Arousal/physiology; Circadian Rhythm/physiology; Depressive Disorder/complications/physiopathology; Disorders of Excessive Somnolence/diagnosis/etiology/therapy; Humans
Abstract :
[en] The complaint of excessive daytime sleepiness (EDS), commonly encountered in clinical practice, may arise from a variety of psychiatric disorders, most importantly depression. Even though EDS frequently leads depressed patients to seek medical assistance, it is commonly under-evaluated and under-diagnosed. Therefore, a comprehensive understanding and management of EDS is essential in the clinical assessment of depression. Within a theoretical framework, a chronobiological approach may shed new light on the complex interaction of EDS and depression. In this review, studies on EDS and depression are summarized and discussed within the context of circadian and sleep regulatory mechanisms. Furthermore, potential chronobiological therapeutic strategies are proposed to address some of the unmet needs in the treatment of EDS and depression.
Fava M. Daytime sleepiness and insomnia as correlates of depression. J Clin Psychiatry 65 (2004) 27-32
Young T.B. Epidemiology of daytime sleepiness: definitions, symptomatology and prevalence. J Clin Psychiatry 65 (2004) 12-16
Colt H.G., Haas H., and Rich G.B. Hypoxemia vs sleep fragmentation as cause of EDS in obstructive sleep apnea. Chest 100 (1992) 1542-1548
Breslau N., Roth T., Rosenthal L., and Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry 39 (1996) 411-418
Hublin C., Kapiro J., Partinen M., Heikkilä K., and Koskenvuo M. Daytime sleepiness in an adult Finnish population. J Intern Med 239 (1996) 417-423
Ohayon M.M., and Roth T. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiat Res 37 (2003) 9-15
Breslau N., Roth T., Rosenthal L., and Andreski P. Daytime sleepiness: an epidemiological study of young adults. Am J Public Health 87 (1997) 1649-1653
Tylee A., Gastpar M., Lepine J.P., and Mendlewicz J. DEPRESS II (Depression Research in European Society II): a patient survey of the symptoms, disability and current management of depression in the community. DEPRESS Steerling Committee. Int Clin Psychopharmacol 14 (1999) 139-151
Wirz-Justice A. Chronobiology and mood disorders. Dialog Clin Neurosci 5 (2003) 315-325
Cano-Lozano M.C., Espinosa-Fernandez L., Miro E., and Buela-Casal G. A review of sleep disorders in depression. Rev Neurol 36 (2003) 366-375
Wirz-Justice A. Circadian disturbances in depression: therapeutic perspectives. Medicographia 25 (2003) 29-36
Stokes P.E. The potential role of excessive cortisol induced by HPA hyperfunction in the pathogenesis of depression. Eur Neuropsychopharmacol 5 (1996) 77-82
Schule C., Baghai T., Zwanzger P., Minov C., Padberg F., and Rupprecht R. Sleep deprivation and hypothalamic-pituitary-adrenal (HPA) axis activity in depressed patients. J Psychiatr Res 35 (2001) 239-247
Post R.M. Adjunctive strategies in the treatment of refractory bipolar depression: clinician options in the absence of a systematic database. Pharmacotherapy 6 (2005) 531-546
Duncan W.C. Circadian rhythms and the pharmacology of affective illness. Pharamacol Ther 71 (1996) 253-312
Nagayama H. Chronic administration of imipramine and lithium changes the phase-angle relationship between activity and core body temperature circadian rhythms. Chronobiol Int 13 (1996) 251-259
Abe M., Herzog E.D., and Block G.D. Lithium lengthens the circadian period of individual suprachiasmatic nucleus neurons. Neuroreport 28 11 (2000) 3261-3264
Ohayon M.M., Caulet M., and Philip P. How sleep and mental disorders are related to daytime sleepiness. Arch Intern Med 157 (1997) 2645-2652
National Institutes of Health State of the Science State Conference. Sleep 2005;28:1049-1057.
