Association between subjective sleep quality and depression on immunocompetence in low-income women at risk for cervical cancer

Objective: The purpose of this study was to investigate whether subjective sleep quality is more strongly associated with immunocompetence than depres sion among women at risk for cervical cancer. Methods: Participants were 91 women referred for colposcopy because of abnormal results on a Pap smear. On the day of the procedure, participants completed the Center for Epidemio logical Studies Depression Scale, two indices of subjective sleep quality ( ie, satisfaction with sleep obtained and degree of sleep restfulness), and a health behaviors assessment questionnaire. Levels of peripheral blood lym phocyte subpopulations (helper T, cytotoxic/suppressor T, NK, and B cells) were also assessed at this time. Approximately 10 days later, the presence of depressive disorder was assessed using the Structured Clinical Interview for DSM-III-R. Results: Hierarchical regression analyses revealed that sat isfaction with the amount of sleep obtained was significantly associated wi th the circulating number and percentage of helper T cells (T-H/CD4(+)) and the percentage of cytotoxic/suppressor T cells (T-C/CD8(+)), after control ling for confounder variables (ie, age, smoking status, and drug use). Depr ession was significantly associated only with the percentage of T-C cells. Sleep satisfaction remained significantly associated with the number and pe rcentage of T-H cells and percentage of T-C cells after controlling for the variance explained by depression. Conclusions: Results of this study sugge st that subjective sleep quality shares a significant and independent porti on of the variance with immunity that is not accounted for by depression. A lthough the long-term impact of these immune alterations on disease progres sion needs to be directly explored, it may be important to systematically s creen for and manage sleep disturbance in women at high risk for cervical c ancer.