The Relationship between Perceived Sleep Quality, Polysomnographic Measures and Depressive Symptoms in Chemically-Injured Veterans: A Pilot Study


Objective: Sleep complaints are common among Iranian chemically-injured veterans. The growing body of research has investigated (in) equalities between such subjective complaints and objective sleep records. Moreover, sleep complaints are associated with depressive symptoms. Depressive symptoms, also, have been frequently reported in chemically-injured veterans. Therefore, the purpose of this pilot study was to investigate the relationship between perceived sleep quality, polysomnographic measures and depressive symptoms in Iranian veterans with chemical injuries.
Methods: In this pilot study, 35 Iranian veterans with chemical injuries complaining of a sleep problem were selected. Initially, participants were evaluated via all-night polysomnography, then, they completed the research questionnaires. Collected data were analyzed using Pearson correlation coefficients.
Results: Data analyses showed that there was no significant correlation between many of self-reposted variables and polysomnogaphic recordings, h wever, remarkable relationships were found between the Pittsburgh Sleep Quality Index and the Beck Depression Inventory scores.
Conclusion: The findings indicated that sleep complaints of chemically-injured veterans are not equivalent to objective sleep disturbances, however, these complaints are largely associated with level of depression. This study emphasizes the important role of mood in sleep evaluation. Further, the findings suggest using a combination of both subjective and objective measures for accurate assessment of sleep quality in Iranian veterans with chemical injuries (i.e., multimethod approach).

Vahedi E, Taheri S, Alaedini F, Poursaleh Z, Ameli J , Ghanei M. Correlations of sleep disorders with severity of obstructive airway disease in mustard gas-injured patients. Sleep Breath 2012; 16: 443-451.

Tavallaie SA, Asaari S, Habibi M. Subjective sleep quality in chemical warfare veterans. J Psychiatry Clin Psych 2006; 12: 263-269.

Madarshahian F, Hassanabadi M. [Sleep disturbances in chemical and non-chemical war victims (Persian)]. Iran J War Public Health 2009; 2: 27-32.

Hirshkowitz M, Seplowitz-Hafkin RG, Sharafkhaneh A. Sleep Disorders. In: Sadock BJ, Sadock VA, Ruiz P, eds. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, 9th eds. Lippincott Williams & Wilkins, 2009.

Lund HG. The discrepancy between subjective and objective measures of sleep in older adults receiving CBT for comorbid insomnia [Dissertation]. USA, Richmond: Virginia Commonwealth University; 2011.

Majer M, Jones JF, Unger ER, et al. Perception versus polysomnographic assessment of sleep in CFS and non-fatigued control subjects: results from a population-based study. BMC Neurol 2007; 7: 40.

Hossain JL, Ahmad P, Reinish LW, Kayumov L, Hossain NK , Shapiro CM. Subjective fatigue and subjective sleepiness: two independent consequences of sleep disorders? J Sleep Res 2005; 14: 245-253.

Watson NF, Kapur V, Arguelles LM, Goldberg J, Schmidt DF, Armitage R, et al. Comparison of subjective and objective measures of insomnia in monozygotic twins discordant for chronic fatigue syndrome. Sleep 2003; 26: 324-328.

Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14: 540-545.

Hebert S, Fullum S, Carrier J. Polysomnographic and quantitative electroencephalographic correlates of subjective sleep complaints in chronic tinnitus. J Sleep Res 2011; 20: 38-44.

Vitiello MV, Larsen LH , Moe KE. Age-related sleep change: Gender and estrogen effects on the subjective-objective sleep quality relationships of healthy, noncomplaining older men and women. J Psychosom Res 2004; 56: 503-510.

Hall M, Buysse DJ, Nowell PD, Nofzinger EA, Houck P, Reynolds CF, 3rd, et al. Symptoms of stress and depression as correlates of sleep in primary insomnia. Psychosom Med 2000; 62: 227-230.

Liscombe MP, Hoffmann RF, Trivedi MH, Parker MK, Rush AJ , Armitage R. Quantitative EEG amplitude across REM sleep periods in depression: preliminary report. J Psychiatry Neurosci 2002; 27: 40-46.

Foster FG, Kupfer DJ, Coble P, McPartland RJ. Rapid eye movement sleep density. An objective indicator in severe medical-depressive syndromes. Arch Gen Psychiatry 1976; 33: 1119-1123.

Thase ME, Buysse DJ, Frank E, Cherry CR, Cornes CL, Mallinger AG, et al. Which depressed patients will respond to interpersonal psychotherapy? The role of abnormal EEG sleep profiles. Am J Psychiatry 1997; 154: 502-509.

Riemann D, Hohagen F, Bahro M , Berger M. Sleep in depression: the influence of age, gender and diagnostic subtype on baseline sleep and the cholinergic REM induction test with RS 86. Eur Arch Psychiatry Clin Neurosci 1994; 243: 279-290.

van den Bemt L, Schermer T, Bor H, Smink R, van Weel-Baumgarten E, Lucassen P, et al. The risk for depression comorbidity in patients with COPD. Chest 2009; 135: 108-114.

