Association of Sleep Reactivity and Anxiety Sensitivity with Insomnia-Related Depression and Anxiety among City Government Employees in Japan

Round 1

Reviewer 1 Report

This is interesting manuscript. However I found the following mainly minor flaws:

1. Please report your manuscript strictly in accordance to the STROBE Statement https://www.equator-network.org/reporting-guidelines/strobe/

Please use the STROBE checklist.

2. The introduction is poor. Please add a paragraph that sleep disorders including insomnia can present within the lifespan and paragraph about insomnia and COVID-19 pandemic which is important and current issue. Please write why your study is novel and important before the aim of study. Please use the following latest and reliable literature:

Topaloglu-Ak A, Kurtulmus H, Basa S, Sabuncuoglu O. Can sleeping habits be associated with sleep bruxism, temporomandibular disorders and dental caries among children? Dent Med Probl. 2022;59(4):517–522. doi:10.17219/dmp/150615

Kocevska D, Lysen TS, Dotinga A, Koopman-Verhoeff ME, Luijk MPCM, Antypa N, Biermasz NR, Blokstra A, Brug J, Burk WJ, Comijs HC, Corpeleijn E, Dashti HS, de Bruin EJ, de Graaf R, Derks IPM, Dewald-Kaufmann JF, Elders PJM, Gemke RJBJ, Grievink L, Hale L, Hartman CA, Heijnen CJ, Huisman M, Huss A, Ikram MA, Jones SE, Velderman MK, Koning M, Meijer AM, Meijer K, Noordam R, Oldehinkel AJ, Groeniger JO, Penninx BWJH, Picavet HSJ, Pieters S, Reijneveld SA, Reitz E, Renders CM, Rodenburg G, Rutters F, Smith MC, Singh AS, Snijder MB, Stronks K, Ten Have M, Twisk JWR, Van de Mheen D, van der Ende J, van der Heijden KB, van der Velden PG, van Lenthe FJ, van Litsenburg RRL, van Oostrom SH, van Schalkwijk FJ, Sheehan CM, Verheij RA, Verhulst FC, Vermeulen MCM, Vermeulen RCH, Verschuren WMM, Vrijkotte TGM, Wijga AH, Willemen AM, Ter Wolbeek M, Wood AR, Xerxa Y, Bramer WM, Franco OH, Luik AI, Van Someren EJW, Tiemeier H. Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis. Nat Hum Behav. 2021 Jan;5(1):113-122. doi: 10.1038/s41562-020-00965-x.

Lovato N, Lack L. Insomnia and mortality: A meta-analysis. Sleep Med Rev. 2019 Feb;43:71-83. doi: 10.1016/j.smrv.2018.10.004.

Chaput JP, Yau J, Rao DP, Morin CM. Prevalence of insomnia for Canadians aged 6 to 79. Health Rep. 2018 Dec 19;29(12):16-20.

Fila-Witecka K, Malecka M, Senczyszyn A, Wieczorek T, Wieckiewicz M, Szczesniak D, Piotrowski P, Rymaszewska J. Sleepless in Solitude-Insomnia Symptoms Severity and Psychopathological Symptoms among University Students during the COVID-19 Pandemic in Poland. Int J Environ Res Public Health. 2022 Feb 23;19(5):2551. doi: 10.3390/ijerph19052551.

   

Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021 Feb;8(2):130-140. doi: 10.1016/S2215-0366(20)30462-4. Epub 2020 Nov 9. Erratum in: Lancet Psychiatry. 2021 Jan;8(1):e1.

Morin CM, Bjorvatn B, Chung F, Holzinger B, Partinen M, Penzel T, Ivers H, Wing YK, Chan NY, Merikanto I, Mota-Rolim S, Macêdo T, De Gennaro L, Léger D, Dauvilliers Y, Plazzi G, Nadorff MR, Bolstad CJ, Sieminski M, Benedict C, Cedernaes J, Inoue Y, Han F, Espie CA. Insomnia, anxiety, and depression during the COVID-19 pandemic: an international collaborative study. Sleep Med. 2021 Nov;87:38-45. doi: 10.1016/j.sleep.2021.07.035.

Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, Zandi MS, Lewis G, David AS. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020 Jul;7(7):611-627. doi: 10.1016/S2215-0366(20)30203-0.

Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry. 2021 May;8(5):416-427. doi: 10.1016/S2215-0366(21)00084-5.

