One-Year Actigraphy Study of Sleep and Rest-Activity Rhythms as Markers of Relapse in Depression.
Given its recurrent nature and burden, major depressive disorder (MDD) warrants reliable methods of relapse prediction.
To determine whether actigraphy-derived parameters, measured over 1 to 2 years, are associated with relapse.
This was an observational cohort study with data collection from July 2016 to January 2019. The setting was multicentric. A referred sample of participants from outpatient psychiatric and primary care clinics across Canada were followed up for 1 to 2 years. Participants had a diagnosis of MDD and Montgomery-Åsberg Depression Rating Scale (MADRS) score less than or equal to 14 at baseline.
Actigraphy-derived parameters measured over 1 to 2 years.
The primary outcome was relapse, defined as any of the following: MADRS score greater than or equal to 22 for 2 consecutive weeks, psychiatric hospitalization, emergence of suicidal intent or behavior, or antidepressant treatment escalation-all adjudicated by an independent panel. Continuous actigraphy data were averaged every 2 weeks.
From a referred sample of 102 adults, 93 participants (mean [SD] age, 39.1 [12.7] years; 58 female [62%]) contributed approximately 32 000 complete actigraphy days (median, 46 weeks). In Cox models adjusted for age, sex, season, and baseline MADRS score, baseline lower sleep regularity (hazard ratio [HR], 0.46; 95% CI, 0.28-0.74; P = .002), lower relative amplitude (RA; HR, 0.45; 95% CI, 0.29-0.70; P < .001), lower sleep efficiency (HR, 0.57; 95% CI, 0.38-0.85; P = .005), higher wake after sleep onset (HR, 1.77; 95% CI, 1.12-2.80; P = .01), and higher nighttime activity (HR, 1.86; 95% CI, 1.32-2.62; P < .001) were associated with relapse. In time-varying models, greater composite phase deviation (HR, 1.76; 95% CI, 1.04-2.98; P = .04) and lower RA (HR, 0.45; 95% CI, 0.21-0.97; P = .046) were associated with relapse, with RA remaining significant even after adjusting for concurrent MADRS scores (HR, 0.60; 95% CI, 0.36-0.98; P = .04). Actigraphy significantly differentiated individuals experiencing relapse from those with an ultrastable (MADRS score <14 throughout) and unstable (transient MADRS score, 14-22 without relapse) clinical course.
Actigraphy measures of sleep phase variability and daily activity amplitude were associated with depressive relapse, supporting actigraphy as a potential scalable biomarker to identify high-risk individuals and enable timely, personalized relapse prevention in MDD.
To determine whether actigraphy-derived parameters, measured over 1 to 2 years, are associated with relapse.
This was an observational cohort study with data collection from July 2016 to January 2019. The setting was multicentric. A referred sample of participants from outpatient psychiatric and primary care clinics across Canada were followed up for 1 to 2 years. Participants had a diagnosis of MDD and Montgomery-Åsberg Depression Rating Scale (MADRS) score less than or equal to 14 at baseline.
Actigraphy-derived parameters measured over 1 to 2 years.
The primary outcome was relapse, defined as any of the following: MADRS score greater than or equal to 22 for 2 consecutive weeks, psychiatric hospitalization, emergence of suicidal intent or behavior, or antidepressant treatment escalation-all adjudicated by an independent panel. Continuous actigraphy data were averaged every 2 weeks.
From a referred sample of 102 adults, 93 participants (mean [SD] age, 39.1 [12.7] years; 58 female [62%]) contributed approximately 32 000 complete actigraphy days (median, 46 weeks). In Cox models adjusted for age, sex, season, and baseline MADRS score, baseline lower sleep regularity (hazard ratio [HR], 0.46; 95% CI, 0.28-0.74; P = .002), lower relative amplitude (RA; HR, 0.45; 95% CI, 0.29-0.70; P < .001), lower sleep efficiency (HR, 0.57; 95% CI, 0.38-0.85; P = .005), higher wake after sleep onset (HR, 1.77; 95% CI, 1.12-2.80; P = .01), and higher nighttime activity (HR, 1.86; 95% CI, 1.32-2.62; P < .001) were associated with relapse. In time-varying models, greater composite phase deviation (HR, 1.76; 95% CI, 1.04-2.98; P = .04) and lower RA (HR, 0.45; 95% CI, 0.21-0.97; P = .046) were associated with relapse, with RA remaining significant even after adjusting for concurrent MADRS scores (HR, 0.60; 95% CI, 0.36-0.98; P = .04). Actigraphy significantly differentiated individuals experiencing relapse from those with an ultrastable (MADRS score <14 throughout) and unstable (transient MADRS score, 14-22 without relapse) clinical course.
Actigraphy measures of sleep phase variability and daily activity amplitude were associated with depressive relapse, supporting actigraphy as a potential scalable biomarker to identify high-risk individuals and enable timely, personalized relapse prevention in MDD.
Authors
Tonon Tonon, Nexha Nexha, Cunningham Cunningham, d'Eon d'Eon, Chakrabarty Chakrabarty, Farzan Farzan, Foster Foster, Harkness Harkness, Hassel Hassel, Ho Ho, Lam Lam, Milev Milev, Minuzzi Minuzzi, Müller Müller, Nunes Nunes, Parikh Parikh, Quilty Quilty, Rotzinger Rotzinger, Soares Soares, Taylor Taylor, Turecki Turecki, Uher Uher, Kennedy Kennedy, Frey Frey
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