Sleep Initiation and Maintenance Disorders: Buysse DJ

Buysse DJ. · No affiliation provided · Sleep. · Pubmed #16268371 No free full text.

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Buysse DJ. · No affiliation provided · Sleep. · Pubmed #14655907 No free full text.

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Reynolds CF, Buysse DJ, Nofzinger EA, Hall M, Dew MA, Monk TH. · No affiliation provided · J Am Geriatr Soc. · Pubmed #11347799 No free full text.

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Reynolds CF, Buysse DJ, Kupfer DJ. · No affiliation provided · JAMA. · Pubmed #10086440 No free full text.

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Franzen PL, Buysse DJ. · Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA · Dialogues Clin Neurosci. · Pubmed #19170404 No free full text.

Abstract: The majority of individuals with depression experience sleep disturbances. Depression is also over-represented among populations with a variety of sleep disorders. Although sleep disturbances are typical features of depression, such symptoms sometimes appear prior to an episode of depression. The bidirectional associations between sleep disturbance (especially insomnia) and depression increase the difficulty of differentiating cause-and-effect relationships between them. Longitudinal studies have consistently identified insomnia as a risk factor for the development of a new-onset or recurrent depression, and this association has been identified in young, middle-aged, and older adults. Studies have also observed that the combination of insomnia and depression influences the trajectory of depression, increasing episode severity and duration as well as relapse rates. Fortunately, recent studies have demonstrated that both pharmacological and nonpharmacological interventions for insomnia may favorably reduce and possibly prevent depression. Together, these findings suggest that sleep-related symptoms that are present before, during, andlor after a depressive episode are potentially modifiable factors that may play an important role in achieving and maintaining depression remission.

Germain A, Buysse DJ, Nofzinger E. · Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Room E-1124, Pittsburgh, PA 15213, USA. · Sleep Med Rev. · Pubmed #17997114 links to  free full text

Abstract: Posttraumatic stress disorder (PTSD) is a prevalent disorder that is associated with poor clinical and health outcomes, and considerable health care utilization and costs. Recent estimates suggest that 5-20% of military personnel who serve in current conflicts in Iraq and Afghanistan meet diagnostic criteria for PTSD. Clinically, sleep disturbances are core features of PTSD that are often resistant to first-line treatments, independently contribute to poor daytime functioning, and often require sleep-focused treatments. Physiologically, these observations suggest that PTSD is partially mediated by sleep disruption and its neurobiological correlates that are not adequately addressed by first-line treatments. However, polysomnographic studies have provided limited insights into the neurobiological underpinnings of PTSD during sleep. There is an urgent need to apply state-of-the-science sleep measurement methods to bridge the apparent gap between the clinical significance of sleep disturbances in PTSD and the limited understanding of their neurobiological underpinnings. Here, we propose an integrative review of findings derived from neurobiological models of fear conditioning and fear extinction, PTSD, and sleep-wake regulation, suggesting that the amygdala and medial prefrontal cortex can directly contribute to sleep disturbances in PTSD. Testable hypotheses regarding the neurobiological underpinnings of PTSD across the sleep-wake cycle are offered.

Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. · Université Laval, Québec, Canada. · Sleep. · Pubmed #17162986 No free full text.