Guilleminault C., and Brooks S.N. EDS - a challenge for the practising neurologist. Brain 124 (2001) 1482-1491
Bixler E.O., Vgontzas A.N., Lin H.M., Calhoun S.L., Vela-Bueno A., and Kales A. EDS in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endoc Metabol 90 (2005) 4510-4515
Bittencourt L.R.A., Silva R.S., Santos R.F., Pires M.L.N., and Mello M.T. Excessive daytime sleepiness. Rev Bras Psiquiatr 27 (2005) 16-21
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV-TR). Washington (DC): American Psychiatric Press; 2000.
Chellappa S.L., and Araújo J.F. EDS in patients with depressive disorder. Rev Bras Psiquiatr 28 (2006) 126-130
Chellappa S.L., and Araujo J.F. Sleep disorders and suicidal ideation in patients with depressive disorder. Psychiatr Res 153 (2007) 131-136
In: Schmidtke A., Bille-Brahe U., De Leo D., Kerkhof A., and Wasserman D. (Eds). Suicidal behaviour in Europe: results from the WHO/EURO Multicentre Study on Suicidal Behaviour (2001), Hogrefe & Huber, Göttingen, Germany
Van Heeringen K. The neurobiology of suicide and suicidality. Can J Psychiatry 48 (2003) 292-300
Ohayon M.M. The effects of breathing-related sleep disorders on mood disturbances in the general population. J Clin Psychiatry 64 (2003) 1195-2000
Sharafkhaneh A., Giray N., Richardson P., Young T., and Hirshkowitz M. Association of psychiatric disorders and sleep apnea in a large cohort. Sleep 28 (2005) 1405-1411
Schuster S.R., Tabba M., and Sahota P. Relationship between the cardiometabolic syndrome and obstructive sleep apnea. J Cardio Metabolic Syndrome 1 (2006) 204-208
Schröder C.M., and O'Hara R. Depression and obstructive sleep apnea (OSA). Ann Gen Psychiatry 4 (2005) 13 doi:10.1186/1744-859X-4-13
Gami A.S., and Somers V.K. Obstructive sleep apnea, metabolic syndrome, and cardiovascular outcomes. Eur Heart J 25 (2004) 709-711
Lett H.S., Blumenthal J.A., Babyak M.A., Sherwood A., Strauman T., Robins C., et al. Depression as a risk factor for coronary artery disease: evidence mechanisms and treatment. Psychosom Med 66 (2004) 305-315
Raikkonen K., Matthews K.A., and Kuller L.H. The relationship between psychological risk attributes and the metabolic syndrome in healthy women: antecedent or consequence?. Metabolism 51 (2002) 1573-1577
McCaffery J.M., Niaura R., Todaro J.F., Swan G.E., and Carmelli D. Depressive symptoms and metabolic risk in adult male twins enrolled in the National Heart, Lung, and Blood Institute twin study. Psychosom Med 65 (2003) 490-497
Ramasubbu R. Insulin resistance: a metabolic link between depressive disorder and atherosclerotic vascular diseases. Med Hypotheses 59 (2002) 537-551
Wirz-Justice A., and Van den Hoofdakker R.H. Sleep deprivation in depression: what do we know, where do we go?. Biol Psychiatry 46 (1999) 445-453
Boivin D.B. Influence of sleep-wake and circadian rhythm disturbances in psychiatric disorders. J Psychiatry Neurosci 25 (2000) 446-458
Murray G. Diurnal mood variation in depression: a signal of disturbed circadian function?. J Affect Disord 102 (2007) 47-53
Van den Hoofdakker R.H. Chronobiological theories of nonseasonal affective disorders and their implications for treatment. J Biol Rhythms 9 (1994) 157-183
Gordijn M.C.M., Beersma D.G.M., Bouhuys A.L., Reinink E., and Van den Hoofdakker R.H. A longitudinal study of diurnal mood variation in depression: characteristics and significance. J Affect Disord 31 (1994) 261-273
Ohayon M.M. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6 (2000) 97-111
Thase M.E., Fasicka A.L., Berman S.R., Simon A.D., and Reynolds C.F. Electroencephalographic sleep profiles in single-episode and recurrent unipolar forms of major depression: comparison during acute depressive states. Biol Psychiatry 38 (1995) 99-108
Riemann D., Berger M., and Voderholzer U. Sleep and depression - results from psychobiological studies: an overview. Biol Psychology 57 (2001) 67-103
