Using heart rate profiles during sleep as a biomarker of depression
Open accessAbstract
BACKGROUND: Abnormalities in heart rate during sleep linked to impaired neuro-cardiac modulation may provide new information about physiological sleep signatures of depression. This study assessed the validity of an algorithm using patterns of heart rate changes during sleep to discriminate between individuals with depression and healthy controls. METHODS: A heart rate profiling algorithm was modeled using machine-learning based on 1203 polysomnograms from individuals with depression referred to a sleep clinic for the assessment of sleep abnormalities, including insomnia, excessive daytime fatigue, and sleep-related breathing disturbances (n = 664) and mentally healthy controls (n = 529). The final algorithm was tested on a distinct sample (n = 174) to categorize each individual as depressed or not depressed. The resulting categorizations were compared to medical record diagnoses. RESULTS: The algorithm had an overall classification accuracy of 79.9% [sensitivity: 82.8, 95% CI (0.73-0.89), specificity: 77.0, 95% CI (0.67-0.85)]. The algorithm remained highly sensitive across subgroups stratified by age, sex, depression severity, comorbid psychiatric illness, cardiovascular disease, and smoking status. CONCLUSIONS: Sleep-derived heart rate patterns could act as an objective biomarker of depression, at least when it co-occurs with sleep disturbances, and may serve as a complimentary objective diagnostic tool. These findings highlight the extent to which some autonomic functions are impaired in individuals with depression, which warrants further investigation about potential underlying mechanisms.
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An increased arousal of the autonomic nervous system that is possible with depression is likely to affect heart rate dynamics during sleep.
“an increased arousal of autonomic nervous system that is possible with depression is likely to affect heart rate dynamics during sleep [56].”
From Digital Biomarkers for Depression Screening With Wearable Devices: Cross-sectional Study With Machine Learning Modeling (2021) · cites this paper as [56]
Greater variation of nighttime heart rate between 2 AM and 4 AM and between 4 AM and 6 AM indicates greater severity of depressive symptoms.
“our findings suggest that a greater variation of nighttime heart rate between 2 AM and 4 AM and between 4 AM and 6 AM indicates greater severity of depressive symptoms”
From Digital Biomarkers for Depression Screening With Wearable Devices: Cross-sectional Study With Machine Learning Modeling (2021) · cites this paper as [56]
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Cites
(2000) · PubMed · Cited by 13,173 · see citing works
Obesity : Preventing and managing the global epidemic
Akram, D. S., Astrup, A. V., Atinmo, T., Boissin, J.-L., Bray, G. A., Carroll, K. N., Chitson, P., Chen, C., Dietz, W. H., Hill, J. O., et al. (2000) · Research at the University of Copenhagen (University of Copenhagen) · Cited by 12,945 · see citing works
Kleiger, R. E., Miller, J. P., Bigger, J. T., & Moss, A. J. (1987) · The American Journal of Cardiology · doi:10.1016/0002-9149(87)90795-8 · Cited by 3,995 · see citing works
Epidemiology of insomnia: what we know and what we still need to learn
Ohayon, M. M. (2002) · Sleep Medicine Reviews · doi:10.1053/smrv.2002.0186 · Cited by 3,743 · cited 1× · see citing works
“[12], and sleep disruptions are known to be detrimental to cardiovascular function.”
BackgroundTracey, K. J. (2002) · Nature · doi:10.1038/nature01321 · Cited by 3,728 · see citing works
Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis.
Howren, M. B., Lamkin, D. M., & Suls, J. (2009) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181907c1b · Cited by 2,766 · see citing works
Sympathetic neural mechanisms in obstructive sleep apnea.