Abstract: BACKGROUND: Recognition that psychological and behavioral factors play an important role in insomnia has led to increased interest in therapies targeting these factors. A review paper published in 1999 summarized the evidence regarding the efficacy of psychological and behavioral treatments for persistent insomnia. The present review provides an update of the evidence published since the original paper. As with the original paper, this review was conducted by a task force commissioned by the American Academy of Sleep Medicine in order to update its practice parameters on psychological and behavioral therapies for insomnia. METHODS: A systematic review was conducted on 37 treatment studies (N = 2246 subjects/patients) published between 1998 and 2004 inclusively and identified through Psyclnfo and Medline searches. Each study was systematically reviewed with a standard coding sheet and the following information was extracted: Study design, sample (number of participants, age, gender), diagnosis, type of treatments and controls, primary and secondary outcome measures, and main findings. Criteria for inclusion of a study were as follows: (a) the main sleep diagnosis was insomnia (primary or comorbid), (b) at least 1 treatment condition was psychological or behavioral in content, (c) the study design was a randomized controlled trial, a nonrandomized group design, a clinical case series or a single subject experimental design with a minimum of 10 subjects, and (d) the study included at least 1 of the following as dependent variables: sleep onset latency, number and/or duration of awakenings, total sleep time, sleep efficiency, or sleep quality. RESULTS: Psychological and behavioral therapies produced reliable changes in several sleep parameters of individuals with either primary insomnia or insomnia associated with medical and psychiatric disorders. Nine studies documented the benefits of insomnia treatment in older adults or for facilitating discontinuation of medication among chronic hypnotic users. Sleep improvements achieved with treatment were well sustained over time; however, with the exception of reduced psychological symptoms/ distress, there was limited evidence that improved sleep led to clinically meaningful changes in other indices of morbidity (e.g., daytime fatigue). Five treatments met criteria for empirically-supported psychological treatments for insomnia: Stimulus control therapy, relaxation, paradoxical intention, sleep restriction, and cognitive-behavior therapy. DISCUSSION: These updated findings provide additional evidence in support of the original review's conclusions as to the efficacy and generalizability of psychological and behavioral therapies for persistent insomnia. Nonetheless, further research is needed to develop therapies that would optimize outcomes and reduce morbidity, as would studies of treatment mechanisms, mediators, and moderators of outcomes. Effectiveness studies are also needed to validate those therapies when implemented in clinical settings (primary care), by non-sleep specialists. There is also a need to disseminate more effectively the available evidence in support of psychological and behavioral interventions to health-care practitioners working on the front line.

Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM. · Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA. · Sleep. · Pubmed #17040003 No free full text.

Abstract: STUDY OBJECTIVES: To present expert consensus recommendations for a standard set of research assessments in insomnia, reporting standards for these assessments, and recommendations for future research. PARTICIPANTS: N/A. INTERVENTIONS: N/A. METHODS AND RESULTS: An expert panel of 25 researchers reviewed the available literature on insomnia research assessments. Preliminary recommendations were reviewed and discussed at a meeting on March 10-11, 2005. These recommendations were further refined during writing of the current paper. The resulting key recommendations for standard research assessment of insomnia disorders include definitions/diagnosis of insomnia and comorbid conditions; measures of sleep and insomnia, including qualitative insomnia measures, diary, polysomnography, and actigraphy; and measures of the waking correlates and consequences of insomnia disorders, such as fatigue, sleepiness, mood, performance, and quality of life. CONCLUSIONS: Adoption of a standard research assessment of insomnia disorders will facilitate comparisons among different studies and advance the state of knowledge. These recommendations are not intended to be static but must be periodically revised to accommodate further developments and evidence in the field.

Moul DE, Hall M, Pilkonis PA, Buysse DJ. · Department of Psychiatry, Western Psychiatric Institute and Clinic, Sleep and Chronobiology Center, University of Pittsburgh, Room E-1119, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. · Sleep Med Rev. · Pubmed #15144961 No free full text.

Abstract: Self-report measures continue to provide key information in the evaluation and treatment of insomnia. While knowledge development about insomnia continues to require multi-trait, multi-method studies, self-report measures remain central in most study designs. The available stock of insomnia-related questionnaires has a substantial heterogeneity in their formats, foci, scopes, and other attributes. While there may be benefits from using specially tailored questionnaires in particular circumstances, in other cases the information quality of a study will be downgraded by poor choice of questionnaires. To assist clinicians and investigators in selecting questionnaires wisely, the present paper reviews questionnaire criteria and attribute priorities for clinical trials, theory tests, observational studies, and aging studies concerning insomnia. An extensive table of currently available questionnaires is provided, and some needs for future questionnaire development are also identified.

