Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

The relationship between depression, daytime napping, daytime dysfunction, and snoring in 0.5 million Chinese populations: exploring the effects of socio-economic status and age

Authors: Yuning Liu, Tingting Peng, Siqiao Zhang, Kun Tang

Published in: BMC Public Health | Issue 1/2018

Login to get access

Abstract

Background

Daytime napping has been postulated as both a protective and a risk factor for depression in previous studies. In addition to these conflicting results, research gaps also exist with regard to controlling confounding bias between daytime napping and depression and examining the potential association within the Chinese population. To facilitate the prevention and diagnosis of depression, this study aims to provide insight into the association of daytime napping and depression in 0.5 million Chinese adults by fully controlling confounders, and further examine the modifying effects of socio-economic status (SES) and age.

Methods

Data were drawn from the baseline of a Chinese cohort study of 0.5 million adults. Depressive status was measured by the Composite International Diagnostic Inventory (CIDI). Logistic regression models were used to examine the association between depression and daytime napping adjusted for SES, sleep-related factors, lifestyle factors and related diseases. Further stratified analyses were conducted to identify the modifying effects of socio-economic status and age.

Results

The odds ratio of depression by daytime napping was 1.15 (95% CI: 1.01–1.31) in females and 1.42 (95% CI: 1.18–1.71) in males. Factors including living in a rural area (OR = 1.31, 95% CI: 1.13–1.52), receiving less education (OR = 1.42, 95% CI: 1.22–1.66), getting married (OR = 1.24, 95% CI: 1.10–1.40) and being 45–65 years old (OR = 1.29, 95% CI: 1.12–1.49) had a modifying effect on daytime napping and depression that could strengthen the association.