Somers, V. K., Dyken, M. E., Clary, M. P., & Abboud, F. M. (1995) · Journal of Clinical Investigation · doi:10.1172/jci118235 · Cited by 2,527 · see citing works
Sleep and Psychiatric Disorders: A Meta-analysis
Benca, R. M. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820080059010 · Cited by 1,468 · see citing works
Heart rate and cardiovascular mortality: The Framingham study
Kannel, W. B., Kannel, C., Paffenbarger, R. S., & Cupples, L. A. (1987) · American Heart Journal · doi:10.1016/0002-8703(87)90666-1 · Cited by 1,292 · see citing works
Kemp, A. H., Quintana, D. S., Gray, M. A., Felmingham, K. L., Brown, K., & Gatt, J. M. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.12.012 · Cited by 1,286 · see citing works
Clinical diagnosis of depression in primary care: a meta-analysis
Mitchell, A. J., Vaze, A., & Rao, S. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60879-5 · Cited by 1,251 · see citing works
Redline, S. S., Tishler, P. V., SCHLUCHTER, M. D., Aylor, J. E., Clark, K., & Graham, G. C. (1999) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.159.5.9809079 · Cited by 1,167 · see citing works
Sleep and mental disorders: a meta-analysis of polysomnographic research
Baglioni, C., Nanovska, S., Regen, W., Spiegelhalder, K., Feige, B., Nissen, C., Reynolds, C. F., & Riemann, D. (2016) · Psychological Bulletin · doi:10.1037/bul0000053 · Cited by 1,074 · see citing works
The visual scoring of sleep in adults
Silber, M. H., Ancoli-Israel, S., Bonnet, M. H., Chokroverty, S., Grigg-Damberger, M. M., Hirshkowitz, M., Kapen, S., Keenan, S. A., Kryger, M. H., Penzel, T., et al. (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26814 · Cited by 1,064 · see citing works
Machine learning and its applications to biology
Tarca, A. L., Carey, V. J., Chen, X.-W., Romero, R., & Drăghici, S. (2007) · PLoS Computational Biology · doi:10.1371/journal.pcbi.0030116 · Cited by 656 · see citing works
The Familial Aggregation of Obstructive Sleep Apnea
Redline, S., Tishler, P. V., Tosteson, T. D., Williamson, J., Kump, K., Browner, I., Ferrette, V., & Krejci, P. (1995) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm/151.3_pt_1.682 · Cited by 473 · see citing works
Zhong, X., Hilton, H. J., Gates, G. J., Jelic, S., Stern, Y., Bartels, M. N., DeMeersman, R. E., & Basner, R. C. (2005) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00620.2004 · Cited by 468 · see citing works
Caples, S. M., Gami, A. S., & Somers, V. K. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-3-200502010-00010 · Cited by 462 · see citing works
Heart rate variability in obesity and the effect of weight loss
Karason, K., Mølgaard, H., Wikstrand, J., & Sjöström, L. (1999) · The American Journal of Cardiology · doi:10.1016/s0002-9149(99)00066-1 · Cited by 402 · see citing works
Heart rate variability and inflammation: A meta-analysis of human studies
Williams, D. P., Koenig, J., Carnevali, L., Sgoifo, A., Jarczok, M. N., STERNBERG, E. M., & Thayer, J. F. (2019) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2019.03.009 · Cited by 367 · see citing works
O’Reilly, C., Gosselin, N., Carrier, J., & Nielsen, T. (2014) · Journal of Sleep Research · doi:10.1111/jsr.12169 · Cited by 358 · see citing works
Effects of sleep deprivation on neural circulatory control
Kato, M., Phillips, B. G., Sigurdsson, G., Narkiewicz, K., Pesek, C. A., & Somers, V. K. (2000) · Hypertension · doi:10.1161/01.hyp.35.5.1173 · Cited by 348 · see citing works
(2006) · Technical Report Series 936 · doi:10.2471/trs.06.930 · Cited by 347 · see citing works
Successful Separation of Depressed, Normal, and Insomniac Subjects by EEG Sleep Data
Gillin, J. C. (1979) · Archives of General Psychiatry · doi:10.1001/archpsyc.1979.01780010091010 · Cited by 321 · see citing works
Relationship between major depression and heart rate variability.
Agelink, M. W., Boz, C., Ullrich, H., & Andrich, J. (2002) · Psychiatry Research · doi:10.1016/s0165-1781(02)00225-1 · Cited by 312 · see citing works
Scaling Up Scientific Discovery in Sleep Medicine: The National Sleep Research Resource
Dean, D. A., Goldberger, A. L., Mueller, R., Kim, M. J., Rueschman, M., Mobley, D. R., Sahoo, S. S., Jayapandian, C. P., Cui, L., Morrical, M. G., et al. (2016) · SLEEP · doi:10.5665/sleep.5774 · Cited by 311 · see citing works
Wake and sleep EEG provide biomarkers in depression
Steiger, A., & Kimura, M. (2009) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2009.08.013 · Cited by 302 · see citing works
Patel, S. R. (2019) · Annals of Internal Medicine · doi:10.7326/aitc201912030 · Cited by 269 · see citing works
Effect of acute sleep deprivation on vascular function in healthy subjects
Sauvet, F., Leftheriotis, G., Gomez-Merino, D., Langrume, C., Drogou, C., Van Beers, P., Bourrilhon, C., Florence, G., & Chennaoui, M. (2010) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00851.2009 · Cited by 268 · see citing works
Relation of obesity and diet to sympathetic nervous system activity.
