Relationship among Sleep Quality, Heart Rate Variability, Fatigue, Depression, and Anxiety in Adults

Ju Ah Kim; Seung Wan Kang

doi:10.7469/kjan.2017.29.1.87

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Kim and Kang: Relationship among Sleep Quality, Heart Rate Variability, Fatigue, Depression, and Anxiety in Adults

Original Article

Korean J Adult Nurs 2017;29(1):87-97.

Published online: NaN February 2017

DOI: https://doi.org/10.7469/kjan.2017.29.1.87

Relationship among Sleep Quality, Heart Rate Variability, Fatigue, Depression, and Anxiety in Adults

Ju Ah Kim, MSN, RN¹, Seung Wan Kang, Ph.D., MD^2,

^¹Doctoral Student, College of Nursing, Seoul National University, Seoul

^²Assistant Professor, College of Nursing, Seoul National University, Seoul, Korea

Corresponding author: Kang, Seung Wan College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-747-7422, Fax: +82-2-745-7422, E-mail: drdemian@snu.ac.kr

Received 16 January 201722 February 2017 Accepted 26 February 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to investigate the relationship among sleep quality, heart rate variability (HRV), fatigue, depression, and anxiety reported by Korean adults.

Methods

A cross-sectional study of 208 adults aged 20~60 years was conducted using a short-term HRV analysis and self-reported questionnaires of Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale, Beck Depression Inventory, and State Trait Anxiety Inventory.

Results

Subjects with good sleep quality (PSQI score≤5) had higher HRV total power (t=2.03, p=.043) and high-frequency (t=2.04, p=.043) with lower fatigue (t=-4.08, p<.001), depressive mood (t=-3.66, p<.001), and trait anxiety (t=-3.84, p<.001) than subjects with poor sleep quality. Poor sleep quality was negatively correlated with HRV total power (r=-.17, p=.016), high-frequency (r=-.14, p=.049), and positively fatigue (r=.39, p<.001), depression (r=.44, p<.001), state anxiety (r=.23, p=.001) and trait anxiety (r=.34, p<.001).

Conclusion

The results indicated that sleep quality is correlated with HRV which reflects the activities of the autonomic nerve system, fatigue, depression, and anxiety in adults.

Keywords: Sleep, Heart rate, Fatigue, Depression, Anxiety

REFERENCES

1.Sohn CH., Kim MS., Kim HJ., Kim SY., Lee JH., Jhun HJ, et al. Sleep patterns and morning heart rate variability among daytime workers in Korea. Korean Journal of Occupational and Environmental Medicine. 2005. 17(3):208–15.

2.Kim O., Kim AJ., Kim SW., Baik SH., Yang KM. Fatigue, depression and sleep in young adult and middle-aged. Journal of Korean Academy of Nursing. 2003. 33(5):618–24.

3.National Health Insurance Service. Sleeping disorder 2015 [Internet]. Wonju: National Health Insurance Service Korea;2015. [cited 2015 October 15]. Available from:. http://www.nhis.or.kr/menu/retriveMenuSet.xx?menuId=D4000.

4.Asghari A., Farhadi M., Kamrava SK., Ghalehbaghi B., Nojomi M. Subjective sleep quality in urban population. Archives of Iranian Medicine. 2012. 15(2):95–8.

5.Eun GS., Cha SE. Survey on sleep duration and associated factors among men and women in Korea. Statistics Research. 2010. 15(2):82–103.

6.Yu JH., Rawtaer I., Fam J., Jiang MJ., Feng L., Kua EH, et al. Sleep correlates of depression and anxiety in an elderly Asian population. Psychogeriatrics. 2016. 16(3):191–5. https://doi.org/10.1111/psyg.12138.

7.Xhyheri B., Manfrini O., Mazzolini M., Pizzi C., Bugiardini R. Heart rate variability today. Progress in Cardiovascular Diseases. 2012. 55(3):321–31. https://doi.org/10.1016/j.pcad.2012.09.001.

