Abstract Body (Do not enter title and authors here): Background: Sleep duration has emerged as a potential modifiable risk factor influencing both cardiovascular disease (CVD) and mental health outcomes. This study aimed to assess the prevalence of clinical depression among participants with CVD, examine sleep duration, and assess the association between sleep duration and clinical depression.
Methods: We used data from six waves of the Behavioral Risk Factor Surveillance System (BRFSS) with available sleep assessments (2013, 2014, 2016, 2018, 2020, 2022). We restricted the analyses for people reporting having CVD, with the final analytical sample including 319,470 adults. We used two sets of guidelines to categorize sleep based on its duration: A) normative (7-9 hours), short (<7 hours), and long (≥9 hours); and B) Inadequate sleep (<6 hours/day) versus adequate (≥6 hours/day). Weighted multivariate logistic regression was used to assess the association of clinical depression with sleep duration among people with CVD.
Results: Participants were mostly male (55.3%) and white (69.4%). Among the whole sample (N=319,470), 85,547 (28.5%) were diagnosed with clinical depression. Regarding sleep duration, 179,407 (54.1%) participants reported normative duration, 110,921 (38.9%) participants reported short duration, and 21,932 (7%) reported long duration. When examining sleep adequacy, 208,549 (61.9%) were classified as having adequate sleep, while 110,921 (38.1%) had inadequate sleep. Compared to those with normative sleep duration, both, participants with short and long sleep duration were more likely to have clinical depression (Adjusted Odds Ratio (aOR) =1.5, p<.001; aOR=1.7, p<.001 respectively). Additionally, participants with inadequate sleep were more likely to have clinical depression (aOR=1.37, p<.001) compared to those with adequate sleep.
Conclusion: Regardless of the guidelines followed to categorize healthy sleep duration (whether 6 or 7 hours/day for adults) there was a significant association between insufficient sleep and clinical depression among people with CVD. Interventions aimed at improving sleep duration could play a vital role in the mental health wellbeing of individuals with CVD. This vulnerable population, having dual burden of clinical depression and CVD were more likely to experience inadequate sleep that may lead to poor treatment outcomes. Further research is needed to quantify the impact of sleep duration and outcomes on the co-morbidity of CVD and depression.