Baran AS , Richert AC. Obstructive sleep apnea and depression. CNS Spectr 2003; 8: 128-134.

Vafaee B, Seidy A. Prevalence of depression among physically disabled veterans in northwestern Iran. Iran J Med Sci 2004; 29: 43-44.

Farrahi-Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16: 79-82.

Beck AT, Steer RA, Ball R , Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996; 67: 588-597.

Ghassemzadeh H, Mojtabai R, Karamghadiri N , Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety 2005; 21: 185-192.

Ghoshal AG, Sarkar S, Roy DJ, Das RK , Ray M. Polysomnographic profile in a sleep laboratory in Kolkata: a retrospective analysis of 714 cases. J Assoc Physicians India 2010; 58: 415-419.

Loredo JS, Ancoli-Israel S, Kim EJ, Lim WJ, Dimsdale JE. Effect of continuous positive airway pressure versus supplemental oxygen on sleep quality in obstructive sleep apnea: a placebo-CPAP-controlled study. Sleep 2006; 29: 564-571.

Leger D, Guilleminault C, Dreyfus JP, Delahaye C, Paillard M. Prevalence of insomnia in a survey of 12,778 adults in France. J Sleep Res 2000; 9: 35-42. Tsuchiyama K, Nagayama H, Kudo K, Kojima K , Yamada K. Discrepancy between subjective and objective sleep in patients with depression. Psychiatry Clin Neurosci 2003; 57: 259-264.

Hayashida K, Inoue Y, Chiba S, Yagi T, Urashima M, Honda Y, et al. Factors influencing subjective sleepiness in patients with obstructive sleep apnea syndrome. Psychiatry Clin Neurosci 2007; 61: 558-563.

Hayashida K, Inoue Y, Chiba S, T Yagi, M Urashima, . Factors influencing subjective sleepiness in patients with obstructive sleep apnea syndrome. Psychiatry Clin Neurosci 2007; 61: 558–563.

Dhruva A, Paul SM, Cooper BA, Lee K, West C, Aouizerat BE, et al. A longitudinal study of measures of objective and subjective sleep disturbance in patients with breast cancer before, during, and after radiation therapy. J Pain Symptom Manage 2012; 44: 215-228.

Quera-Salva MA, Orluc A, Goldenberg F, Guilleminault C. Insomnia and use of hypnotics: study of a French population. Sleep 1991; 14: 386-391.

Argyropoulos SV, Hicks JA, Nash JR, Bell CJ, Rich AS, Nutt DJ, et al. Correlation of subjective and objective sleep measurements at different stages of the treatment of depression. Psychiatry Res 2003; 120: 179-190.

Rotenberg VS, Indursky P, Kayumov L, Sirota P, Melamed Y. The relationship between subjective sleep estimation and objective sleep variables in depressed patients. Int J Psychophysiol 2000; 37: 291-297.

Beck AT. Depression: Causes and treatment. Philadelphia, University of Pennsylvania Press; 1967.

Benca RM, Obermeyer WH, Thisted RA , Gillin JC. Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psychiatry 1992; 49: 651-668; discussion 669-670.

Riemann D, Berger M , Voderholzer U. Sleep and depression--results from psychobiological studies: an overview. Biol Psychol 2001; 57: 67-103.

Omvik S, Pallesen S, Bjorvatn B, Sivertsen B, Havik OE , Nordhus IH. Patient characteristics and predictors of sleep medication use. Int Clin Psychopharmacol 2010; 25: 91-100.

Pallesen S, Nordhus IH, Nielsen GH, Havik OE, Kvale G, Johnsen BH, et al. Prevalence of insomnia in the adult Norwegian population. Sleep 2001; 24: 771-779.

Kaneita Y, Uchiyama M, Takemura S, Yokoyama E, Miyake T, Harano S, et al. Use of alcohol and hypnotic medication as aids to sleep among the Japanese general population. Sleep Med 2007; 8: 723-732.

Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. Sleep 2006; 29: 85-93.

Khateri S, Ghanei M, Keshavarz S, Soroush M , Haines D. Incidence of lung, eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent. J Occup Environ Med 2003; 45: 1136-1143.

Kushida CA, Chang A, Gadkary C, Guilleminault C, Carrillo O , Dement WC. Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients. Sleep Med 2001; 2: 389-396.

Diener E, Eid M. Handbook of multimethod measurement in psychology. Washington, DC: American Psychological Association; 2006.

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How to Cite
Moshkani Farahani D, Tavallaie A, Vahedi E, Rezaiemaram P, Naderi Z, Talaie A. The Relationship between Perceived Sleep Quality, Polysomnographic Measures and Depressive Symptoms in Chemically-Injured Veterans: A Pilot Study. Iran J Psychiatry. 1;9(3):169-74.