Buysse DJ. · Sleep and Chronobiology Program, Department of Psychiatry, University of Pittsburgh School of Medicine, USA. · Geriatrics. · Pubmed #14989593 No free full text.

Abstract: Insomnia and depression are related to each other on the level of epidemiology, clinical presentation, neurobiology, and treatment implications. The changes in sleep seen in older adults make these relationships particularly strong. Epidemiological studies show that depression is one of the strongest risk factors for current insomnia, but recent evidence indicates that this relationship is bi-directional: current insomnia is a risk factor for future depression. Changes in objective measures of sleep in depression mirror the changes seen in the aging process. Treating sleep disturbances may improve outcomes in patients with depression. Physicians should routinely question their older patients about sleep problems and depression.

Jindal RD, Buysse DJ, Thase ME. · Mental Health Intervention Research Center, University of Pittsburgh School of Medicine, PA 15213, USA. · Am J Psychiatry. · Pubmed #14702243 links to  free full text

Abstract: Insomnia and depression are common problems with profound public health consequences. When left untreated, both conditions have high rates of persistence and recurrence. Maintenance treatment for depression is fairly well established, but there is no evidence-based consensus regarding the safety and efficacy of maintenance therapy for insomnia. Consequently, long-term treatment of insomnia is driven primarily by the individual choices of patients and their clinicians. This article compares and contrasts the current state of research in the maintenance therapy of depression and insomnia and highlights gaps in the insomnia literature.

Lenhart SE, Buysse DJ. · Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA 15213-2582, USA. · Ann Pharmacother. · Pubmed #11724098 No free full text.

Abstract: OBJECTIVE: To provide recommendations for the short-term management of insomnia in hospitalized patients and review patient assessment, nonpharmacologic treatment modalities, and selection of hypnotic medications. DATA SOURCES: Review articles and primary literature representative of current knowledge regarding the treatment of insomnia were identified by MEDLINE search (1966-January 2001). Search terms included insomnia (sleep initiation and maintenance disorders), benzodiazepines, zaleplon, zolpidem, and trazodone. DATA SYNTHESIS: Literature regarding the management of insomnia in hospitalized patients is limited; therefore, data pertinent to the treatment of ambulatory patients must be extrapolated to the inpatient setting. When evaluating insomnia in hospitalized patients, it seems reasonable to obtain a thorough history and physical examination to identify potential underlying etiologies. Treatment of these underlying etiologies should be considered. When the use of a sedative-hypnotic agent is necessary, medication and dose selection should be based on the pharmacokinetic and adverse effect profiles of each agent. Patent-specific characteristics should also be considered to provide effective treatment while minimizing adverse effects. CONCLUSIONS: Nonpharmacologic approaches to the treatment of insomnia should be considered for hospitalized patients. When sedative-hypnotic medications must be administered, the pharmacokinetic profile of intermediate-acting benzodiazepines (e.g., lorazepam, temazepam) makes them good first-line agents. Zaleplon and zolpidem are also attractive hypnotic agents; however, they are typically reserved for second-line therapy due to cost. Trazodone may be an alternative for patients unable to take benzodiazepines.

Nowell PD, Buysse DJ. · Psychiatry Department, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756, USA. · Depress Anxiety. · Pubmed #11568978 No free full text.

Abstract: Mood disorders and chronic insomnia share complex theoretical and clinical relationships. This article reviews the subjective symptoms and polysomnographic findings of subjects with mood and insomnia syndromes. The polysomnographic findings reviewed include macro-architectural and micro-architectural data. Various treatments of patients with insomnia and mood disorders will be presented, including both behavioral and pharmacological interventions.

Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. · Université Laval, Ecole de Psychologie, Ste-Foy, Quebec, Canada. · Sleep. · Pubmed #10617176 No free full text.