Lewy A.J., Lefler B.J., Emens J.S., and Bauer V.K. The circadian basis of winter depression. Proc Nat Acad Sciences 103 (2006) 7414-7419
Bouhuys A.L. Towards a model of mood responses to sleep deprivation in depressed patients. Biol Psychiatry 29 (1991) 600-612
Berger M., Vollmann J., Hohagen F., Konig A., Lohner H., Voderholzer U., et al. Sleep deprivation combined with consecutive sleep phase advance as a fast-acting therapy in depression: an open pilot trial in medicated and unmedicated patients. Am J Psychiatry 154 (1997) 870-872
Steiger A. Sleep and the hypothalamo-pituitary-adrenocortical system. Sleep Med Rev 6 (2002) 125-138
Miller A.H. Hypothyroidism in major depression: relevance to pathophysiology and treatment. Biol Psychiatry 49 (2001) 391-404
Cajochen C., Kräuchi K., and Wirz-Justice A. Role of melatonin in the regulation of human circadian rhythms and sleep. J Neuroendocrinol 15 (2003) 432-437
Lewy A.J. Clinical applications of melatonin in circadian disorders. Dialogues Clin Neurosci 5 (2003) 399-413
Wefelmeyer T., and Kuhs H. Diurnal mood variation in melancholic patients and healthy controls. Psychopathology 29 (1996) 184-192
Phillips M.L., Drevets W.C., Rauch S.L., and Lane R. Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biol Psychiatry 54 (2003) 504-514
Buysse D.J., Nofzinger E.A., Germain A., Meltzer C.C., Wood A., and Ombao H. Regional brain glucose metabolism during morning and evening wakefulness in humans: preliminary findings. Sleep 27 (2004) 1245-1254
Germain A., Nofzinger E.A., Meltzer C.C., Wood A., Kupfer D.J., Moore R.Y., and Buysse D.J. Diurnal variation in regional brain glucose metabolism in depression. Biol Psychiatry 62 (2007) 438-445
Klein D.C., Moore R.Y., and Reppert S.M. Suprachiasmatic nucleus: the mind's clock (1991), Oxford University Press, New York
Berson D.M., Dunn F.A., and Takao M. Phototransduction by retinal ganglion cells that set the circadian clock. Science 295 (2002) 1070-1073
Provencio I., Rodriguez I.R., Jiang G., Hayes W.P., Moreira E.F., and Rollag M.D. A novel human opsin in the inner retina. J Neurosci 20 (2000) 600-605
Schibler U., Ripperger J., and Brown S.A. Peripheral circadian oscillators in mammals: time and food. J Biol Rhythms 18 (2003) 250-260
Borbely A.A., and Wirz-Justice A. Sleep, sleep deprivation and depression. Human Neurobiol 1 (1982) 205-210
Daan S., Beersma D.G.M., and Borbely A.A. Timing of human sleep: recovery process gated by a circadian pacemaker. Am J Physiol Regul Integr Comp Physiol 246 (1984) 161-183
Wirz-Justice A. Biological rhythm disturbances in mood disorders. Int Clin Psychopharmacol 21 (2006) S11-S15
Boivin D.B., Czeisler C.A., Dijk D.J., Duffy J.F., Folkard S., Minors D.S., et al. Complex interaction of the sleep-wake cycle and circadian phase modulates mood in healthy subjects. Arch Gen Psychiatry 54 (1997) 145-152
Wehr T.A., and Wirz-Justice A. Internal coincidence model for sleep deprivation and depression. In: Koella W.P. (Ed). Sleep (1981), Basel, Karger
Duffy J.F., and Dijk D.J. Getting through to circadian oscillators: why use constant routines?. J Biol Rhythms 17 (2002) 4-13
Dijk D.J., Shanahan T.L., Duffy J.F., Ronda J.M., and Czeisler C.A. Variation of electroencephalographic activity during non-rapid eye movement and rapid eye movement sleep with phase of circadian melatonin rhythm in humans. J Physiol 505 (1997) 851-858
Koorengevel K.M., Beersma D.G., den Boer J.A., and van den Hoofdakker R.H. Mood regulation in seasonal affective disorder patients and healthy controls studied in forced desynchrony. Psychiatry Res 117 (2003) 57-74
Cajochen C., Khalsa S.B.S., Wyatt J.K., Czeisler C.A., and Dijk D.J. EEG and ocular correlates of circadian melatonin phase and human performance decrements during sleep loss. Am J Physiol Regul Integr Comp Physiol 277 (1999) 640-649