Conclusions

A significantly positive association was found between depression and daytime napping, as well as daytime dysfunction, snoring and both shorter and longer sleep duration. Lower SES and age could possibly modify the association. Further clinical or epidemiological studies are needed to investigate the mechanism and facilitate the prevention of depression.
Literature
1.
Bursztyn M, Ginsberg G, Hammerman-Rozenberg R, Stessman J. The siesta in the elderly: risk factor for mortality? Arch Intern Med. 1999;159(14):1582–6.CrossRefPubMed
2.
Monk TH, Buysse DJ, Carrier J, et al. Effects of afternoon "siesta" naps on sleep, alertness, performance, and circadian rhythms in the elderly. Sleep. 2001;24(6):680–7.CrossRefPubMed
3.
Dinges DF, Orne MT, Whitehouse WG, et al. Temporal placement of a nap for alertness: contributions of circadian phase and prior wakefulness. Sleep. 1987;10(4):313–29.PubMed
4.
Lin D, Sun K, Li F, et al. Association between habitual daytime napping and metabolic syndrome: a population-based study. Metabolism. 2014;63(12):1520–7.CrossRefPubMed
5.
Fang W, Li Z, Wu L, et al. Longer habitual afternoon napping is associated with a higher risk for impaired fasting plasma glucose and diabetes mellitus in older adults: results from the Dongfeng-Tongji cohort of retired workers. Sleep Med. 2013;14(10):950–4.CrossRefPubMed
6.
Martin JL, Ancoli-Israel S. Napping in older adults. Sleep Medicine Clinics. 2006;1(2):177–86.CrossRef
7.
Cao Z, Shen L, Wu J, et al. The effects of midday nap duration on the risk of hypertension in a middle-aged and older Chinese population: a preliminary evidence from the Tongji-Dongfeng cohort study, China. J Hypertens. 2014;32(10):1993–8.CrossRefPubMed
8.
Backhaus J, Junghanns K. Daytime naps improve procedural motor memory. Sleep Med. 2006;7(6):508–12.CrossRefPubMed
9.
Lahl O, Wispel C, Willigens B, et al. An ultra-short episode of sleep is sufficient to promote declarative memory performance. J Sleep Res. 2008;17(1):3–10.CrossRefPubMed
10.
Milner CE, Cote KA. Benefits of napping in healthy adults: impact of nap length, time of day, age, and experience with napping. J Sleep Res. 2009;18(2):272–81.CrossRefPubMed
11.
Hays JC, Blazer DG, Foley DJ. Risk of napping: excessive daytime sleepiness and mortality in an older community population. J Am Geriatr Soc. 1996;44(6):693–8.CrossRefPubMed
12.
Campos H, Siles X. Siesta and the risk of coronary heart disease: results from a population-based, case-control study in Costa Rica. Int J Epidemiol. 2000;29(3):429–37.CrossRefPubMed
13.
Qin X, Wang S, Hsieh CR. The prevalence of depression and depressive symptoms among adults in China: estimation based on a National Household Survey. China Econ Rev. 2016;
14.
Teasdale JD. Negative thinking in depression: cause, effect, or reciprocal relation. Advances in Behaviour Research and Therapy. 1983;5(1):3–25.CrossRef
15.
Halaris A. Inflammation, heart disease, and Depression. Current Psychiatry Reports. 2013;15(10):1–9.CrossRef
16.
Kizilbash AH, Vanderploeg RD, Curtiss G, et al. The effects of depression and anxiety on memory performance. Arch Clin Neuropsychol. 2002;17(1):57–67.CrossRefPubMed
17.
Burke L. The impact of maternal depression on familial relationships. International Review of Psychiatry. 2003;15(3):243–55.CrossRefPubMed
18.
Soósová MS, Macejová Ž, Zamboriová M, Dimunová L. Anxiety and depression in Slovak patients with rheumatoid arthritis. J Ment Health. 2016:1–7.
19.
20.
Zhe Jin (2016) current status of depression treatment and drug market in China, Daily Economics 2016–09-27(007).
21.
Baglioni C, Battagliese G, Feige B, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135(1):10–9.CrossRefPubMed
22.
LaGrotte C, Fernandez-Mendoza J, Calhoun SL, et al. The relative association of obstructive sleep apnea, obesity and excessive daytime sleepiness with incident depression: a longitudinal, population-based study. Int J Obes. 2016;40(0)
23.
24.
Taylor DJ, Lichstein KL, Durrence HH, et al. Epidemiology of insomnia, depression, and anxiety. Sleep. 2005;28(11):1457–64.CrossRefPubMed
25.
Chellappa SL, Schroder C, Cajochen C. Chronobiology, excessive daytime sleepiness and depression: is there a link? Sleep Med. 2008;10(5):505–14.CrossRefPubMed
26.
Shen J, Hossain N, Streiner DL, et al. Excessive daytime sleepiness and fatigue in depressed patients and therapeutic response of a sedating antidepressant. J Affect Disord. 2011;134(1):421–6.CrossRefPubMed
27.
Peppard PE, Szklo-Coxe M, Hla KM, Young T. Longitudinal association of sleep-related breathing disorder and depression. JAMA Intern Med. 2006;166(16):1709–15.CrossRef
28.
Foley DJ, Vitiello MV, Bliwise DL, et al. Frequent napping is associated with excessive daytime sleepiness, depression, pain, and Nocturia in older adults: findings from the National Sleep Foundation '2003 sleep in America' poll. Am J Geriatr Psychiatr. 2007;15(4):344–50.CrossRef
29.