Bhat S, Chokroverty S. Sleep disorders and COVID-19. Sleep Med. 2022 Mar;91:253-261. doi: 10.1016/j.sleep.2021.07.021.

3. Authors cited a lot of old and very old references which are outdated. Please do not cite articles which are older than 10 years. You can use articles which are mentioned above instead of old references.

4. Please provide the name of the bioethics committee that approved the study and the approval number.

5. Please provide demographic data of the tested sample in Results not Materials and Methods.

6. Please describe precisely the process of questionnaire survey distribution and the tools that were used for it in Materials and Methods.

7. The last remark is related to the tested sample. I mean the tested sample is a group of city government employees in Japan. Therefore I recommend to use the following title "Association of Sleep Reactivity and Anxiety Sensitivity with Insomnia-Related Depression and Anxiety among city government employees in Japan". I recommend to revise the aim of the study within abstract and manuscript body. I mean please use "The present study aimed to examine whether sleep reactivity and anxiety sensitivity
are associated with insomnia-related depression and anxiety among city government employees in Japan.". You have to also revise the conclusions after all corrections because conclusions have to correspond with new title and aim.

 

Author Response

We would like to thank you for the time you spent reviewing this manuscript. We have found your comments very useful; they have helped us to improve the manuscript significantly. Listed below are the comments you provided and explanations regarding how we have addressed them.

This is interesting manuscript. However I found the following mainly minor flaws:

1. Please report your manuscript strictly in accordance to the STROBE Statement https://www.equator-network.org/reporting-guidelines/strobe/

Please use the STROBE checklist.

<Reply> Thank you for useful comment. We reviewed the STROBE statement, and added a power analysis and revised the text.

Revised manuscript; Line 89–90

A total 1810 employees (699 males, 1111 females, mean age (standard deviation): 45.33 (12.20) years) were completely responded to the measures (Figure 1).

Revised manuscript; Line 145–148

We conducted a post-hoc power analysis using the results of a multiple regression analysis for GAD-7 and PHQ-9 in this study. With regression dfs of 10, residual df of 198, f2 [R2] of 0.43 [0.30] and 0.32 [0.24], α = 0.001, power (1 – β) was estimated at 0.99, and 0.99, respectively.

Revised manuscript; Line 249–255

4.4. Sample size

The sample size was calculated based on a power analysis using an effect size f2, which was calculates with multiple regression analysis. With f2 = 0.15 (moderate effect size), α = 0.01, power (1 – β) was estimated at 0.80, it was calculated that a total sample size was 160. Since the general population has been reported that nearly 17% of them experience chronic insomnia [3], therefore, we recruited a thousand participants or more.

 

2. The introduction is poor. Please add a paragraph that sleep disorders including insomnia can present within the lifespan and paragraph about insomnia and COVID-19 pandemic which is important and current issue. Please write why your study is novel and important before the aim of study.

<Reply> Thank you for your kind comment. With regard to epidemiological studies, we replaced the mostly references that were less than 10 years old. However, the papers written on the key concepts and measures of this study were retained. Additionally, we have revised the manuscript to address this comment.

Revised manuscript; Line 29–40

Approximately 20–40% of the general population has been reported to experience insomnia symptoms [1–3] and nearly 17% of them experience chronic insomnia [3]. In addition, insomnia can present within the lifespan and be often chronicity [1,2], which is associated with the onset or recurrence of depression and resistance to depression treatment [4–6].

During coronavirus disease 2019 (COVID-19) pandemic, insomnia has become a serious issue. In an international collaborative study [7], 36.7% of community sample complained insomnia symptom. Insomnia during the pandemic associated with symptoms of posttraumatic stress and psychological distress [8]. In addition, infection anxiety during COVID-19 associated with insomnia, depression, and anxiety [9]. Furthermore, individuals diagnosed with COVID-19 have a higher risk of subsequently onset of insomnia disorder than those infected with other viruses (e.g., influenza) [10,11].

Revised manuscript; Line 72–74

However, previous studies have examined depression and anxiety symptoms without adequately distinguishing between their symptoms.

Revised manuscript; Line 78–83

If this hypothesis is proven, it becomes apparent which characteristics of anxiety sensitivity and sleep reactivity cause the specific emotional problems. In particular, a tendency for an increased risk of mortality associated with hypnotic use in individuals with insomnia was reported [32], the development and provision of more effective non-pharmacologic treatment is certainly important.

