Polysomnography in seasonal affective disorder: A systematic review and meta-analysis

Background: . Although sleep disturbances are ubiquitous in depression, studies assessing sleep architecture lead to conflicting results, possibly because of the heterogeneity in this disorder. We aimed to focus on Seasonal Affective Disorder (SAD), which is directly associated with circadian and sleep homeostasis impairments. Methods: . A systematic search was conducted in July 2019. Original papers reporting data about night sleep architecture using polysomnography (PSG), in SAD or remitted-SAD and controls, were included. Results: . Seven studies were retained and included 183 individuals, including 109 patients with SAD and 74 healthy controls. The random-effects meta-analysis showed that rapid eye movement sleep (REM) was signifi-cantly increased in SAD compared to controls (REM amount: SMD=1[0.11,1.88], p = 0.027; REM percentage: SMD=0.71[0.02,1.40], p = 0.045). Remitted SAD patients, compared to controls, also had a significantly increased REM sleep (REM amount: SMD=1.84[0.78,2.90], p<0.001; REM percentage: SMD=1.27[0.51,2.03], p = 0.001) and a significantly decreased REM latency (SMD=-0.93[-1.73,-0.13], p = 0.022). No differences were observed for total sleep time, sleep efficiency, and slow-wave-sleep. Limitations:. Most studies had small sample size, with no placebo group and with open designs. Conclusions:. REM sleep amount and latency appear altered both during the acute and remitted phase of SAD, representing trait markers with interesting diagnosis and therapeutic implications.