Abstract: This paper reviews the evidence regarding the efficacy of nonpharmacological treatments for primary chronic insomnia. It is based on a review of 48 clinical trials and two meta-analyses conducted by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on non-drug therapies for the clinical management of insomnia. The findings indicate that nonpharmacological therapies produce reliable and durable changes in several sleep parameters of chronic insomnia sufferers. The data indicate that between 70% and 80% of patients treated with nonpharmacological interventions benefit from treatment. For the typical patient with persistent primary insomnia, treatment is likely to reduce the main target symptoms of sleep onset latency and/or wake time after sleep onset below or near the 30-min criterion initially used to define insomnia severity. Sleep duration is also increased by a modest 30 minutes and sleep quality and patient's satisfaction with sleep patterns are significantly enhanced. Sleep improvements achieved with these behavioral interventions are sustained for at least 6 months after treatment completion. However, there is no clear evidence that improved sleep leads to meaningful changes in daytime well-being or performance. Three treatments meet the American Psychological Association (APA) criteria for empirically-supported psychological treatments for insomnia: Stimulus control, progressive muscle relaxation, and paradoxical intention; and three additional treatments meet APA criteria for probably efficacious treatments: Sleep restriction, biofeedback, and multifaceted cognitive-behavior therapy. Additional outcome research is needed to examine the effectiveness of treatment when it is implemented in clinical settings (primary care, family practice), by non-sleep specialists, and with insomnia patients presenting medical or psychiatric comorbidity.

Germain A, Shear MK, Hall M, Buysse DJ. · Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA. · Behav Res Ther. · Pubmed #16777060 No free full text.

Abstract: OBJECTIVE: Sleep disturbances are a core feature of post-traumatic stress disorder (PTSD), and are often resistant to first-line pharmacological and psychological PTSD interventions. The goal of this pilot study was to explore the effects of a very brief intervention for PTSD-related nightmares and insomnia in victims of violent crimes with PTSD. METHODS: Seven adult victims of violent crimes with a current diagnosis of PTSD received a single, 90-min intervention session that used cognitive-behavioral techniques aimed at reducing post-traumatic nightmares and insomnia. Sleep diary measures, and measures of sleep quality, PTSD severity, anxiety, and depression were completed at baseline and 6 weeks post-intervention. RESULTS: Improvements in self-report and sleep diary measures of sleep quality and dream frequency were observed post-intervention. Clinically meaningful reductions in daytime PTSD symptom severity were also observed. CONCLUSIONS: A very brief behavioral intervention targeting post-traumatic nightmares and insomnia was associated with significant improvements in sleep and daytime PTSD symptom severity. Brief sleep-focused intervention may be helpful adjuncts to first-line PTSD treatments.

Hoch CC, Reynolds CF, Buysse DJ, Monk TH, Nowell P, Begley AE, Hall F, Dew MA. · The Intervention Research Center for Late Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA. · J Gerontol B Psychol Sci Soc Sci. · Pubmed #11192338 No free full text.

Abstract: We tested two interventions for improving sleep consolidation and depth in normal elderly participants: a modification of sleep-restriction therapy and sleep-hygiene education. Twenty-one elderly participants without sleep disorders were randomized to sleep hygiene plus bed restriction (i.e., restricting time in bed by 30 minutes nightly for one year) or to sleep hygiene alone. Participants in the bed-restriction group showed a median increase in sleep efficiency of 6.1% versus 1.8% in participants receiving sleep hygiene instruction, and an increase in allnight delta EEG power. Self-reported mood on awakening in the morning showed greater improvement over the first eight weeks in the sleep-hygiene condition. The use of sleep hygiene was associated with initial improvement in daytime well-being, whereas bed restriction led to sustained improvements in sleep continuity and sleep depth.

Nowell PD, Reynolds CF, Buysse DJ, Dew MA, Kupfer DJ. · Sleep and Chronobiology Center, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213, USA. · J Clin Psychiatry. · Pubmed #10084634 No free full text.