 

3. Authors cited a lot of old and very old references which are outdated. Please do not cite articles which are older than 10 years. You can use articles which are mentioned above instead of old references.

<Reply> With regard to epidemiological studies, we replaced the mostly references that were less than 10 years old. However, the papers written on the key concepts and measures of this study were retained.

 

4. Please provide the name of the bioethics committee that approved the study and the approval number.

<Reply> We have described them in procedure section; The study was approved by the ethics committee of Shiga University of Medical Science (R2017-111),

 

5. Please provide demographic data of the tested sample in Results not Materials and Methods.

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Line 90–93

In this study, 4.4% were taking sleep medication, 3.3% antianxiety medication, and 2.4% antidepressants. Of them, 0.6% were cardiovascular and 0.9% cerebral infarction, and 11.7% were shift workers.

 

6. Please describe precisely the process of questionnaire survey distribution andthe tools that were used for it in Materials and Methods.

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Line 209–214

A total of 2081 participants were government employees of Koka City, which is a rural city in Shiga Prefecture, Japan. Employees for whom the consent of a legal representative was required for participation were excluded in this study. Questionnaires were distributed to these employees and a total of 1852 participants returned the questionnaire. Of these, 1810 employees were completely responded to the measures (Figure 1). The questionnaire survey was conducted from October 1, 2021, to March 18, 2022.

 

7. The last remark is related to the tested sample. I mean the tested sample is a group ofcity government employees in Japan. Therefore I recommend to use the following title "Association of Sleep Reactivity and Anxiety Sensitivity with Insomnia-Related Depression and Anxiety amongcity government employees in Japan". I recommend to revise the aim of the study within abstract and manuscript body. I mean please use "The present study aimed to examine whether sleep reactivity and anxiety sensitivity are associated with insomnia-related depression and anxiety among city government employees in Japan.". You have to also revise the conclusions after all corrections because conclusions have to correspond with new title and aim.

 

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Title

Association of Sleep Reactivity and Anxiety Sensitivity with Insomnia-Related Depression and Anxiety among city government employees in Japan

Revised manuscript; Line 13–15

This study aimed to examine whether sleep reactivity and anxiety sensitivity are associated with insomnia-related depression and anxiety among city government employees in Japan.

Revised manuscript; Line 84–86

The present study aimed to examine whether sleep reactivity and anxiety sensitivity are associated with insomnia-related depression and anxiety among city government employees in Japan.

Revised manuscript; Line 150–152

This study aimed to examine whether sleep reactivity and anxiety sensitivity are associated with insomnia-related depression and anxiety among city government employees in Japan.

Revised manuscript; Line 199–202

Third, participants in this study were limited to city government employees. It would be necessary to confirm whether similar results can be obtained in a community sample in the future.

Revised manuscript; Line 280–282

Sleep reactivity was strongly related to depressive symptoms and anxiety sensitivity was highly associated with anxiety symptoms in city government employees with insomnia in Japan.

Reviewer 2 Report

In the current article titled "Association of Sleep Reactivity and Anxiety Sensitivity with Insomnia-Related Depression and Anxiety" by Isa Okajima et al, the authors have conducted a thorough survey of the city government employees of Koka City in Japan and presented data on the association of sleep reactivity and anxiety sensitivity with Insomnia-related depression and anxiety. The findings indicate that sleep reactivity is associated with depression, and anxiety sensitivity is associated with anxiety symptoms in individuals with insomnia. While the article presents a lot of information from the survey and outlines the summary accordingly, below are a few suggestions/comments that need to be addressed to further improve the quality of this article as well as increase the readership and citations for this article in the future.

1. Line 46: Change 'was' to 'is' in the statement (Anxiety sensitivity is defined as...)

2. Line 47: What is panic disorder? Define in this paragraph.

3. Are sleep reactivity and anxiety sensitivity associated with other diseases (eg. cancer and neurological/cardiovascular diseases)? Please consider describing it as a separate paragraph in the introduction or discussion.

4. Lines 117-118: Please state the symptoms that are called 'depressive symptoms' and 'anxiety symptoms' stated in these lines. What kind of symptoms are observed?

5. Lines 120-121: 'Prevalence' word is repeated twice, and the statement doesn't make clear sense. Please consider re-writing the statement.

