Associations between depressive symptoms and sleep duration for predicting cardiovascular disease onset: A prospective cohort study

Background: The joint effects of depressive symptoms and sleep on the risk of cardiovascular disease (CVD) are not well understood. The purpose of this study was to assess the combined impact of depressive symptoms and sleep duration on the incidence of CVD among middle-aged and older Chinese individuals. Methods: Data were from the China Health and Longitudinal Study conducted in 2013, 2015, and 2018. A total of 9595 participants aged >= 45 years without a history of CVD in 2013 were included. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale (elevated depressive symptoms cutoff > 10). Average sleep duration was self-reported. Logistic regression analyses adjusted for age, sex, marital status, education and other potential confounders were conducted. Results: In total, 1072 (11.2%) participants reported CVD incidents over the 5-year period. Elevated depressive symptoms (OR = 1.49, 95% CI = 1.30-1.72) and short sleep duration (OR = 1.21, 95% CI = 1.05-1.40) were independently associated with an increased CVD risk in the fully adjusted model. Individuals with short sleep duration/low depressive symptoms (OR = 1.34, 95% CI = 1.12-1.60), short sleep duration/elevated depressive symptoms (OR = 1.70, 95% CI = 1.41-2.50), or long sleep duration/elevated depressive symptoms (OR = 2.13, 95% CI = 1.38-3.27) were more likely to develop CVD than those with normal sleep duration/low depressive symptoms. Limitations: Depressive symptoms and sleep duration were self-reported. Conclusions: A stronger risk of CVD was found when depressive symptoms and short or long sleep durations occurred together, suggesting that an integrated approach to sleep and depressive symptoms might be a feasible strategy for the prevention of CVD.