Abstract: BACKGROUND: Primary insomnia is a persistent and recurrent disorder as well as a risk factor for depression. The goal of this study was to determine whether paroxetine, a nonsedating antidepressant, would be effective in the treatment of patients with primary insomnia. METHOD: Fifteen patients meeting DSM-IV criteria for primary insomnia received paroxetine at bedtime for 6 weeks in an open, flexible-dose trial (median dose = 20 mg). Patients were assessed with daily sleep diaries, baseline and treatment polysomnography, and weekly standardized clinical evaluations. RESULTS: Of the 14 patients who completed the study (1 dropped out owing to side effects), 11 improved with treatment, and 7 of these 11 no longer met diagnostic criteria for insomnia. Although self-reported sleep quality (measured by the Pittsburgh Sleep Quality Index) and daytime well-being (measured by the Profile of Mood States) improved with treatment, the quantity of sleep, measured by diary and by polysomnography, did not change consistently with these improvements. Power spectral analysis suggested that paroxetine treatment may be associated with decreases in power in frequencies within the delta and alpha frequency ranges. CONCLUSION: These results support the effectiveness of paroxetine in the acute treatment of primary insomnia. Further evaluation with controlled and longitudinal designs is warranted.

Okun ML, Kravitz HM, Sowers MF, Moul DE, Buysse DJ, Hall M. · University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA 15213, USA. · J Clin Sleep Med. · Pubmed #19317380 No free full text.

Abstract: STUDY OBJECTIVES: The objective was to psychometrically evaluate the Insomnia Symptom Questionnaire (ISQ), a self-report instrument designed to establish a clinically relevant case definition of insomnia consistent with widely used insomnia classification criteria, using methods from classical test theory and item response theory (IRT). METHODS: The ISQ was evaluated using IRT algorithms in a cohort of 362 pre-, peri- and post-menopausal women recruited for the SWAN (Study of Women's Health Across the Nation) Sleep Study. This yielded a dichotomous outcome consistent with the presence/absence of insomnia. The internal consistency and criterion validity of the dichotomized ISQ were compared to traditional measures of sleep from sleep diaries, polysomnography, and the Pittsburgh Sleep Quality Index using kappa statistics, and indices of sensitivity, specificity, positive and negative predictive value (PPV), and likelihood ratio tests (LRs). RESULTS: The ISQ identified 9.8% of the sample as meeting insomnia, consistent with established diagnostic criteria. Reliability was established with Cronbach alpha (alpha = 0.89). The ISQ had high specificity (> 90%), but sensitivity, PPV, NPV, and LRs varied according to which sleep measure was used. Concurrent validity was not confirmed with any of the traditional sleep summary measures (kappas < 0.30). CONCLUSIONS: The ISQ captures the multidimensionality of insomnia better than traditional sleep measures as it ascertains symptoms of insomnia that are based on DSM-IV and RDC criteria. The high specificities suggest that the ISQ has a high probability of correctly identifying those without insomnia and would be a cost-effective tool in large observational studies in which the prevalence of insomnia is likely to be about 10%. Further evaluation of the ISQ, including validation against clinical interviews, is warranted.

Nebes RD, Buysse DJ, Halligan EM, Houck PR, Monk TH. · Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA. · J Gerontol B Psychol Sci Soc Sci. · Pubmed #19204069 No free full text.

Abstract: This study examined the relation between sleep quality and cognitive performance in older adults, controlling for common medical comorbidities. Participants were community volunteers who, while not selected on the basis of their sleep, did report substantial variability in sleep quality. Good and poor sleepers differed on tests of working memory, attentional set shifting, and abstract problem solving but not on processing speed, inhibitory function, or episodic memory. Poor sleep was also associated with increased depressive symptomatology but only for functional symptoms (e.g., decreased concentration) and not for mood (e.g., sadness). The relationships between sleep quality and cognition were not explained by confound factors such as cerebrovascular disease, depression, or medication usage. Sleep problems may contribute to performance variability between elderly individuals but only in certain cognitive domains.

