Regular sleep patterns, not just duration, critical for mental health: association of accelerometer-derived sleep regularity with incident depression and anxiety

Abstract

Background Depression and anxiety are prevalent mental health disorders. While sleep duration has been extensively studied, sleep regularity may play a critical role. We aimed to examine associations between objectively measured sleep regularity and incident depression and anxiety and to investigate whether meeting recommended sleep duration modifies these associations. Methods In 79,666 UK Biobank participants without baseline depression or anxiety, wrist accelerometers worn for 7 days yielded a sleep regularity index (SRI) and average sleep duration. SRI was categorized as irregular (≤51), moderately irregular (52-70), or regular (≥71). Sleep duration was classified by age-specific recommendations (7-9 hours for ages 18-64 years; 7-8 hours for over 65 years). Cox regression models assessed associations between sleep parameters and mental health outcomes. Results During a median follow-up of 7.5 years, 1,646 participants developed depression, and 2,097 developed anxiety. Compared to irregular sleepers, regular sleepers had a 38% lower depression risk (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.52-0.73) and a 33% lower anxiety risk (HR, 0.67; 95%CI, 0.58-0.77). Participants with both irregular sleep and nonrecommended duration exhibited the highest risks (depression HR, 1.91; 95%CI, 1.55-2.35; anxiety HR, 1.61; 95%CI, 1.35-1.93). Notably, irregular sleepers who met duration guidelines still faced elevated risks (depression HR, 1.48; 95%CI, 1.18-1.86; anxiety HR, 1.35; 95%CI, 1.11-1.64). Conclusions Greater sleep regularity is independently associated with lower depression and anxiety risk regardless of sleep duration, suggesting that sleep-wake consistency should be considered in mental health promotion strategies alongside traditional sleep duration recommendations.