8.Suh S., Ellis RJ., Sollers JJ., Thayer JF., Yang HC., Emery CF. The effect of anxiety on heart rate variability, depression, and sleep in chronic obstructive pulmonary disease. Journal of Psychosomatic Research. 2013. 74(5):407–13. https://doi.org/10.1016/j.jpsychores.2013.02.007.

9.Stein PK., Pu Y. Heart rate variability, sleep and sleep disorders. Sleep Medicine Reviews. 2012. 16(1):47–66. https://doi.org/10.1016/j.smrv.2011.02.005.

10.Kageyama T., Nishikido N., Kobayashi T., Kurokawa Y., Kaneko T., Kabuto M. Self-reported sleep quality, job stress, and daytime autonomic activities assessed in terms of short-term heart rate variability among male white-collar workers. Industrial Health. 1998. 36(3):263–72.

11.Dishman RK., Nakamura Y., Garcia ME., Thompson RW., Dunn AL., Blair SN. Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. International Journal of Psychophysiology. 2000. 37(2):121–33. https://doi.org/10.1016/S0167-8760(00)00085-4.

12.Lee CK., Yoo SK. An analysis of relationship between self-reported anxiety, depressiveness and parametors of heart rate variability based on photoplethysmography. Korean Journal of the Science of Emotion & Sensibility. 2012. 15(3):345–54.

13.Zhong X., Hilton HJ., Gates GJ., Jelic S., Stern Y., Bartels MN, et al. Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation. Journal of Applied Physiology. 2005. 98(6):2024–32. https://doi.org/10.1152/japplphysiol.00620.2004.

14.Åkerstedt T., Axelsson J., Lekander M., Orsini N., Kecklund G. Do sleep, stress, and illness explain daily variations in fatigue? A prospective study. Journal of Psychosomatic Research. 2014. 76(4):280–5. https://doi.org/10.1016/j.jpsychores.2014.01.005.

15.Boneva RS., Decker MJ., Maloney EM., Lin JM., Jones JF., Helga-son HG, et al. Higher heart rate and reduced heart rate variability persist during sleep in chronic fatigue syndrome: a population-based study. Autonomic Neuroscience. 2007. 137(1):94–101. https://doi.org/10.1016/j.autneu.2007.08.002.

16.O'Leary K., Bylsma LM., Rottenberg J. Why might poor sleep quality lead to depression? A role for emotion regulation. Cognition and Emotion. 2016. 1–9. https://doi.org/10.1080/02699931.2016.1247035.

17.Yang AC., Tsai SJ., Yang CH., Kuo CH., Chen TJ., Hong CJ. Reduced physiologic complexity is associated with poor sleep in patients with major depression and primary insomnia. Journal of Affective Disorders. 2011. 131(1):179–85. https://doi.org/10.1016/j.jad.2010.11.030.

18.Lee KS., Lee DB., Kwon IS., Cho YC. Depressive symptoms and their association with sleep quality, occupational stress and fatigue among small-scaled manufacturing male workers. Korean Journal of Occupational and Environmental Medicine. 2011. 23(2):99–111.

19.Nyer M., Farabaugh A., Fehling K., Soskin D., Holt D., Papakostas GI, et al. Relationship between sleep disturbance and depression, anxiety, and functioning in college students. Depression and Anxiety. 2013. 30(9):873–80. https://doi.org/10.1002/da.22064.

20.Buysse DJ., Reynolds CF., Monk TH., Berman SR., Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research. 1989. 28(2):193–213.

21.Sohn SI., Kim DH., Lee MY., Cho YW. The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep and Breathing. 2012. 16(3):803–12. https://doi.org/10.1007/s11325-011-0579-9.

22.Krupp LB., LaRocca NG., Muir-Nash J., Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology. 1989. 46(10):1121–3.

23.Rhee MK., Lee YH., Park SH., Sohn CH., Chung YC, et al. A standardization study of Beck Depression Inventory 1 - Korean version (K - BDI): reliability and factor analysis. The Korean Journal of Psychopathology. 1995. 4(1):77–95.

24.Beck AT., Steer RA., Carbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review. 1988. 8(1):77–100.

