Qualidade do sono e cronotipo em pacientes deprimidos de uma região de baixa latitude

Abstract

The circadian rhythm is closely linked to the sleep regulation process (sleep/wake), which has demonstrated a bidirectional relationship with various diseases, including depression. The evening chronotype, a behavioral manifestation of the circadian timing system, has been shown to be a risk factor for the development of psychiatric disorders. Furthermore, sleep problems are noted in the clinical histories of depressed patients. However, in psychiatric clinical practice, little emphasis is given to diagnostic and therapeutic approaches related to chronobiological aspects. Circadian dysregulations, eveningness and poor sleep quality had not yet been evaluated in depressed patients treated by the SUS in the state of Alagoas. The objective of this study was to analyze the chronotype and sleep in patients diagnosed with depression (MD) (n= 16, 11 women) compared with healthy participants (n= 29, 17 women), treated at HUPAA/UFAL and CAPS in Maceió, AL. Characteristics of studied populations residing in regions of lower latitudes (higher temperatures; earlier sunrise; longer day length; longer average duration of sunlight) were previously associated with the prevalence of morningness, while regions of higher latitudes there was a prevalence of eveningness. The patients in this research were assisted in the research scenarios of the Psychiatry Outpatient Clinic of a Hospital and Psychosocial Care Centers and residents of the city of Maceió, which has latitude: -9.66625, and Longitude: -35.73519° 39′ 59″ South, 35° 44 ′ 6″ West, the hypothesis that guides this study is that the association between eveningness and depression would not be found in a low latitude region. To assess the diagnosis of depression, the “Mini International Neuropsychiatric Interview” was used; to assess the intensity of depressive symptoms, the “Beck Depression Inventory (BDI) was used. To determine the chronotype, the Horne-Ostberg Test (HO) and the Munich Chronotype Questionnaire (MCTQ) were used, which was also used to determine sleep parameters. To assess sleep quality, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESP) were used. The results demonstrated that patients have worse body mass indexes (BMI) (p=0.01) when compared to healthy participants. HO/MEQ scores (p= 0.01) were significantly lower in the MD group, indicating eveningness in this group, even in treatment, a sample of low latitude origin. There was a significant association between MD and worse sleep quality (p=0.001), with depressed patients also experiencing greater sleep inertia on weekdays (SIW) (p=0.04), in addition to greater difficulty waking up and feeling alert. compared to individuals in the healthy group and took longer to get out of bed during the week (p= 0.02) and on days off (p = 0.01). There was a positive correlation between the Pittsburgh scores (sleep quality) and the BDI (severity of depression), indicating that as sleep quality worsens, depression symptoms tend to intensify (p=0.05). It is important that mental health professionals include the assessment of sleep chronotype, routine, habits and quality in their clinical practice and consider the possibility of specific interventions to improve sleep quality in depressed patients. Our results did not support the hypothesis that guided this investigation, however they corroborated the literature for other regions at different latitudes. More clinicalbased research is recommended that compares social, genetic and environmental factors such as latitude and seasonality with larger and more diverse samples, in order to produce more findings in different populations and contexts in different regions of Brazil and the world so that make scientific conclusions more viable and objective.