Objective short sleep duration is associated with elevated blood pressure in depression: The autonomic nerve dysfunction effect

Abstract

The relationship between sleep disturbance, autonomic nerve dysfunction, and blood pressure in patients with major depressive disorder (MDD) was unclear. We studied 66 patients with MDD and 66 age-matched and sex-matched controls. Objective and subjective sleep were assessed using the polysomnography and Pittsburgh Sleep Quality Index, respectively. Autonomic nerve function was assessed using the heart rate variability (HRV). The averaged evening and morning systolic (SBP) and diastolic blood pressure (DBP) were analyzed. In patients with MDD, each 1 h reduction in an objective sleep duration was associated with 2.56-mmHg increase in SBP (p = 0.011) and 1.59-mmHg increase in DBP (p = 0.043). Increase in NREM-heart rate (HR), NREM-low frequency normalized unit (LFnu), and REM-HR and decrease in NREM-standard deviation of NN intervals, NREM-root mean square of successive differences, and NREM-LFnu were associated with shorter objective sleep duration (all p ≤ 0.043) and higher SBP and DBP (all p ≤ 0.037). These HRV mediated the association between objective sleep duration and BP with 17-79% mediating effects. No association was observed between subjective sleep duration and BP in patients with MDD or between objective/subjective sleep duration and BP in controls. In conclusion, objective, but not subjective short sleep duration, is associated with increased blood pressure in patents with MDD, that is mediated by autonomic nerve dysfunction.

Keywords

autonomic nerve dysfunction / blood pressure / major depressive disorder / mediating effect / sleep duration

References

[1] Bromet E, Andrade LH, Hwang I, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011; 9(1):90. https://doi.org/10.1186/1741-7015-9-90

[2] Liu Q, He H, Yang J, Feng X, Zhao F, Lyu J. Changes in the global burden of depression from 1990 to 2017: findings from the global burden of disease study. J Psychiatr Res. 2020; 126: 134-140. https://doi.org/10.1016/j.jpsychires.2019.08.002

[3] Shi S, Liang J, Liu T, et al. Depression increases sympathetic activity and exacerbates myocardial remodeling after myocardial infarction: evidence from an animal experiment. PLoS One. 2014; 9(7):e101734. https://doi.org/10.1371/journal.pone.0101734

[4] Murphy MJ, Peterson MJ. Sleep disturbances in depression. Sleep Med Clin. 2015; 10(1): 17-23. https://doi.org/10.1016/j.jsmc.2014.11.009

[5] Alcantara C, Biggs ML, Davidson KW, et al. Sleep disturbances and depression in the multi-ethnic study of atherosclerosis. Sleep. 2016; 39(4): 915-925. https://doi.org/10.5665/sleep.5654

[6] Solelhac G, Berger M, Strippoli MF, et al. Objective polysomnography-based sleep features and major depressive disorder subtypes in the general population. Psychiatry Res. 2023; 324:115213. https://doi.org/10.1016/j.psychres.2023.115213

[7] Dai Y, Vgontzas AN, Chen L, et al. A meta-analysis of the association between insomnia with objective short sleep duration and risk of hypertension. Sleep Med Rev. 2024; 75:101914. https://doi.org/10.1016/j.smrv.2024.101914

[8] Dai Y, Chen B, Chen L, et al. Insomnia with objective short sleep duration is associated with hypertension. J Sleep Res. 2023; 32(4):e13833. https://doi.org/10.1111/jsr.13833

[9] Dai Y, Chen B, Chen L, et al. Insomnia with objective, but not subjective, short sleep duration is associated with increased risk of incident hypertension: the Sleep Heart Health Study. J Clin Sleep Med. 2023; 19(8): 1421-1428. https://doi.org/10.5664/jcsm.10570

[10] Li Y, Lin S. Mediating effect of sympathetic activation on the association between objective short sleep duration and increased blood pressure in patients with chronic insomnia. Sleep Med. 2022; 100(suppl 1):S131. https://doi.org/10.1016/j.sleep.2022.05.358

[11] Jin B, Zhang H, Song F, Wu G, Yang H. Interaction of sleep duration and depression on cardiovascular disease: a retrospective cohort study. BMC Public Health. 2022; 22(1):1752. https://doi.org/10.1186/s12889-022-14143-3

[12] Gangwisch JE, Malaspina D, Posner K, et al. Insomnia and sleep duration as mediators of the relationship between depression and hypertension incidence. Am J Hypertens. 2010; 23(1): 62-69. https://doi.org/10.1038/ajh.2009.202

[13] Tai B, Dawood T, Macefield VG, Yiallourou SR. The association between sleep duration and muscle sympathetic nerve activity. Clin Auton Res. 2023; 33(6): 647-657. https://doi.org/10.1007/s10286-023-00965-7

[14] Fernandez-Mendoza J, Baker JH, Vgontzas AN, Gaines J, Liao D, Bixler EO. Insomnia symptoms with objective short sleep duration are associated with systemic inflammation in adolescents. Brain Behav Immun. 2017; 61: 110-116. https://doi.org/10.1016/j.bbi.2016.12.026

[15] Ma SN, Liu XH, Cai WS. Preventive noninvasive vagal nerve stimulation reduces insufficient sleep-induced depression by improving the autonomic nervous system. Biomed Pharmacother. 2024; 173:116344. https://doi.org/10.1016/j.biopha.2024.116344

[16] Bourdillon N, Jeanneret F, Nilchian M, Albertoni P, Ha P, Millet GP. Sleep deprivation deteriorates heart rate variability and photoplethysmography. Front Neurosci. 2021; 15:642548. https://doi.org/10.3389/fnins.2021.642548

[17] Sarmiento C, Lau C. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.; 2020: 125-129. DSM-5.