Hall MH, Matthews KA, Kravitz HM, Gold EB, Buysse DJ, Bromberger JT, Owens JF, Sowers M. · Department of Psychiatry University of Pittsburgh, Pittsburgh, PA 15213, USA. · Sleep. · Pubmed #19189781 links to  free full text

Abstract: STUDY OBJECTIVES: To examine racial differences in sleep in a large cohort of midlife women and to evaluate whether indices of socioeconomic status (SES) are associated with racial differences in sleep. DESIGN: Cross-sectional study. SETTING: Participants' homes. PARTICIPANTS: Caucasian (n=171), African American (n=138) and Chinese women (n=59). INTERVENTIONS: None. MEASUREMENTS: Sleep quality was assessed with the Pittsburgh Sleep Quality Index. Polysomnographically assessed sleep duration, continuity, architecture, and NREM electroencephalograhic (EEG) power were calculated over multiple nights. Sleep disordered breathing and periodic leg movements were measured on a separate night. Linear regression analysis was used to model the independent and synergistic effects of race and SES on sleep after adjusting for other factors that impact sleep in midlife women. Indices of SES were self-reported educational attainment and financial strain. RESULTS: Sleep was worse in African American women than Caucasian participants as measured by self-report, visual sleep stage scoring, and NREM EEG power. Slow wave sleep differences were also observed between Chinese and Caucasian participants. Racial differences persisted after adjustment for indices of SES. Although educational attainment was unrelated to sleep, financial strain was associated with decreased sleep quality and lower sleep efficiency. Financial strain-by-race interactions were not statistically significant, suggesting that financial strain has additive effects on sleep, independent of race. CONCLUSIONS: Independent relationships between race and financial strain with sleep were observed despite statistical adjustment for other factors that might account for these relationships. Results do not suggest that assessed indices of SES moderate the race-sleep relationship, perhaps due to too few women of low SES in the study.

Troxel WM, Buysse DJ, Hall M, Matthews KA. · Department of Psychiatry, University of Pittsburgh. · Behav Sleep Med. · Pubmed #19116797 No free full text.

Abstract: Previous research suggests that divorced individuals, particularly women, have higher rates of sleep disturbances as compared to married individuals. Among the married, however, little is known about the association between relationship quality and sleep. The present study examined the association between marital happiness and self-reported sleep disturbances in a sample of midlife women drawn from the Study of Women's Health Across the Nation (SWAN), a multi-site, multi-ethnic, community-based study (N = 2,148). Marital happiness was measured using a single item from the Dyadic Adjustment Scale, and sleep disturbance was assessed using 4 items from the Women's Health Initiative Insomnia Rating Scale (WHIIRS). After controlling for relevant covariates, maritally happy women reported fewer sleep disturbances, with the association evident among Caucasian women and to a lesser extent among African American women.

Buysse DJ, Germain A, Hall ML, Moul DE, Nofzinger EA, Begley A, Ehlers CL, Thompson W, Kupfer DJ. · Neuroscience Clinical and Translational Research Center and Sleep Medicine Institute, University ofPittsburgh School ofMedicine, Pittsburgh, PA, USA. · Sleep. · Pubmed #19090323 links to  free full text

Abstract: STUDY OBJECTIVES: To compare NREM EEG power in primary insomnia (PI) and good sleeper controls (GSC), examining both sex and NREM period effects; to examine relationships between EEG power, clinical characteristics, and self-reports of sleep. DESIGN: Overnight polysomnographic study. SETTING: Sleep laboratory. PARTICIPANTS: PI (n=48; 29 women) and GSC (n=25; 15 women). INTERVENTIONS: None. MEASUREMENTS: EEG power from 1-50 Hz was computed for artifact-free sleep epochs across four NREM periods. Repeated measures mixed effect models contrasted differences between groups, EEG frequency bands, and NREM periods. EEG power-frequency curves were modeled using regressions with fixed knot splines. RESULTS: Mixed models showed no significant group (PI vs. GSC) differences; marginal sex differences (delta and theta bands); significant differences across NREM periods; and group*sex and group*NREM period interactions, particularly in beta and gamma bands. Modeled power-frequency curves showed no group difference in whole-night NREM, but PI had higher power than GSC from 18-40 Hz in the first NREM period. Among women, PI had higher 16 to 44-Hz power than GSC in the first 3 NREM periods, and higher 3 to 5-Hz power across all NREM periods. PI and GSC men showed no consistent differences in EEG power. High-frequency EEG power was not related to clinical or subjective sleep ratings in PI. CONCLUSIONS: Women with PI, but not men, showed increased high-frequency and low-frequency EEG activity during NREM sleep compared to GSC, particularly in early NREM periods. Sex and NREM period may moderate quantitative EEG differences between PI and GSC.

