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Lara Kierlin, MD, MBA; Frisca Yan-Go, MD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Licht et al¹ discuss a relationship between depression and heart rate variability in their sample, which was also studied for the presence of other health-related variables, including heart disease and chronic medical conditions. Not specifically mentioned in their report is the presence of sleep-related breathing disorders (including sleep apnea) as a potential confounder, which is surprising given the evidence that exists linking these conditions to both diminished heart rate variability² and depression.³

The multiple overnight arousals that occur in sleep apnea result in a number of physiologic insults, including cardiac effects due to sympathetic activation as well as affective dysfunction related to nonrestorative sleep punctuated by apneic periods. Also, there are several diagnostic overlaps between the excessive daytime sleepiness that results from untreated sleep apnea and the symptoms of major depressive disorder, including mood alteration, diminished functionality, fatigue, sleep disturbance, and cognitive changes, . . . [Full Text of this Article]

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Association Between Major Depressive Disorder and Heart Rate Variability in the Netherlands Study of Depression and Anxiety (NESDA)
Carmilla M. M. Licht, Eco J. C. de Geus, Frans G. Zitman, Witte J. G. Hoogendijk, Richard van Dyck, and Brenda W. J. H. Penninx
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