Dahl K., Avery D.H., Lewy A.J., Savage M.V., Brengelmann G.L., Larsen L.H., et al. Dim light melatonin onset and circadian temperature during a constant routine in hypersomnic winter depression. Acta Psychiatr Scand 88 (1993) 60-66
Buysse D.J., Monk T.H., Kupfer D.J., Frank E., and Stapf D. Circadian patterns of unintended sleep episodes during a constant routine in remitted depressed patients. J psychiat Res 29 (1995) 407-416
Wirz-Justice A., Kräuchi K., Brunner D.P., Graw P., Haug H.J., Leonardt G., et al. Circadian rhythms and sleep regulation in seasonal affective disorder. Acta Neuropsychiatr 7 (1995) 41-43
Avery D.H., Larsen L.H., Prinz P.N., Dahl K., Savage M.V., and Brengelmann G.L. Circadian temperature and cortisol rhythms a constant routine are phase-delayed in hypersomnic winter depression. Biol Psychiatry 41 (1997) 1109-1123
Koorengevel K.M., Beersma D.G., den Boer J.A., and van den Hoofdakker R.H. A forced desynchrony study of circadian pacemaker characteristics in seasonal affective disorder. J Biol Rhythms 17 (2002) 463-475
McCarley R.W. Sleep neurophysiology: basic mechanisms underlying control of wakefulness and sleep. In: Chokroverty S. (Ed). Sleep disorders medicine: basic science technical considerations and clinical aspects. 2nd ed (1999), Butterworth-Heinemann, Boston 21-50
Saper C.B., Chou T.C., and Scammell T.E. The sleep switch: hypothalamic control of sleep and wakefulness. Trends Neurosci 24 (2001) 726-731
Lam R.W., Tam E.M., Yatham L.N., Shiah I.S., and Zis A.P. Seasonal depression: the dual vulnerability hypothesis revisited. J Affect Disord 63 (2001) 123-132
Southmayd S.E., Cairns J., and David M.M. Sleep disturbance in depression reconsidered. Can J Psychiatry 36 (1991) 366-373
Vgontzas A.N., Bixler E.O., Kales A., Criley C., and Vela-Bueno A. Differences in nocturnal and daytime sleep between primary and psychiatric hypersomnia: diagnostic and treatment Implications. Psychosomatic Med 62 (2000) 220-226
Guilleminault C., Stoohs R., Clerk A., Cetel M., and Maistros P. A cause of excessive daytime. Sleep 104 (1993) 781-787
Gupta R.M. Approach to the sleepy patient. Med Health 85 (2002) 86-89
Pigeon W.R., Sateia M.J., and Ferguson R.J. Distinguishing between EDS and fatigue: toward improved detection and treatment. J. Psychosom Res 54 (2003) 61-69
Dorrian J., Rogers N., and Dinges D. Psychomotor vigilance performance: neurocognitive assay sensitive to sleep loss. Sleep deprivation: clinical issues, pharmacology and sleep loss effects (2005), Marcel Dekker, New York
Hoddes E., Dement W., and Zarcone V. The development and use of the Stanford sleepiness scale. Psychophysiology 9 (1972) 150
Akerstedt T. Wide awake at odd hours (1996), Swedish Council for Work Life Research, Stockholm
Johns M.W. Sleepiness in different situations measured with the Epworth Sleepiness Scale. Sleep 17 (1991) 703-710
Blatter K., and Cajochen C. Circadian rhythms in cognitive performance: methodological constraints, protocols, theoretical underpinnings. Physiol Behavior 90 (2007) 196-208
Carskadon M.A., Dement W.C., Mitler M.M., Roth T., Westbrook P.R., and Keenan S. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep 9 (1986) 519-524
Cajochen C., Brunner D.P., Krauchi K., Graw P., and Wirz-Justice A. EEG and subjective sleepiness during extended wakefulness in seasonal affective disorder: circadian and homeostatic influences. Biol Psychiatry 47 (2000) 610-617
Terman M., and Terman J.S. Bright light therapy: side effects and benefits across the symptom spectrum. J Clin Psychiatry 60 (1999) 799-808
Even C., Schröder C.M., Friedman S., and Rouillon F. Efficacy of light therapy in nonseasonal depression: a systematic review. J Affect Disord (2007) doi:10.1016/j.jad.2007.09.008.