[18] Berry RB, Albertario CL, Harding SM, et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications Version 2.5. American Academy of Sleep Medicine; 2018.

[19] Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev. 2016; 25: 52-73. https://doi.org/10.1016/j.smrv.2015.01.009

[20] Penzel T, Kantelhardt JW, Bartsch RP, et al. Modulations of heart rate, ECG, and cardio-respiratory coupling observed in polysomnography. Front Physiol. 2016; 7:460. https://doi.org/10.3389/fphys.2016.00460

[21] Boudreau P, Yeh WH, Dumont GA, Boivin DB. Circadian variation of heart rate variability across sleep stages. Sleep. 2013; 36(12): 1919-1928. https://doi.org/10.5665/sleep.3230

[22] Silvani A, Dampney RA. Central control of cardiovascular function during sleep. Am J Physiol Heart Circ Physiol. 2013; 305(12): H1683-H1692. https://doi.org/10.1152/ajpheart.00554.2013

[23] Tochikubo O, Ikeda A, Miyajima E, Ishii M. Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension. 1996; 27(6): 1318-1324. https://doi.org/10.1161/01.hyp.27.6.1318

[24] Gonzales JU, Elavsky S, Cipryan L, Jandačková V, Burda M, Jandačka D. Influence of sleep duration and sex on age-related differences in heart rate variability: findings from program 4 of the HAIE study. Sleep Med. 2023; 106: 69-77. https://doi.org/10.1016/j.sleep.2023.03.029

[25] Colasanto M, Madigan S, Korczak DJ. Depression and inflammation among children and adolescents: a meta-analysis. J Affect Disord. 2020; 277: 940-948. https://doi.org/10.1016/j.jad.2020.09.025

[26] Patel SR, Zhu X, Storfer-Isser A, et al. Sleep duration and biomarkers of inflammation. Sleep. 2009; 32(2): 200-204. https://doi.org/10.1093/sleep/32.2.200

[27] Fink AM, Bronas UG, Calik MW. Autonomic regulation during sleep and wakefulness: a review with implications for defining the pathophysiology of neurological disorders. Clin Auton Res. 2018; 28(6): 509-518. https://doi.org/10.1007/s10286-018-0560-9

[28] Cabiddu R, Cerutti S, Viardot G, Werner S, Bianchi AM. Modulation of the sympatho-vagal balance during sleep: frequency domain study of heart rate variability and respiration. Front Physiol. 2012; 3:45. https://doi.org/10.3389/fphys.2012.00045

[29] Xu Y, Qu B, Liu F, Gong Z, Zhang Y, Xu D. Sleep deprivation and heart rate variability in healthy volunteers: effects of REM and SWS sleep deprivation. Comput Math Methods Med. 2023; 2023(1):7121295. https://doi.org/10.1155/2023/7121295

[30] Vgontzas AN, Puzino K, Fernandez-Mendoza J, Krishnamurthy VB, Basta M, Bixler EO. Effects of trazodone versus cognitive behavioral therapy in the insomnia with short sleep duration phenotype: a preliminary study. J Clin Sleep Med. 2020; 16(12): 2009-2019. https://doi.org/10.5664/jcsm.8740

[31] Li Y, Vgontzas AN, Fernandez-Mendoza J, Fang J, Puzino K, Bixler EO. Effect of trazodone versus cognitive-behavioural treatment on high- and slow-frequency activity during non-rapid eye movement sleep in chronic insomnia: a pilot, randomized clinical trial. J Sleep Res. 2021; 30(5):e13324. https://doi.org/10.1111/jsr.13324

[32] JH Baker, AN Vgontzas, J Fernandez-Mendoza, et al., 0413 effects of trazodone on blood pressure: a longitudinal, observational study of patients presenting to a sleep disorder clinic, Sleep. 2018; 41(Suppl l l_1):A157. https://doi.org/10.1093/sleep/zsy061.412

[33] Huang Y, Mai W, Cai X, et al. The effect of zolpidem on sleep quality, stress status, and nondipping hypertension. Sleep Med. 2012; 13(3): 263-268. https://doi.org/10.1016/j.sleep.2011.07.016

[34] Ding L, Chen B, Dai Y, Li Y. A meta-analysis of the first-night effect in healthy individuals for the full age spectrum. Sleep Med. 2022; 89: 159-165. https://doi.org/10.1016/j.sleep.2021.12.007

RIGHTS & PERMISSIONS

2025 The Author(s). Sleep Research published by John Wiley & Sons Australia, Ltd on behalf of Chinese Sleep Research Society.