The relationship between subjective, objective sleep, anxiety and depression in patients with insomnia, parasomnias, sleep apnea syndrome: a comparative analysis

Abstract

Acknowledging the close relationship between anxiety, depression and sleep disorders, somnology suggests a number of mechanisms that explain it - models of comorbidity, catalysis or perpetuation of sleep disorders by anxiety and depression as well as the model of sleep disorders as 'chronic stress.' In many respects, studies are complicated by the difference in the links between objective and subjective sleep disorders with anxiety and depression. The aim of this paper is to study the relationship of objective and subjective sleep disorders with anxiety and depression in patients with chronic insomnia in comparison with patients with sleep apnea and parasomnias. The study involved 77 patients with sleep apnea, 18 patients with parasomnias, 105 patients with chronic insomnia. Patients filled the Hospital Anxiety and Depression Scale, the Epworth Sleepiness Scale, the Sleep Quality Chtcklist, the Sleep Apnea Screening Questionnaire, and most of the patients (46, 15, and 93, respectively) underwent polysomnographic examination overnight. The subjective poor well-being of patients with insomnia was determined not so much by their quality of sleep as by the subjective assessment of impaired daytime functioning and breathing during sleep. In patients with sleep apnea, anxiety and depression are also not associated with an objective apnea index, although to some extent associated with objective sleep difficulties (latent periods of falling asleep and deep sleep, lower sleep efficiency). However, as with insomnia, they are associated with a subjective assessment of impaired daytime functioning and breathing during sleep. After statistical control of objective sleep indicators, anxiety and depression in all three groups are associated with worse subjective sleep in general, although with regard to depression this relationship was stronger in patients with insomnia, compared to patients with sleep apnea.