25.Spielberger CD. State-trait anxiety inventory: a comprehensive bibliography. Consulting Psychologists Press;1989.

26.Chang AK., Choi J. Predictors of sleep quality among young adults in Korea: gender differences. Issues in Mental Health Nursing. 2016. 37(12):918–28. https://doi.org/10.1080/01612840.2016.1235636.

27.Curcio G., Ferrara M., Gennaro LD. Sleep loss, learning capacity and academic performance. Sleep Medicine Reviews. 2006. 10(5):323–37. https://doi.org/10.1016/j.smrv.2005.11.001.

28.Gouin JP., Wenzel K., Boucetta S., O'Byrne J., Salimi A., Dang-Vu TT. High-frequency heart rate variability during worry predicts stress-related increases in sleep disturbances. Sleep Medicine. 2015. 16(5):659–64. https://doi.org/10.1016/j.sleep.2015.02.001.

29.Park MS., Choi MA., Lee HK., Lee MH. Quality of sleep and heart rate variability by physical activity in high school students. Child Health Nursing Research. 2015. 21(3):195–203. https://doi.org/10.4094/chnr.2015.21.3.195.

30.Son YJ., Park YR. Relationships between sleep quality, fatigue and depression on health promoting behavior by shift-work patterns in university hospital nurses. Journal of Korean Biological Nursing Science. 2011. 13(3):229–37.

Figure 1.

Correlations between total power, high-frequency and sleep quality, depression.

Table 1.

Comparisons of General Characteristics by Sleep Quality (N=208)

Variables	Categories	Total (N=208)	Good sleepers (n=115)	Bad sleepers (n=93)	x² or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	63 (30.3)	38 (33.0)	25 (26.9)	0.93	.336
Gender	Female	145 (69.7)	77 (67.0)	68 (73.1)	0.93	.336
Age (year)	20~29	51 (24.5)	30 (26.1)	10 (10.8)	0.38	.998
	30~39	52 (25.0)	26 (22.6)	23 (24.7)
	40~49	52 (25.0)	30 (26.1)	34 (36.6)
	50~60	53 (25.5)	29 (25.2)	26 (28.0)
		40.56±11.72	40.52±11.60	40.61±11.94	-0.05	.959
Education level completed	≥High school	192 (92.3)	105 (91.3)	87 (93.5)	0.30	.582
Education level completed	＜High school	16 (7.7)	10 (8.7)	6 (6.5)	0.30	.582
Job	Employed	144 (69.2)	80 (69.6)	64 (68.8)	0.10	.761
Job	Unemployed	64 (30.8)	35 (30.4)	29 (31.2)	0.10	.761
Living status	Live alone	51 (24.5)	27 (23.5)	24 (25.8)	0.50	.823
Living status	Live with family	157 (75.5)	88 (76.5)	69 (74.2)	0.50	.823
Economic status	High	6 (2.9)	2 (1.7)	4 (4.3)	0.73	.833
	Middle	190 (91.3)	106 (92.2)	84 (90.3)
	Low	12 (5.8)	7 (6.1)	5 (5.4)
Presence of chronic disease	Yes	57 (27.4)	27 (23.5)	30 (32.3)	2.14	.144
Presence of chronic disease	No	151 (72.6)	88 (76.5)	63 (67.7)	2.14	.144
BMI (kg/m²)		23.39±3.33	23.54±3.69	23.22±2.83	0.71	.476
Body fat mass (%)		27.33±7.09	27.53±7.54	27.07±6.52	0.47	.643

Good sleepers=Pittsburgh sleep quality index score ≤5; Bad sleeper=Pittsburgh sleep quality index score＞5; BMI=body mass index.

Table 2.

