Key result
Male sex is linked to higher LF/HF ratio in drug-naive MDD compared with females.
Why the study?
Differential patterns of sympathetic nervous system activation across genders may contribute to varying cardiovascular and cerebrovascular risks in major depressive disorder, but the underlying factors remain unclear. This study investigated the associations between subjective sleep alterations, blood pressure, emotional state, and gender-specific sympathetic activation.
Cross-Sectional (n=75)
No
In first-episode, drug-naive major depressive disorder patients, subjective sleep impairments are associated with gender-divergent patterns of heart rate variability, whereas lower blood pressure consistently correlates with heightened sympathetic activation across both sexes.
Answers are grounded in this paper and cite their sources.
Gender-specific HRV associations in MDD warrant clinical caution; hypothesis-generating and requires longitudinal studies before any practice implications.
Background Major depressive disorder (MDD) exhibits significant gender disparities in prevalence. Previous studies have indicated that differential patterns of sympathetic nervous system activation in different gender may contribute to varying cardiovascular/cerebrovascular risks in MDD, though underlying factors remain unclear. In this study, we aim to investigate the association between subjective sleep alterations, blood pressure, emotional state, and gender-specific sympathetic activation in MDD. Methods We collected and analyzed ECG data from 50 female and 25 male age-matched, first-episode, drug-naive MDD patients. Autonomic nerve function was assessed using heart rate variability (HRV). Subjective sleep indicators of SE, SOL, short sleep, and poor sleep quality were evaluated utilizing the Pittsburgh Sleep Quality Index (PSQI). Emotional characteristics were quantified via the Hamilton Depression Scale-17 (HAMD-17) and Hamilton Anxiety Scale (HAMA). Resting systolic (SBP) and diastolic blood pressure (DBP) were also measured upon arrival. Results In male MDD patients, each 1% reduction in SE was associated with a 0.350ms decrease in SDNN. In females, each 1-minute reduction in SOL was associated with a 0.004-unit increase in LF/HF ratio; while short sleep (< 6h) was associated with increased RMSSD and pNN50 (all p ≤ 0.048). Reduced DBP in males correlated with different patterns (decreased pNN50 and HF(nu); increased LF(nu) and LF/HF ratio) (all p ≤ 0.033). In females, only reduced SBP was associated with each 1-mmHg decrease linked to a 0.040-unit increase in LF/HF ratio. Conclusion Subjective sleep disturbances exhibits disparity in gender-specific patterns of sympathetic-vagal balance in MDD. However, blood pressure reduction consistently correlated with sympathetic activation across both genders, revealing distinct autonomic-mediated pathophysiological pathways that may underlie differential cardiovascular susceptibility in MDD.
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Ban et al. (2026) conducted a cross-sectional in Major depressive disorder (n=75). Subjective sleep impairment and resting blood pressure vs. Gender-stratified comparison (Male vs. Female MDD patients) was evaluated on Heart rate variability LF/HF ratio (p=0.021). Subjective sleep impairment and reduced blood pressure showed gender-specific associations with heart rate variability in drug-naive MDD, with higher LF/HF in males vs females.
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