Ohayon MM, Zulley J. Prevalence of naps in the general population. Sleep Hypnosis. 1999;1(3):88–97.
30.
Dhand R, Sohal H. Good sleep, bad sleep! The role of daytime naps in healthy adults. Curr Opin Pulm Med. 2006;12(6):379–82.CrossRefPubMed
31.
Hare DL, Toukhsati SR, Johansson P, Jaarsma T. Depression and cardiovascular disease: a clinical review[J]. Eur Heart J. 2013;35(21): 1365–72.
32.
Steel J, Geller D, Marsh W, Antoni M, Penedo F, et al. Depression and increased risk of mortality in cancer: the underlying biological mechanisms remain elusive. Depression. 2016;15:5.
33.
Carlsson AC, Wändell P, Ösby U, Zarrinkoub R, Wettermark B, et al. High prevalence of diagnosis of diabetes, depression, anxiety, hypertension, asthma and COPD in the total population of Stockholm, Sweden–a challenge for public health. BMC Public Health. 2013;13(1):670.CrossRefPubMedPubMedCentral
34.
Abdel-Kader K, Unruh ML, Weisbord SD. Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol. 2009;4(6):1057–64.CrossRefPubMedPubMedCentral
35.
Calhoun SL, Vgontzas AN, Fernandez-Mendoza J, Mayes SD, Tsaoussoglou M, Basta M, Bixler EO. Prevalence and risk factors of excessive daytime sleepiness in a community sample of young children: the role of obesity, asthma, anxiety/depression, and sleep. Sleep. 2011;34(4):503–7.CrossRefPubMedPubMedCentral
36.
Ko FY, Yang AC, Tsai SJ, Zhou Y, Xu LM. Physiologic and laboratory correlates of depression, anxiety, and poor sleep in liver cirrhosis. BMC Gastroenterol. 2013;13(1):18.CrossRefPubMedPubMedCentral
37.
Nicassio PM, Wallston KA. Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis. J Abnorm Psychol. 1992;101(3):514.CrossRefPubMed
38.
Mammen G, Faulkner G. Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med. 2013;45(5):649–57.CrossRefPubMed
39.
Wiltink J, Michal M, Wild PS, Zwiener I, Blettner M, et al. Associations between depression and different measures of obesity (BMI, WC, WHtR, WHR). BMC Psychiatry. 2013;13(1):223.CrossRefPubMedPubMedCentral
40.
Schofield MJ, Khan A. Predictors of prescribed medication use for depression, anxiety, stress, and sleep problems in mid-aged Australian women. Soc Psychiatry Psychiatr Epidemiol. 2014;49(11):1835–47.CrossRefPubMed
41.
Brunello N, Armitage R, Feinberg I, et al. Depression and sleep disorders: clinical relevance, economic burden and pharmacological treatment. Neuropsychobiology. 2000;42(3):107–19.CrossRefPubMed
42.
Luca A, Luca M, Calandra C, et al. Sleep disorders and depression: brief review of the literature, case report, and nonpharmacologic interventions for depression. Clin Interv Aging. 2013:1033–9.
43.
Naska A, Oikonomou E, Trichopoulou A, Psaltopoulou T, Trichopoulos D. Siesta in healthy adults and coronary mortality in the general population. Arch Intern Med. 2007;167(3):296–301.CrossRefPubMed
44.
Lorant V, Deliege D, Eaton WW, et al. Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol. 2003;157(2):98–112.CrossRefPubMed
45.
Buckhalt JA, Elsheikh M, Keller P. Children's sleep and cognitive functioning: race and socioeconomic status as moderators of effects. Child Dev. 2007;78(1):213–31.CrossRefPubMed
46.
Chen Z, Chen J, Collins R, Guo Y, Peto R, et al. China Kadoorie biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up[J]. Int J Epidemiol. 2011;40(6):1652–66.CrossRefPubMedPubMedCentral
47.
Kessler RC. Clinical calibration of DSM-IV diagnoses in the world mental health (WMH) version of the World Health Organization (WHO) composite international diagnostic interview (WMH-CIDI). Int J Methods Psychiatr Res. 2004;13(2):122–39.CrossRefPubMed
48.
49.
Eaton WW. Case identification in psychiatric epidemiology: a review. International Review Psychiatry. 2007;19(5):497–507.CrossRef
50.
Mezuk B, Chen Y, C Y, Guo Y, Bian Z, et al. Depression, anxiety, and prevalent diabetes in the Chinese population: findings from the China Kadoorie biobank of 0.5 million people. J Psychosom Res. 2013;(6):511–7.
51.
Chen Z, Chen J, Collins R, et al. China Kadoorie biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up. Int J Epidemiol. 2011;40(6):1652–66.CrossRefPubMedPubMedCentral
52.
L G, Xie J, Long J, Chen Q, Chen Q, et al. Epidemiology of major depressive disorder in mainland China: a systematic review[J]. PLoS One. 2013;8(6):e65356.CrossRef
53.
Lu J, Ruan Y, Huang Y, Yao J, Dang W, et al. Major depression in Kunming: prevalence, correlates and co-morbidity in a south-western city of China. J Affect Disord. 2008;111:221–6.CrossRefPubMed
54.
Zhao ZH, Huang YQ, LI J, Deng HH, Huang XM, et al. An epidemiological survey of mental disorders in Guangzhou area. Chinese Journal of Nervous and Mental Diseases. 2009;35:530–4.
55.
Suna X, Zhenga B, Lv J, Guob Y, Bian Z, et al. Sleep behavior and depression: findings from the China Kadoorie biobank of 0.5 million Chinese adults. Journal of affective disorders. 2017;299:120–4.
56.
Ohayon MM. Interactions between sleep normative data and sociocultural characteristics in the elderly. J Psychosom Res. 2004;56(5):479–86.CrossRefPubMed
