Risk of depressive symptom burden across central disorders of hypersomnolence: A nationwide multicenter study

Abstract

Introduction: Central disorders of hypersomnolence (CDH) significantly impair quality of life, yet the burden of depressive symptoms across their subtypes remains poorly understood. We aimed to examine the clinical profiles and risk factors for depression burden among patients with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH). Methods: We included 171 patients from 11 tertiary sleep centers in South Korea and 69 patients with CDH from Seoul National University Hospital. We analyzed data from polysomnography and the multiple sleep latency test. Depression burden was assessed using the Beck Depression Inventory-II (BDI-II) or Patient Health Questionnaire9 (PHQ-9) (n = 119). Multivariable logistic regression was performed to identify independent risk factors for depression burden. Results: The prevalence of depression burden (BDI-II >= 16 or PHQ-9 >= 10) and clinical insomnia (Insomnia Severity Index >= 15) were 52.9% and 38.7%, respectively. The risk of depression burden was most pronounced in patients with IH (63.9%), whereas the NT2 group (36.7%) showed a significantly lower risk (OR 0.26; 95% CI 0.09-0.78, with IH as the reference). Clinical insomnia (OR 5.08; 95% CI 2.10-12.29), and young adults aged 19-29 years (OR 3.12; 95% CI 1.02-9.86) were significant risk factors for depression burden. Conclusion: More than half of patients with CDH experience a substantial depressive burden, which is most prominent in those with IH. These findings highlight the importance of regular psychiatric screening and integrated multidisciplinary care to improve clinical outcomes and quality of life.