Comparisons of Sleep Quality (N=208)

PSQI Subcategories	Range	Total (N=208)	Good sleepers (n=115)	Bad sleepers (n=93)	x² or t	p
PSQI Subcategories	Range	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	x² or t	p
Total PSQI score	0~21	5.65±3.15	3.46±1.32	8.35±2.60	-16.50	＜.001
Subjective sleep quality	0~3	1.20±0.74	0.83±0.53	1.65±0.72	-9.09	＜.001
Sleep latency (minute)	0 (≤15)	120 (57.7)	85 (73.9)	35 (37.6)	52.58	＜.001
	1 (16~30)	60 (28.8)	29 (25.2)	31 (33.3)
	2 (31~59)	20 (9.6)	1 (0.9)	19 (20.4)
	3 (≥60)	8 (3.8)	․	8 (8.6)
	0~3	1.03±0.95	0.54±0.61	1.65±0.93	-9.99	＜.001
Sleep duration (hour)	0 (≥7)	64 (30.8)	54 (47.0)	10 (10.8)	21.12	＜.001
	1 (6~7)	71 (34.1)	48 (41.7)	23 (24.7)
	2 (5~6)	44 (21.2)	10 (8.7)	34 (36.6)
	3 (＜5)	29 (13.9)	3 (2.6)	26 (28.0)
	0~3	1.18±1.02	0.67±0.75	1.82±0.97	-9.40	＜.001
Habitual sleep efficiency	0~3	0.46±0.85	0.06±0.24	0.95±1.06	-7.92	＜.001
Sleep disturbance	0~3	1.11±1.08	0.73±0.85	1.58±1.16	-5.92	＜.001
Frequency of taking sleeping pill	0 (0)	203 (97.6)	115 (100.0)	88 (94.6)	584.65	＜.001
	1 (≤1/week)	1 (0.5)	․	1 (1.1)
	2 (1~2/week)	2 (1.0)	․	2 (2.2)
	3 (≥3/week)	2 (1.0)	․	2 (2.2)
	0~3	0.05±0.36	0.00±0.00	0.12±0.53	-2.16	.034
Daytime dysfunction	0~3	0.52±0.80	0.30±0.58	0.81±0.95	-4.56	＜.001

PSQI=PittsburGh Sleep Quality Index.

Table 3.

Heart Rate Variability, Fatigue, Depression, and State Trait Anxiety by Sleep Quality (N=208)

Variables	Total (N=208)	Good sleepers (n=115)	Bad sleepers (n=93)	t	p
Variables	M±SD	M±SD	M±SD	t	p
Total power (ms²)	1,295.38±1,133.08	1,432.50±1,294.56	1125.83±871.49	2.03	.043
LF (ms²)	433.01±593.08	486.59±662.37	366.74±489.65	1.45	.148
HF (ms²)	304.57±395.88	351.97±467.80	245.96±274.19	2.04	.043
LF/HF ratio	2.72±3.94	2.56±3.44	2.93±4.50	-0.67	.501
FSS	2.94±1.41	2.59±1.23	3.37±1.50	-4.08	＜.001
BDI	6.45±6.12	5.06±5.34	8.16±6.61	-3.66	＜.001
S-STAI	36.78±8.89	35.75±8.89	38.07±8.78	-1.88	.062
T-STAI	39.62±10.43	37.20±9.55	42.61±10.74	-3.84	＜.001

LF=low frequency; HF=high frequency; LF/HF ratio=low frequency/ high frequency ratio; FSS=fatigue severity scale; BDI=beck depression inventory; S–STAI=state-state trait anxiety inventory; T-STAI=trait-state trait anxiety inventory.

Table 4.

Correlations of Sleep Quality, Fatigue, Depression, and Anxiety

Variables	PSQI	FSS	BDI	S-STAI	T-STAI
PSQI	1
FSS	.39 (＜.001)	1
BDI	.44 (＜.001)	.37 (＜.001)	1
S-STAI	.23 (.001)	.28 (＜.001)	.59 (＜.001)	1
T-STAI	.34 (＜.001)	.41 (＜.001)	.69 (＜.001)	.72 (＜.001)	1

PSQI=Pittsburgh sleep quality index; FSS=fatigue severity scale; BDI=beck depression inventory; S-STAI=state-state trait anxiety inventory; T-STAI=trait-state trait anxiety inventory.

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