Effect of the Interaction Between Depression and Sleep Disorders on Stroke Occurrence: A 17-Year Prospective Cohort Study in Korea
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초록
Objective Previous studies have provided inconclusive results on the association between depression and stroke risk, and the potential modifying effect of comorbid insomnia on this association remains unclear. Our study aimed to clarify the independent roles of depression and insomnia as risk factors for stroke and to investigate the possibility of an interaction effect between these two conditions on stroke incidence.Methods We used data from the Korean Genome and Epidemiology Study. The primary exposure was depression, measured by the Beck Depression Inventory. The secondary exposure was insomnia. The main outcome was the occurrence of stroke observed in biennial follow-up surveys. Cox proportional regression analysis was performed to estimate the effects of depression and insomnia on stroke incidence. We also conducted interaction analysis to investigate the interaction between depression and insomnia on stroke incidence.Results During 16 years of follow-up involving 3,301 individuals, we documented 172 cases of new-onset stroke (4.3 cases per 1,000 person-years). Cox proportional logistic regression analysis showed that severe depression significantly increased the risk of stroke (hazard ratio [HR]: 2.06, 95% confidence interval [CI]: 1.13–3.75), whereas mild and moderate depression did not increase this risk. Interaction analysis demonstrated that stroke risk was increased with only moderate (HR: 2.04, 95% CI: 1.04–4.00) and severe (HR: 3.01, 95% CI: 1.43–6.31) depression among individuals without insomnia.Conclusion Although general depression does not significantly increase stroke risk, moderate-to-severe depression may increase this risk, particularly in individuals without insomnia.
Abstract
Objective Previous studies have provided inconclusive results on the association between depression and stroke risk, and the potential modifying effect of comorbid insomnia on this association remains unclear. Our study aimed to clarify the independent roles of depression and insomnia as risk factors for stroke and to investigate the possibility of an interaction effect between these two conditions on stroke incidence.Methods We used data from the Korean Genome and Epidemiology Study. The primary exposure was depression, measured by the Beck Depression Inventory. The secondary exposure was insomnia. The main outcome was the occurrence of stroke observed in biennial follow-up surveys. Cox proportional regression analysis was performed to estimate the effects of depression and insomnia on stroke incidence. We also conducted interaction analysis to investigate the interaction between depression and insomnia on stroke incidence.Results During 16 years of follow-up involving 3,301 individuals, we documented 172 cases of new-onset stroke (4.3 cases per 1,000 person-years). Cox proportional logistic regression analysis showed that severe depression significantly increased the risk of stroke (hazard ratio [HR]: 2.06, 95% confidence interval [CI]: 1.13–3.75), whereas mild and moderate depression did not increase this risk. Interaction analysis demonstrated that stroke risk was increased with only moderate (HR: 2.04, 95% CI: 1.04–4.00) and severe (HR: 3.01, 95% CI: 1.43–6.31) depression among individuals without insomnia.Conclusion Although general depression does not significantly increase stroke risk, moderate-to-severe depression may increase this risk, particularly in individuals without insomnia.
참고문헌 (21)
- Katan M, "Global burden of stroke", Semin Neurol, 38, pp.208~211 (2018)
- Armstrong JR, "Aspiration pneumonia after stroke : intervention and prevention", Neurohospitalist, 1, pp.85~93 (2011)
- Ozturk S, "Stroke and stroke risk factors as disease burden", Health Risk Anal, 4, pp.146~ (2021)
- Nowbar AN, "Mortality from ischemic heart disease", Circ Cardiovasc Qual Outcomes, 12, pp.e005375~ (2019)
- Beckett CW, "The role of immunomodulators in treatment-resistant depression : case studies", Cell Death Discov, 8, pp.367~ (2022)
- Pan A, "Depression and risk of stroke morbidity and mortality : a meta-analysis and systematic review", JAMA, 306, pp.1241~1249 (2011)
- Carney RM, "Depression, the autonomic nervous system, and coronary heart disease", Psychosom Med, 67(Suppl 1), pp.S29~S33 (2005)
- Osimo EF, "Inflammatory markers in depression : a meta-analysis of mean differences and variability in 5, 166 patients and 5, 083 controls", Brain Behav Immun, 87, pp.901~909 (2020)
- Ellis C, "The association between major depression, health behaviors, and quality of life in adults with stroke", Int J Stroke, 7, pp.536~543 (2012)
- Taylor DJ, "Epidemiology of insomnia, depression, and anxiety", Sleep, 28, pp.1457~1464 (2005)
- Wu MP, "Insomnia subtypes and the subsequent risks of stroke : report from a nationally representative cohort", Stroke, 45, pp.1349~1354 (2014)
- Jackson-Koku G, "Beck depression inventory", Occup Med(Lond), 66, pp.174~175 (2016)
- Jonas BS, "Symptoms of depression as a prospective risk factor for stroke", Psychosom Med, 62, pp.463~471 (2000)
- Barlinn K, "Exploring the risk-factor association between depression and incident stroke : a systematic review and meta-analysis", Neuropsychiatr Dis Treat, 11, pp.1~14 (2014)
- van West D, "Activation of the inflammatory response system : a new look at the etiopathogenesis of major depression", Neuro Endocrinol Lett, 20, pp.11~17 (1999)
- Bonnet F, "Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease", Atherosclerosis, 178, pp.339~344 (2005)
- Zhao F, "Shared genetic risk factors for depression and stroke", Prog Neuropsychopharmacol Biol Psychiatry, 93, pp.55~70 (2019)
- Javaheri S, "Insomnia and risk of cardiovascular disease", Chest, 152, pp.435~444 (2017)
- Jarrin DC, "Insomnia and hypertension : a systematic review", Sleep Med Rev, 41, pp.3~38 (2018)
- Johnson KA, "The association of insomnia disorder characterised by objective short sleep duration with hypertension, diabetes and body mass index : a systematic review and meta-analysis", Sleep Med Rev, 59, pp.101456~ (2021)
- Morssinkhof MWL, "Sex hormones, insomnia, and sleep quality : subjective sleep in the first year of hormone use in transgender persons", Sleep Med, 107, pp.316~326 (2023)