Sleep Disturbances Are Highly Predictive of Major Depressive Disorder Recurrence

This work was sponsored by Takeda Pharmaceuticals U.S.A., Inc., and Lundbeck LLC Background: Association of sleep disturbances with major depressive disorder (MDD) is well documented yet the role of hypersomnolence in MDD is unknown. Methods: In this longitudinal study, we evaluated symptoms and the impact of sleep disturbances over 3 years via 2 interview waves conducted from 2002–2015 in adult participants from the general US population in 8 states. Of 12,218 wave 1 (W1) participants, 10,931 were interviewed again for wave 2 (W2) 3 years later. Predictors of recurrence were determined using logistic regression. Results: 12-month prevalence of MDD was 9.5% in W1 and 12.1% in W2. Overall, 41.8% of interviewees with MDD in W1 still reported depressive symptoms in W2 and 6% experienced MDD recurrence (complete/partial remission at W1 with full episode at W2, or complete remission at W1 with partial remission at W2) (95% CI, 2.3%–2.9%). Characteristics in W1 predicting recurrent MDD in W2 included sleep dissatisfaction (relative risk [RR] 3.4; 95% CI, 2.6–4.6), insomnia with (RR 3.8; 95% CI, 2.7–5.3) or without (RR 2.2; 95% CI, 1.5–3.2) excessive daytime sleepiness (EDS), and hypersomnolence (an unrefreshing prolonged main sleep period >9 hours) (RR 5.5; 95% CI, 3.2–9.5). Compared with participants without MDD in W1 (n=10,091), participants with recurrent MDD at W2 (n=284) had more hypersomnolence (7.7% vs 1.9%), insomnia (20.4% vs 12.7%), insomnia with EDS (30.7% vs 11.3%), and global sleep dissatisfaction (37.8% vs 13.7%). Conclusion: Sleep disturbances appear early in the care pathway and are highly predictive of recurrent MDD.