Wirz-Justice A., Benedetti F., Berger M., Lam R.W., Martiny K., Terman M., et al. Chronotherapeutics (light and wake therapy) in affective disorders. Psychol Medicine 35 (2005) 939-944
Giedke H., and Schwarzler F. Therapeutic use of sleep deprivation in depression. Sleep Med Rev 6 (2002) 361-377
Benedetti F., Barbini B., and Fulgosi M.C. Combined total sleep deprivation and light therapy in the treatment of drug-resistant bipolar depression: acute response and long-term remission rates. J Clin Psychiatry 66 (2005) 1535-1540
Cajochen C. Alerting effects of light. Sleep Med Rev 11 (2007) 453-464
Loving R.T., Kripke D.F., and Shuchter S.R. Bright light augments antidepressant effects of medication and wake therapy. Depress Anxiety 16 (2002) 1-3
Lam R.W., and Levitan R.D. Pathophysiology of seasonal affective disorder: a review. J Psychiatry Neurosci 25 (2000) 469-480
Martiny K., Lunde M., Unden M., Dam H., and Bech P. Adjunctive bright light in non-seasonal major depression: results from clinician-rated depression scales. Acta Psychiatr Scand 112 (2005) 117-125
Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression (Cochrane Review). In: The Cochrane Library, Chichester, UK: Wiley & Sons, Ltd.2004.
Berger M., Vollmann J., Hohagen F., Konig A., Lohner H., Voderholzer U., and Riemann D. Sleep deprivation combined with consecutive sleep phase advance as a fast-acting therapy in depression. Am J Psychiatry 154 (1997) 870-872
DeBatista C., Lambke A., and Solvason H.B. A prospective trial of modafinil as an adjunctive treatment of major depression. J Clin Psychopharmacol 24 (2004) 87-90
DeBatista C., Doghramji K., and Menza M.A. Adjuvant modafinil for the short-term treatment of fatigue and sleepiness in patients with major depressive disorder: A preliminary double-blind, placebo-controlled study. J Clin Psychiatry 64 (2003) 1057-1064
Loo H., D'haenen H., and Hale A. Determination of the dose of agomelatine, a melatoninergic agonist and selective 5-HT2c antagonist, in the treatment of major depressive disorder: a placebo-controlled dose range study. Int J Neuropsychopharmacol 17 (2002) 239-247
Cajochen C., Krauchi K., Mori D., Graw P., and Wirz-Justice A. Melatonin and S-20098 increase REM sleep and wake-up propensity without modifying NREM sleep homeostasis. Am J Physiol Regul Integr Comp Physiol 272 (1997) 1189-1196
Hamon M., and Bourgoin S. Pharmacological profile of antidepressants: a likely basis for their efficacy and side effects?. Eur Neuropsychopharmacol 16 (2006) 625-632
Brisbare-Roch C., Dingemanse J., Koberstein R., Hoever P., Aissaoui H., and Flores S. Promotion of sleep by targeting the orexin system in rats, dogs and humans. Nat Med 12 (2007) 150-155