Matthew is an associate editor of The American Journal of Managed Care® (AJMC®). He has been working on AJMC® since 2019 after receiving his Bachelor's degree at Rutgers University–New Brunswick in journalism and economics.
An irregular sleeping schedule is associated with a greater risk of depression in the long term, with consequences similar to results seen among persons who sleep fewer hours overall or stay up late most nights.
Early-career physicians with an irregular sleep schedule were found to be at an increased risk for depression over the long term, with short-term consequences shown to affect mood the next day, according to study findings published in npj Digital Medicine.
Although several factors play a distinct role in evaluating sleep health, the researchers highlight that studies often focus solely on sleep duration in their analyses. Moreover, 24-hour total sleep time (TST), an established critical driver of major depression, remains poorly understood due to reliance “on either self-report assessments or traditional objective sleep measurements restricted to cross-sectional time frames and small cohorts.”
Seeking to build on emerging evidence that has identified the sleep-wake schedule as a particularly important and stable contributor to health over time, they assessed 2115 early-career physicians (mean [SD] age, 27.5 [2.4] years; 56% female) who were all in their first year of residency training after medical school. Participants were analyzed in the 2 weeks prior to the study and then for 1 year during residency, which was characterized by long, intense work days and irregular work schedules that contributed to day-to-day variance in sleep.
Through the study, the authors aimed to:
They evaluated sleep via wearable device, daily mood with a smartphone application, and depression through the 9-item Patient Health Questionnaire (PHQ-9).
"The advanced wearable technology allows us to study the behavioral and physiological factors of mental health, including sleep, at a much larger scale and more accurately than before, opening up an exciting field for us to explore," said lead study author Yu Fang, MSE, research specialist at the Michigan Neuroscience Institute, in a statement. "Our findings aim not only to guide self-management on sleep habits but also to inform institutional scheduling structures."
Among the study cohort, several factors were associated with more depressive symptoms:
In comparing the aggregated impact of sleep variability and mean sleep parameters, both were found to be similar in magnitude on PHQ-9 scores (both: r2, 0.01).
Furthermore, after evaluating objective sleep duration and sleep-wake timing on mood the next day, improved next-day mood was associated with:
“Variability in sleep parameters substantially impacted mood and depression, similar in magnitude to the mean levels of sleep parameters,” concluded the study authors. “Interventions that target sleep consistency, along with sleep duration, hold promise to improve mental health.”
Due to the young patient cohort, authors note that study findings are not representative of the general population.
Fang Y, Forger DB, Frank E, Sen S, Goldstein C. Day-to-day variability in sleep parameters and depression risk: a prospective cohort study of training physicians. NPJ Digit Med. Published online February 18, 2021. doi:10.1038/s41746-021-00400-z