57.
Almeida OP, Tamai S, Garrido R. Sleep complaints among the elderly: results from a survey in a psychogeriatric outpatient clinic in Brazil. Int Psychogeriatr. 1999;11(01):47–56.CrossRefPubMed
58.
Jung KI, Song CH, Ancoli-Israel S, et al. Gender differences in nighttime sleep and daytime napping as predictors of mortality in older adults: the rancho Bernardo study. Sleep Med. 2013;14(1):12–9.CrossRefPubMed
59.
Stone KL, Ewing SK, Ancoli Israel S, et al. Self-reported sleep and nap habits and risk of mortality in a large cohort of older women. J Am Geriatr Soc. 2009;57(4):604–11.CrossRefPubMedPubMedCentral
60.
Plante DT, Finn LA, Hagen EW, et al. Longitudinal associations of hypersomnolence and depression in the Wisconsin sleep cohort study. J Affect Disord. 2017;207(0):197–202.CrossRefPubMed
61.
Tanabe N, Iso H, Seki N, et al. Daytime napping and mortality, with a special reference to cardiovascular disease: the JACC study. Int J Epidemiol. 2010;39(1):233–43.CrossRefPubMed
62.
Feinberg I, Maloney T, March JD. Precise conservation of NREM period 1 (NREMP1) delta across naps and nocturnal sleep: implications for REM latency and NREM/REM alternation. Sleep. 1992;15(5):400–3.CrossRefPubMed
63.
Pandi-Perumal SR, Moscovitch A, Srinivasan V, Spence DW, Cardinali DP, Brown GM. Bidirectional communication between sleep and circadian rhythms and its implications for depression: lessons from agomelatine. Prog Neurobiol. 2009;88(4):264–71.CrossRefPubMed
64.
Bocchio-Chiavetto, L., Bagnardi, V., Zanardini, R., Molteni, R., Gabriela Nielsen, M., Placentino, A., ... & Gennarelli, M. (2010). Serum and plasma BDNF levels in major depression: a replication study and meta-analyses. The World Journal of Biological Psychiatry, 11(6), 763–773.
65.
Leng Y, Ahmadi-Abhari S, Wainwright NW, Cappuccio FP, Surtees PG, Luben R, et al. Daytime napping, sleep duration and serum C reactive protein: a population-based cohort study. BMJ Open. 2014;4(11):e006071.CrossRefPubMedPubMedCentral
66.
Lorant V, Croux C, Weich S, et al. Depression and socio-economic risk factors: 7-year longitudinal population study. Br J Psychiatry. 2007;190(4):293–8.CrossRefPubMed
67.
Haus E, Smolensky M. Biological clocks and shift work: circadian dysregulation and potential long-term effects. Cancer Causes Control. 2006;17(4):489–500.CrossRefPubMed
68.
Patel NP, Grandner MA, Xie D. "Sleep disparity" in the population: poor sleep quality is strongly associated with poverty and ethnicity. BMC Public Health. 2010;10(1):475.CrossRefPubMedPubMedCentral
69.
Vyas MV, Garg AX, Iansavichus AV. Shift work and vascular events: systematic review and meta-analysis. BMJ. 2012;
70.
Zilli I, Ficca G, Salzarulo P. Factors involved in sleep satisfaction in the elderly. Sleep Med. 2009;10(2):233–9.CrossRefPubMed
71.
Leblanc MF, Desjardins S, Desgagné A. The relationship between sleep habits, anxiety, and depression in the elderly. Nature and Science of Sleep. 2015;7:33.PubMedPubMedCentral
72.
Milner CE, Cote KA. A dose-response investigation of the benefits of napping in healthy young, middle, and older adult age groups. Sleep and Biological Rhythms. 2007;6(1):2–15.CrossRef
73.
Tanaka H, Taira K, Arakawa M, Toguti H, Urasaki C, et al. Effects of short nap and exercise on elderly people having difficulty in sleeping. Psychiatry Clinical Neurosciences. 2001;55(3):173–4.CrossRefPubMed
74.
Creighton C. Effects of afternoon rest on the performance of geriatric patients in a rehabilitation hospital: a pilot study. Am J Occup Ther. 1995;49(8):775–9.CrossRefPubMed
Metadata
Title
The relationship between depression, daytime napping, daytime dysfunction, and snoring in 0.5 million Chinese populations: exploring the effects of socio-economic status and age
Authors
Yuning Liu
Tingting Peng
Siqiao Zhang
Kun Tang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5629-9

Other articles of this Issue 1/2018

BMC Public Health 1/2018 Go to the issue

Research article

Retrospective analysis of risk factors and gaps in prevention strategies for mother-to-child HIV transmission in Rio de Janeiro, Brazil

Research article

Association of self-reported sedentary time with insulin resistance among Korean adults without diabetes mellitus: a cross-sectional study

Research article

Public health implications of changing patterns of recruitment into the South African mining industry, 1973–2012: a database analysis

Research article

The National Alcohol Survey of Households in Trinidad and Tobago (NASHTT): willingness to support changes in policy, laws and regulations

Research article

Assessing the reliability of FTIR spectroscopy measurements and validity of bioelectrical impedance analysis as a surrogate measure of body composition among children and adolescents aged 8–19 years attending schools in Kampala, Uganda

Research article

Exploring status and determinants of prenatal and postnatal visits in western China: in the background of the new health system reform