Potential Maladaptive Sleep-Related Cognitions in Depression with Comorbid Hypersomnolence: An Exploratory Investigation

ABSTRACT

Objective/Background: Dysfunctional sleep-related cognitions (SRCs) have been demonstrated in both insomnia and depression, but have not been evaluated in patients experiencing depression with co-occurring hypersomnolence. Given the prominence of maladaptive thinking in depression with comorbid insomnia, dysfunctional SRCs may also exist in depressed persons experiencing hypersomnolence. Identifying potentially maladaptive SRCs may assist development of cognitive-behavioral strategies to alleviate hypersomnolence and its related impairment, particularly when comorbid with depression.

Participants: Twenty-two unmedicated persons with major depressive disorder (MDD) with comorbid hypersomnolence (MDD+/HYP+), as well as age- and sex-matched persons with MDD without hypersomnolence (MDD+/HYP-) and healthy controls (HC).

Methods: Participants completed the Dysfunctional Beliefs and Attitudes About Sleep–16-item (DBAS-16) and underwent overnight polysomnography. Groups were compared across clinical and sleep domains, as well as DBAS-16 global, subscale, and individual item scores. Additional analyses evaluated DBAS-16 components while controlling for depression severity.

Results: Groups significantly differed across all collected sleep and mood metrics consistent with diagnostic classification. MDD+/HYP+ DBAS-16 global score was significantly elevated, relative to HC, and was comparable to MDD+/HYP-. A DBAS-16 global score significant group effect was maintained while controlling for depression symptom severity, however only individual DBAS-16 items related to quantity and quality of sleep demonstrated particular relevance to MDD+/HYP+ compared to other groups.

Conclusions: Results suggest potentially maladaptive SRCs in MDD+/HYP+. Further efforts are needed to clarify whether these beliefs and attitudes about sleep in persons with hypersomnolence are in fact dysfunctional, as well as identify relevant content for development of a novel hypersomnolence-related SRC metric.

Acknowledgments

We would like to thank the participants whose data were utilized in this investigation. Additionally, we thank the members of Wisconsin Sleep for their assistance in the acquisition of these data.

Disclosure statement

Dr. Rumble currently receives grant support from Merck and has previously received grant support from NIH, both of which are unrelated to the current study. Dr. Plante received grant funding from American Sleep Medicine Foundation, the Brain and Behavior Research Foundation, and NIMH that supported this research. Additionally, Dr. Plante receives grant support from NIA, NINR, and the Madison Education Partnership, has received funding from the University of Illinois at Chicago Occupational and Environmental Health and Safety Education and Research Center/National Institute for Occupational Safety and Health; and has served as a consultant for Teva Australia and Jazz Pharmaceuticals, and served on medical advisory boards for Jazz Pharamecuticals, unrelated to the current study. Jesse Cook has served as a consultant to Bodymatter, Inc.

Role of funding source

There was no influence or involvement from the supporting funding sources in the collection, analyses, or interpretation of these data.

Additional information

Funding

This research was supported by grants to Dr. Plante from the American Sleep Medicine Foundation under Grant number [76-JF-12]; Brain and Behavior Research Foundation under Grant number [19193] and National Institute of Mental Health under Grant number [K23MH099234].