Troisi, R. J., Weiss, S. T., Parker, D. R., Sparrow, D., Young, J. B., & Landsberg, L. (1991) · Hypertension · doi:10.1161/01.hyp.17.5.669 · Cited by 267 · see citing works
Rich, M. W., Saini, J., Kleiger, R. E., Carney, R. M., teVelde, A., & Freedland, K. E. (1988) · The American Journal of Cardiology · doi:10.1016/0002-9149(88)91208-8 · Cited by 259 · see citing works
Baune, B., Smith, E., Reppermund, S., Air, T., Samaras, K., Lux, O., Brodaty, H., Sachdev, P. S., & Trollor, J. N. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.02.006 · Cited by 184 · see citing works
Balogh, S. E., Fitzpatrick, D., Hendricks, S. F., & Paige, S. R. (1993) · PubMed · Cited by 137 · see citing works
Impact of obesity on autonomic modulation, heart rate and blood pressure in obese young people
Rossi, R. C., Vanderlei, L. C. M., Toledo, A. C. C. G., Vanderlei, F. M., Bernardo, A. F. B., Yamada, K. M. H., da Silva, N. T., & de Abreu, L. C. (2015) · Autonomic Neuroscience · doi:10.1016/j.autneu.2015.07.424 · Cited by 129 · see citing works
Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders
Robillard, R., Hermens, D. F., Naismith, S. L., White, D., Rogers, N. L., Ip, T. K. C., Mullin, S. J., Alvares, G. A., Guastella, A. J., Smith, K. L., et al. (2015) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.130247 · Cited by 119 · see citing works
Self-citationCastro‐Diehl, C., Roux, A. V. D., Redline, S. S., Seeman, T. E., Shrager, S., & Shea, S. A. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-1198 · Cited by 104 · see citing works
Peripheral vascular endothelial growth factor as a novel depression biomarker: A meta-analysis
Carvalho, A. F., Köhler, C. A., McIntyre, R. S., Knöchel, C., Brunoni, A. R., Thase, M. E., Quevedo, J., Fernandes, B. S., & Berk, M. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.07.002 · Cited by 86 · see citing works
Harrison, N. A., Cooper, E., Voon, V., Miles, K., & Critchley, H. D. (2013) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2013.02.001 · Cited by 76 · see citing works
The Relationship between Psychiatric Illness and the Circadian Pattern of Heart Rate
Stampfer, H. G. (1998) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048679809062728 · Cited by 51 · see citing works
Vascular Endothelial Growth Factor: A potential diagnostic biomarker for major depression
Clark-Raymond, A., Meresh, E., Hoppensteadt, D., Fareed, J., Sinacore, J., & Halaris, A. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.08.005 · Cited by 42 · see citing works
Pawlowski, M. A., Gazea, M., Wollweber, B., Dresler, M., Holsboer, F., Keck, M. E., Steiger, A., Adamczyk, M., & Mikoteit, T. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.03.026 · Cited by 35 · see citing works
Changes in Heart Rate Variability in Response to Treatment With Electroconvulsive Therapy
Karpyak, V. M., Rasmussen, K. G., Hammill, S. C., & Mrazek, D. A. (2004) · Journal of Ect · doi:10.1097/00124509-200406000-00002 · Cited by 30 · see citing works
Reliability of Circadian Heart Pattern Analysis in Psychiatry
Iverson, G. L., Stampfer, H. G., & Gaetz, M. (2002) · Psychiatric Quarterly · doi:10.1023/a:1016036704524 · Cited by 24 · see citing works
The National Sleep Research Resource
Zhang, G., Cui, L., Mueller, R., et al. (2018) · ACM International Conference on Bioinformatics, Computational Biology, and Health Informatics (ACM-BCB) · doi:10.1145/3233547.3233725 · Cited by 10 · see citing works
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Rykov, Y., Thach, T.-Q., Bojic, I., Christopoulos, G., & Car, J. (2021) · JMIR mHealth and uHealth · doi:10.2196/24872 · Cited by 151 · see citing works
Tazawa, Y., Liang, K.-C., Yoshimura, M., Kitazawa, M., Kaise, Y., Takamiya, A., Kishi, A., Horigome, T., Mitsukura, Y., Mimura, M., et al. (2020) · Heliyon · doi:10.1016/j.heliyon.2020.e03274 · Cited by 101 · see citing works
- Authors
- Saad, M., Ray, L. B., Bujaki, B., Parvaresh, A., Palamarchuk, I., De Koninck, J., Douglass, A., Lee, E. K., Soucy, L. J., Fogel, S., Morin, C. M., Bastien, C., Merali, Z., & Robillard, R.
- Affiliations
- University of Ottawa (CA)
- Royal Ottawa Mental Health Centre (CA)
- Institut Universitaire en Santé Mentale de Québec (CA)
- Université Laval (CA)
- Corresponding author
- Robillard, Rébecca
- ORCID
- Venue
- BMC Psychiatry
- Published
- 2019-06-07
- Volume
- 19
- Issue
- 1
- Pages
- 168-168
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC6554996
- OpenAlex
- W2948133932
- Cited by
- 37
- References
- 44
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 9 · 2020: 2
- FWCI
- 2.89
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- uO Research (University of Ottawa) (submittedVersion, public-domain)
- Funders
- Canadian Institutes of Health Research
- The Royal's Institute of Mental Health Research
- Medibio Limited
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- depression, heart rate during sleep, biomarkers, polysomnography, autonomic dysfunction, sleep disorders, insomnia, depression diagnosis, machine learning classification
- MeSH terms
- Machine Learning, Adolescent, Adult, Aged, Aged, 80 and over, Depression, Electrocardiography, Electroencephalography, Female, Heart Rate, Humans, Male, Middle Aged, Retrospective Studies, Sleep, Sleep Wake Disorders, Polysomnography, Young Adult
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