Sleep and circadian rhythms in delayed sleep-wake phase disorder: Phenotypic differences between patients with and without comorbid depression

Cátia Reis; Luísa K Pilz; Teresa Paiva; Maria Paz Hidalgo; Kenneth P Wright Jr

doi:10.1111/jsr.14437

Sleep and circadian rhythms in delayed sleep-wake phase disorder: Phenotypic differences between patients with and without comorbid depression

J Sleep Res. 2025 Jan 15:e14437. doi: 10.1111/jsr.14437. Online ahead of print.

Authors

Cátia Reis^{1

2

3}, Luísa K Pilz^{4

5}, Teresa Paiva^{3

6

7}, Maria Paz Hidalgo^{8

9}, Kenneth P Wright Jr¹⁰

Affiliations

¹ GIMM - Gulbenkian Institute for Molecular Medicine, Lisbon, Portugal.
² CRC-W - Católica Research Center for Psychological, Family and Social Wellbeing, Faculdade de Ciências Humanas, Universidade Católica Portuguesa, Lisbon, Portugal.
³ ISAMB - Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
⁴ Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
⁵ ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
⁶ CENC - Sleep Medicine Center, Lisbon, Portugal.
⁷ CHRC - Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal.
⁸ Graduate Program in Psychiatry and BehavioralSciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
⁹ Laboratório de Cronobiologia e Sono - Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
¹⁰ Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA.

PMID: 39815363
DOI: 10.1111/jsr.14437

Abstract

Delayed sleep-wake phase disorder involves chronic difficulty going to bed and waking up at conventional times and often co-occurs with depression. This study compared sleep and circadian rhythms between patients with delayed sleep-wake phase disorder with depression (DSWPD-D) and without (DSWPD-ND) comorbid depression. Clinical records of 162 patients with delayed sleep-wake phase disorder (70 DSWPD-D, 92 DSWPD-ND) were analysed, including a subset of 76 patients with circadian phase determined by the dim light melatonin onset. Variables assessed included sleep behaviour on work and free days, weekly sleep duration, social jet lag, chronotype, and phase relationships between dim light melatonin onset and sleep/wake times. Mean (SD) or median [Q1-Q3] values were compared using t-tests or Mann-Whitney. Patients with DSWPD-D showed longer sleep on workdays (DSWPD-D = 7.63 hr [1.70] versus DSWPD-ND = 6.20 hr [1.59]; p < 0.001), but not on free days. DSWPD-D also showed later sleep onset (DSWPD-D = 03:30 14;hours [02:49 hours-04:23 hours], DSWPD-ND = 02:53 hours [02:00 hours-03:41 hours]; p = 0.02) and wake times (DSWPD-D = 11:30 hours [09:30 hours-13:00 hours], DSWPD-ND = 08:45 hours [07:20 hours-11:00 hours]; p < 0.01) on workdays. Furthermore, DSWPD-D showed less social jet lag (DSWPD-D = 0.38 [0.00-1.75] versus DSWPD-ND = 2.17 [1.25-3.03]; p < 0.01), and reported higher anxiety symptoms (DSWPD-D = 71.4% versus DSWPD-ND = 45.8%; p = 0.03) and medication use (DSWPD-D = 75.0% versus DSWPD-ND = 43.8%; p = 0.01). DSWPD-D also showed wider dim light melatonin onset phase relationships with dim light melatonin onset-mid-sleep (DSWPD-D = -5.77 [1.32] versus DSWPD-ND = -4.86 [1.53]; p = 0.01) and dim light melatonin onset-waketime (DSWPD-D = -9.46 [1.82]; DSWPD-ND = -8.13 [2.08]; p = 0.01). Multivariable Poisson regression, adjusted for age and sex, showed more medication use, less social jet lag, and longer weekly sleep duration as significantly associated with DSWPD-D. These findings suggest potential biopsychosocial protective factors linked to depression in delayed sleep-wake phase disorder. Further research is required to confirm these phenotypic differences and their relevance to delayed sleep-wake phase disorder aetiology and treatment.

Keywords: depression; dim light melatonin onset; sleep duration; social jet lag; workdays.