6. Line 140: Please state a few examples of CBT-I treatment.

7. Line 147: Please state a few examples of CAST treatment.

8. Lines 161-163: It seems that a concluding statement is missing, please review the last statement "Depressive...latency" and consider adding another statement that appears to be a conclusion to these lines.

9. Lines 166-172: Were there any night shift workers that took the survey? How many participants were taking sleep/anxiety medications? How many participants taking the survey had cardiovascular or neurological diseases? Were participants asked to state daytime naps? ((Do these factors/questions affect the analysis and data interpretation? If so, please state briefly each of these factors in the '4.1 Participants' section of the Materials and Methods.))

10. Line 200: Correct the word 'parformed' to 'performed'.

Author Response

We would like to thank you for the time you spent reviewing this manuscript. We have found your comments very useful; they have helped us to improve the manuscript significantly. Listed below are the comments you provided and explanations regarding how we have addressed them.

In the current article titled "Association of Sleep Reactivity and Anxiety Sensitivity with Insomnia-Related Depression and Anxiety" by Isa Okajima et al, the authors have conducted a thorough survey of the city government employees of Koka City in Japan and presented data on the association of sleep reactivity and anxiety sensitivity with Insomnia-related depression and anxiety. The findings indicate that sleep reactivity is associated with depression, and anxiety sensitivity is associated with anxiety symptoms in individuals with insomnia. While the article presents a lot of information from the survey and outlines the summary accordingly, below are a few suggestions/comments that need to be addressed to further improve the quality of this article as well as increase the readership and citations for this article in the future.

1. Line 46: Change 'was' to 'is' in the statement (Anxiety sensitivity is defined as...)

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Line 56

Anxiety sensitivity is defined as

2. Line 47: What is panic disorder? Define in this paragraph.

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Line 57–59

It was one type of anxiety disorders characterized by repeated and frequently unanticipated panic attacks.

3. Are sleep reactivity and anxiety sensitivity associated with other diseases (eg. cancer and neurological/cardiovascular diseases)? Please consider describing it as a separate paragraph in the introduction or discussion.

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Line 63–65

Although there are no papers showing that sleep reactivity and anxiety sensitivity are associated with physical diseases, anxiety sensitivity has been found to be associated with pain severity in headache.

4. Lines 117-118: Please state the symptoms that are called 'depressive symptoms' and 'anxiety symptoms' stated in these lines. What kind of symptoms are observed?

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Line 152–154

The results showed that sleep reactivity was strongly associated with depressive symptoms such as hopeless, little energy, and poor appetite, and anxiety sensitivity was highly associated with anxiety symptoms such as nervous, worry, and irritable.

5. Lines 120-121: 'Prevalence' word is repeated twice, and the statement doesn't make clear sense. Please consider re-writing the statement.

<Reply> We have revised the manuscript to address this comment.

6. Line 140: Please state a few examples of CBT-I treatment.

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Line 179–181

For example, remission rates of CBT-I with eight weekly sessions were reported to 57% at post-treatment and 56% at 6-month follow-up [35].

7. Line 147: Please state a few examples of CAST treatment.

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Line 185–187

Currently, CAST with single session has been developed as an approach to directly reduce anxiety sensitivity and improved insomnia symptoms by reduction of anxiety sensitivity [31]

8. Lines 161-163: It seems that a concluding statement is missing, please review the last statement "Depressive...latency" and consider adding another statement that appears to be a conclusion to these lines.

<Reply> We have revised the manuscript to address this comment.

Revised manuscript; Line 204–206

It would be necessary to examine the relationship between sleep reactivity, anxiety sensitivity and the sleep architecture of depressive and anxious insomnia in the future.

9. Lines 166-172: Were there any night shift workers that took the survey? How many participants were taking sleep/anxiety medications? How many participants taking the survey had cardiovascular or neurological diseases? Were participants asked to state daytime naps? ((Do these factors/questions affect the analysis and data interpretation? If so, please state briefly each of these factors in the '4.1 Participants' section of the Materials and Methods.))

<Reply> Thank you for useful comment. The results of a multiple and logistic regression analyses, which adjusted for these variables added to age and sex, showed change in the impact of FIRST and ASI, and therefore, we have revised the manuscript to address this comment.

10. Line 200: Correct the word 'parformed' to 'performed'.

<Reply> We have revised the manuscript to address this comment.