Dombrovski AY, Cyranowski JM, Mulsant BH, Houck PR, Buysse DJ, Andreescu C, Thase ME, Mallinger AG, Frank E. · Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. · Depress Anxiety. · Pubmed #18781665 links to  free full text

Abstract: BACKGROUND: Even low levels of residual symptoms are known to increase the risk of relapse and early recurrence of major depression. It is not known if ongoing psychotherapy lessens this risk. We therefore examined the impact of persistent symptoms, including mood, insomnia, and anxiety symptoms, on time to recurrence in women receiving maintenance interpersonal psychotherapy (IPT-M) for recurrent depression. METHODS: We analyzed data on 131 women aged 20-60 from a 2-year randomized trial of weekly versus twice-monthly versus monthly IPT-M. Participants achieved remission with IPT alone (n=99) or IPT plus sequential antidepressant medication (n=32). Medications were tapered before starting maintenance treatment. Residual symptoms were assessed with the Hamilton Rating Scale for Depression (HRSD; total score and subscales); insomnia was also assessed in 76 women with the Pittsburgh Sleep Quality Index (PSQI). Data analyses used Cox proportional hazards regression models. RESULTS: Neither overall burden of residual symptoms (HRSD total score), nor HRSD mood and anxiety subscale scores predicted recurrence during ongoing IPT-M. In contrast, persistent insomnia measured both by the HRSD-17 insomnia subscale and the PSQI predicted recurrence. Women with persistent insomnia who required sequential pharamacotherapy had the highest recurrence rate (65%) compared to women requiring sequential treatment without insomnia (13%), or women who had recovered with IPT alone but had persistent insomnia (21%) or no insomnia (18%). CONCLUSIONS: Persistent insomnia following the recovery from an episode of recurrent major depression is associated with increased risk of recurrence despite maintenance psychotherapy, particularly for those withdrawn from antidepressant medication.

Buysse DJ. · Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. · Am J Psychiatry. · Pubmed #18519533 links to  free full text

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Mezick EJ, Matthews KA, Hall M, Strollo PJ, Buysse DJ, Kamarck TW, Owens JF, Reis SE. · Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. · Psychosom Med. · Pubmed #18480189 No free full text.

Abstract: OBJECTIVE: To examine the independent and interactive effects of race and socioeconomic status (SES) on objective indices and self-reports of sleep. METHODS: The sleep of 187 adults (41% black; mean age = 59.5 +/- 7.2 years) was examined. Nine nights of actigraphy and two nights of inhome polysomnography (PSG) were used to assess average sleep duration, continuity, and architecture; self-report was used to assess sleep quality. Psychosocial factors, health behaviors, and environmental factors were also measured. RESULTS: Blacks had shorter sleep duration and lower sleep efficiency, as measured by actigraphy and PSG, and they spent less time proportionately in Stage 3-4 sleep, compared with others (p < .01). Lower SES was associated with longer actigraphy-measured latency, more wake after sleep onset as measured by PSG, and poorer sleep quality on the Pittsburgh Sleep Quality Index (p < .05). CONCLUSIONS: Blacks and perhaps individuals in lower SES groups may be at risk for sleep disturbances and associated health consequences.