Physical Activity as a Moderator for Insomnia and Depression Symptoms: EPISONO Eight-Year Cohort Study

Background: Symptoms of depression and anxiety are frequent among patients with chronic insomnia. Physical activity (PA) has a positive effect on both psychiatric disorders and insomnia and is promoted as a non-pharmacological preventive/treatment strategy. We aimed to assess the association between PA levels and sleep quality, the incidence of insomnia, symptoms of depression and anxiety, sleepiness, fatigue, and quality of life in a probabilistic sample of the general population. Methods: 1,042 volunteers aged between 20 and 80 years old were analyzed in an eight-year cohort study - the Sao Paulo Epidemiologic Sleep Study (EPISONO 2007-2015), through polysomnography and questionnaires. The volunteers were assessed for their PA levels, perceived quality of life, daytime sleepiness, symptoms of depression and anxiety, fatigue, sleep quality and incidence of insomnia. Outcomes: Physically active volunteers had a lower risk of developing moderate-severe insomnia compared with non-active individuals (RR=0·25, 95%CI=0·08-0·74). In addition, individuals with insomnia classified as physically active had a lower risk of developing depression symptoms compared with non-active individuals (RR=0·46, 95%CI=0·24-0·90), and a better perception of their quality of life. Interpretation: Higher PA levels had a protective effect on the relative risk of developing symptoms of depression, and was associated with a better perception of quality of life in individuals with insomnia. Trial Registration: ClinicalTrials.gov (NCT00596713) Funding Statement: EPISONO study was supported by Associacao Fundo de Incentivo a Pesquisa (AFIP). Authors grants: MMN (FAPESP: #2018/15921-8), RVTS (FAPESP: 2017/26563- 2), LB (CNPq 300674/2013-9), MLA (CNPq 303756/2017-9), HKMA (CNPq 310276/2017-9), ST (CNPq 306138/2017-4) Declaration of Interests: All authors declare no conflict of interest. Ethics Approval Statement: The study was approved by the Ethics Committee for Research of the Universidade Federal de Sao Paulo/Hospital Sao Paulo (CEP 0593/06). Informed consent was obtained from all the participants.