Abstract：
Sleep difficulties increase the risk of current and future depression, but it is unclear if this relationship is causal.
Prospective cohort study of a community sample of men aged 70-89 years followed for up to 17 years. Initial assessments occurred between 2001 and 2004. Participants were followed until death or 31 December 2018. Patient Health Questionnaire (PHQ-9) ≥ 10 at subsequent waves of assessments (every 2-3 years) or the recorded diagnosis of a depressive disorder in the Western Australian Data Linkage System marked the onset of depression during follow up. We excluded from follow up men with prevalent depression. The systematic review of longitudinal studies examining the association between disrupted sleep and depression in later life followed PRISMA guidelines.
3441 of 5547 older men reported sleep difficulties at study entry. Current or past depression affected 437 of 5547 participants. Of the 4561 older men free of depression, 2693 reported sleep difficulties. The hazard ratio (HR) of incident depression among participants with sleep problems was 1.67 (95%CI = 1.39-2.00). Statistical adjustments for age, place of birth, education, smoking and physical frailty did not change the effect-size of this association. The systematic review identified another 14 studies, and the meta-analysis yielded an overall risk ratio of depression of 1.82 (95%CI = 1.69-1.97), although the overall quality of available evidence was sub-optimal.
Disrupted sleep increases the risk of depression in later life and this seems unlikely to be due to reverse causality. Older adults with sleep difficulties are legitimate targets of interventions to prevent depression.
Prospective cohort study of a community sample of men aged 70-89 years followed for up to 17 years. Initial assessments occurred between 2001 and 2004. Participants were followed until death or 31 December 2018. Patient Health Questionnaire (PHQ-9) ≥ 10 at subsequent waves of assessments (every 2-3 years) or the recorded diagnosis of a depressive disorder in the Western Australian Data Linkage System marked the onset of depression during follow up. We excluded from follow up men with prevalent depression. The systematic review of longitudinal studies examining the association between disrupted sleep and depression in later life followed PRISMA guidelines.
3441 of 5547 older men reported sleep difficulties at study entry. Current or past depression affected 437 of 5547 participants. Of the 4561 older men free of depression, 2693 reported sleep difficulties. The hazard ratio (HR) of incident depression among participants with sleep problems was 1.67 (95%CI = 1.39-2.00). Statistical adjustments for age, place of birth, education, smoking and physical frailty did not change the effect-size of this association. The systematic review identified another 14 studies, and the meta-analysis yielded an overall risk ratio of depression of 1.82 (95%CI = 1.69-1.97), although the overall quality of available evidence was sub-optimal.
Disrupted sleep increases the risk of depression in later life and this seems unlikely to be due to reverse causality. Older adults with sleep difficulties are legitimate targets of interventions to prevent depression.
摘要：
睡眠困难会增加当前和未来抑郁症的风险，但目前尚不清楚这种关系是否是因果关系。
对70-89岁男性社区样本进行前瞻性队列研究，随访长达17年。初步评估发生在2001年至2004年之间。参与者被随访至死亡或2018年12月31日。在随后的评估波（每2-3年）中，患者健康问卷（PHQ-9）≥10，或在西澳大利亚州数据链接系统中记录的抑郁症诊断标志着抑郁症的发作。我们排除了患有普遍抑郁症的男性。根据PRISMA指南，对纵向研究进行了系统评价，以检查晚年睡眠中断与抑郁之间的关系。
5547名老年男性中的3441人在进入研究时报告睡眠困难。当前或过去的抑郁症影响了5547名参与者中的437名。在4561名没有抑郁症的老年男性中，2693报告睡眠困难。有睡眠问题的参与者发生抑郁的风险比（HR）为1.67（95CI=1.39-2.00）。年龄的统计调整，出生地,教育,吸烟和身体虚弱并没有改变这种关联的效应大小.系统评价确定了另外14项研究，荟萃分析得出抑郁症的总体风险比为1.82（95CI=1.69-1.97），尽管现有证据的总体质量并不理想.
睡眠中断会增加晚年患抑郁症的风险，这似乎不太可能是由于反向因果关系。有睡眠困难的老年人是预防抑郁症的干预措施的合法目标。
对70-89岁男性社区样本进行前瞻性队列研究，随访长达17年。初步评估发生在2001年至2004年之间。参与者被随访至死亡或2018年12月31日。在随后的评估波（每2-3年）中，患者健康问卷（PHQ-9）≥10，或在西澳大利亚州数据链接系统中记录的抑郁症诊断标志着抑郁症的发作。我们排除了患有普遍抑郁症的男性。根据PRISMA指南，对纵向研究进行了系统评价，以检查晚年睡眠中断与抑郁之间的关系。
5547名老年男性中的3441人在进入研究时报告睡眠困难。当前或过去的抑郁症影响了5547名参与者中的437名。在4561名没有抑郁症的老年男性中，2693报告睡眠困难。有睡眠问题的参与者发生抑郁的风险比（HR）为1.67（95CI=1.39-2.00）。年龄的统计调整，出生地,教育,吸烟和身体虚弱并没有改变这种关联的效应大小.系统评价确定了另外14项研究，荟萃分析得出抑郁症的总体风险比为1.82（95CI=1.69-1.97），尽管现有证据的总体质量并不理想.
睡眠中断会增加晚年患抑郁症的风险，这似乎不太可能是由于反向因果关系。有睡眠困难的老年人是预防抑郁症的干预措施的合法目标。
