Risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression: A study on 703 individuals

ABSTRACT

Background: Since few studies have investigated the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression, the aim of this study was to examine this risk in a large sample of individuals with major depression. Methods: Data from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. High blood pressure status was defined by the presence of one of the following: self-reports at interview of either a physician-diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140 mmHg or an average diastolic blood pressure ≥90 mmHg during at least two medical examinations. Logistic regression analyses were conducted to examine the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression. Results: After adjustment for major confounding factors associated with high blood pressure, multivariate logistic regression analysis revealed that severe objective insomnia, low complaints of repeated nighttime awakenings or early morning awakening, and intermediate or low self-reported insomnia complaints were significant risk factors of high blood pressure in major depression. Conclusion: In major depression, severe objective insomnia and lower self-reported insomnia complaints are associated with higher risk of high blood pressure, which justifies a better management of objective insomnia and a better assessment of insomnia complaints in this particular subpopulation to avoid the negative consequences related to the co-occurrence of high blood pressure and major depression.

Abbreviations: AHI, Apnea-Hypopnea Index; BDI, Beck Depression Inventory; BMI, Body Mass Index; DSM IV-TR, Diagnostic and Statistical Manual of Mental Disorders fourth edition - Text Revision; ESS, Epworth Sleepiness scale; ISI, Insomnia Severity Index; HBP, High Blood Pressure; OSA, Obstructive Sleep Apnea Syndrome; REM, rapid eye movement sleep.

KEYWORDS:

• Major depression
• insomnia
• high blood pressure
• epidemiology
• risk factor

Highlights

• The prevalence of high blood pressure in major depression is 32.01%

• Objective insomnia is risk factors for high blood pressure in major depression

• Lower insomnia complaints are risk factors for high blood pressure in depression

• Insomnia must be adequately managed in major depression

Acknowledgments

I want to thank Christelle Bouchart (MD) for her support and the sleep laboratory team from the Erasmus Hospital for technical support.

Declarations

Ethics approval and consent to participate

This research protocol was approved by the Hospital and Medical School Ethics Committee of the Erasme Hospital (Brussels University Clinics) (Erasme Reference: P2017/119). At Erasme Hospital, all patients are informed that their data could be used retrospectively for scientific research. If patients do not wish for their data to be used, they must inform the hospital, at which time, this directive is indicated in their medical records, and any future use of their data is prohibited.

Consent for publication

Not applicable.

Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors have no conflicts of interest with the work carried out in this study.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Notes on contributors

Matthieu Hein

MH: principal investigator of the study with active participation in the encoding of data, statistical analysis, interpretation of results and writing of the article. JL: Active participation in the extraction and calculation of data from polysomnography for the realization of the database. GL: Support in the English translation of the manuscript and supervised the research work as a thesis promoter. PL: Support in drafting the manuscript and supervision of the research work as a thesis co-promoter. PH: Support in drafting the manuscript and supervision of research work as a member of the accompanying thesis committee. All authors read and approved the final manuscript.