ArticleBMC psychiatry2025
Associations between sleep duration with depression and the mediating role of physical activity in patients with chronic respiratory diseases: evidence from three nationwide population-based studies.
Article in BMC psychiatry, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChronic obstructive pulmonary disease (COPD), asthma, and asthma-COPD overlap (ACO) are common chronic respiratory diseases that could cause severe mental disorders. Sleep duration and physical activity (PA) are related to depression in various diseases. However, their roles in patients with chronic respiratory diseases remain unknown.
objectiveThis study was designed to investigate the potential relationship among sleep duration, PA, and depression in patients with respiratory disorders.
methodsData from CHARLS, KNHANES, and NHANES were collected. Generalized linear model (GLM) was applied to investigate the link among sleep duration, PA, and depression. Subgroup analyses were performed. Restricted cubic splines (RCS) were applied to investigate possible nonlinear correlations between sleep duration and depression. Additionally, mediation analysis assessed whether PA mediated the association between sleep duration and depression. Network analysis were performed to explore the core symptoms.
resultsSleep duration was significantly associated with depression. Gender-stratified analyses showed a stronger association with depression in males in CHARLS and NHANES. Subgroup analysis by respiratory disease subtypes (COPD, asthma, and ACO) revealed consistent inverse associations between sleep duration and depression across all cohorts. RCS revealed that sleep duration exhibited a nonlinear association with depression severity in three cohorts. Mediation analysis demonstrated that PA accounted for 24.1 % (CHARLS), and 25.5 % (KNHANES) of the sleep duration - depression relationship. According to strength centrality, node CESD3 ‘Felt sadness’ and node CESD2 ‘Trouble focus’ represented the most central positions of the network in CHARLS. In KNHANES and NHANES, node PHQ2 ‘Feeling down, hopeless’ and node PHQ6 ‘Guilt’ as the core symptoms.
conclusionThis study confirms that sleep duration is consistently linked to depression in COPD, asthma, and ACO patients across three countries. PA partially mediates this connection. Key depressive symptoms (e.g., sadness, guilt) were most strongly tied to sleep and activity patterns. Clinicians should consider both sleep and physical activity when managing depression in these patients. Further research is needed to confirm causality and refine interventions.
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