Objective and subjective sleep in patients with non-seasonal major depressive disorder and eveningness – Results from a randomized controlled trial of bright light therapy

• Published in: Sleep medicine 2023-12, Vol.112, p.132-140
• Main Authors: Chan, Joey WY, Feng, Hongliang, Zhang, Jihui, Chan, Ngan Yin, Li, Tim Man Ho, Chau, Steven WH, Liu, Yaping, Li, Shirley Xin, Wing, Yun Kwok
• Format: Article
• Language: English
• Subjects: Actigraphy; Adult; Depression; Depressive Disorder, Major - therapy; Eveningness; Humans; Light; Light therapy; Phototherapy; Prospective Studies; Sleep
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2023.10.013

This study examines the (dis)agreement between objective and subjective sleep and their prospective changes in a randomized controlled trial of bright light therapy (BLT) in patients with major depressive disorder (MDD) and eveningness. A total of 93 adults were randomized to receive either 30-min daily of 10,000 lux BLT or 50lux placebo dim red light therapy (DRL group) for a total of 5 weeks. Actigraphic data were collected at the baseline and during the last week of treatment. (Dis)Concordance of diary and actigraphic sleep parameters were assessed by partial correlations and Bland-Altman plots, and the associations between these discrepancies to depression severity was assessed by linear regression models. Changes of sleep parameters were assessed by linear mixed model. Significant correlations were found between subjective sleep timings and chronotype to actigraphic parameters. Discrepancies between diary- and actigraphic-measures were observed, and patients with more severe depressive symptoms were associated with a greater under-estimation of total sleep time (TST). A greater advance in the diary-based time to fall sleep and rise time were achieved in the BLT group as compared to the DRL group, while diary-based wake after sleep onset (WASO), TST and sleep efficiency (SE) comparably improved with time in both groups. There was no significant difference between the two groups in the actigraphic parameters after treatment. In this study, we found that depression severity influenced subjective report of sleep. BLT led to a greater advance in subjective sleep timings when compared to the placebo group. •In patients with major depression and concomitant eveningness, self-reported sleep timings and circadian preference were strongly correlated with actigraphic-estimated rest-activity timings.•There were significant discrepancies between the objective-subjective sleep parameters, and patients with more severe depressive symptoms were associated with a greater under-estimation of total sleep time.•A gradual advance protocol with either type of light therapy would improve subjective wake after sleep onset, total sleep time and sleep efficiency, but bright light therapy was superior in advancing the subjective sleep timing.