,

Skidmore

2024

Neurorehabil Neural Repair

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Background Rest-activity rhythm (RAR) is a modifiable behavioral factor associated with affect and cognition. Identifying RAR characteristics associated with affect and cognition among stroke survivors provides insight into preventing poststroke affective and cognitive impairment. Objective To examine the associations of RAR characteristics with affect and cognition among community-dwelling stroke survivors. Methods Forty participants with mild stroke (mean age = 52.8; 42.5% female; 55% White) reported their affect and cognitive complaints using ecological momentary assessment and wore an accelerometer for 7 consecutive days and completed the National Institutes of Health Toolbox Cognition Battery. RAR characteristics were extracted using parametric and non-parametric approaches. Multivariable linear regressions were used to identify RAR characteristics associated with affect and cognition. Results Later onset of rest ( B = 0.45; P = .008) and activity ( B = 0.36; P = .041) were positively associated with depressed affect. These associations were reversed for cheerful effect (rest onset: B = −0.42; P = .017; activity onset: B = −0.39; P = .033). Cheerful affect was also positively associated with relative amplitude (ie, distinctions in activity levels between rest and activity; B = .39; P = .030). Intra-daily variability (ie, RAR fragmentation; B = 0.35; P = .042) and later onset of activity ( B = .36; P = .048) were positively associated with cognitive complaints. Less erratic RAR was positively associated with fluid cognition ( B = 0.29; P = .036); RAR fragmentation was positively associated with crystallized cognition ( B = 0.39; P = .015). Conclusions We identified RAR correlates of affect and cognition among stroke survivors, highlighting the value of managing RAR and sleep in stroke rehabilitation. Future studies should test whether advancing the onset of rest and activity, promoting a regular active lifestyle, and improving rest and sleep in the nighttime protect stroke survivors from affective and cognitive impairment.

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“…This results in sleep de cits, such as delayed sleep onset, reduced sleep time, and greater wake after sleep onset in depression 27 . Particularly, individuals with depression are characterized by reduced sleep e ciency (i.e., total sleep duration divided by the time difference between sleep onset and wake-up time) and reduced relative amplitude (i.e., the amplitude between the activity during the day and the night, whereby lower relative amplitude relates to a dampened circadian rhythms amplitude and suggests lower activity during the day and greater activity during the night) 27,43 . To explain the interrelation between sleep-wake disturbances and depression, several neurobiological explanations have been put forward, including abnormalities in arousal 44 , endocrine and monoamine functioning 45 .…”

Section: Introductionmentioning

confidence: 99%

Familial risk for depression is associated with reduced physical activity: evidence from wrist-worn actigraphy

Dell'Acqua,

Benvenuti,

Cellini

et al. 2024

Preprint

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Depression is characterized by reduced physical activity and sleep-wake cycle disturbances, often considered important features of the disease, aligning with the Sensorimotor Systems and the Arousal and Regulatory Systems of the RDoC, respectively. Wrist-worn actigraphy can be leveraged to show objective sleep-wake and daily activity disturbances. While a few studies have suggested that self-reported reduced physical activity and sleep-wake cycle disturbances might both be linked to depression vulnerability, objective actigraphy-based measures in vulnerable samples remain largely unexplored. Seven-day actigraphy data were collected from 20 (13 F) university students with a higher vulnerability to depression, which was determined by the presence of a family history of the condition but no current symptoms, and 32 (21 F) controls with neither a family history of depression nor current depressive symptoms. Actigraphy data were processed using open-source software (GGIR). Daily physical activity, namely gross motor activity, was quantified as average daily acceleration and time spent on moderate-vigorous physical activity (MVPA). The sleep-wake cycle and circadian rhythms were assessed as total sleep duration per night (in hours), sleep within sleep period time (in hours), sleep efficiency (%), and relative amplitude. Individuals with a familial risk for depression showed reduced daily acceleration and time spent in MVPA relative to the control group, particularly on the weekend during their free time away from scheduled activities. On the other hand, the two groups were comparable in terms of sleep estimates. Taken together, reduced physical activity, but not sleep-wake disturbances, seem to be associated with vulnerability to depression and might be a viable target for identification and prevention efforts.

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Rest-Activity Rhythm Characteristics Associated With Depression Symptoms in Stroke Survivors

Cited by 7 publications

References 35 publications

The Association of Multidimensional Sleep Health With HbA1c and Depressive Symptoms in African American Adults With Type 2 Diabetes

The Association of Multidimensional Sleep Health With HbA1c and Depressive Symptoms in African American Adults With Type 2 Diabetes

Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study

Familial risk for depression is associated with reduced physical activity: evidence from wrist-worn actigraphy

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