Chronotype and circadian rhythm in bipolar disorder: A systematic review

Aug 16, 2016Sleep medicine reviews

Daily body clock patterns and sleep timing in bipolar disorder: A systematic review

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Abstract

42 studies involving 3432 bipolar disorder patients indicate significant disruptions in circadian rhythms.

Circadian rhythm disruptions were found in bipolar disorder patients, including those not on medication.
Daily melatonin and cortisol profiles showed a delayed phase in these patients.
Circadian alterations were more frequently linked to depressive episodes than stable mood periods.
Evening chronotype was prevalent among adults with bipolar disorder.
Conflicting evidence exists regarding the relationship between chronotype and depressive symptoms.
Research on the effects of psychoeducation, lithium, and genetics on circadian rhythms in bipolar disorder is limited.

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Despite a complex relationship between mood, sleep and rhythm, the impact of circadian disruptions on bipolar disorder (BD) has not been clarified. The purpose of this systematic review was to define current evidence regarding chronotype and circadian rhythm patterns in BD patients. 42 studies were included, involving 3432 BD patients. Disruption of the biological rhythm was identified, even in drug-naïve BD patients and independently of mood status. Daily profiles of melatonin levels and cortisol indicated a delayed phase. Depression was more frequently associated with circadian alterations than euthymia. Few studies evaluated mania, demonstrating irregular rhythms. Evening type was more common in BD adults. Studies about the influence of chronotype on depressive symptoms showed conflicting results. Only one investigation observed the influences of chronotype in mania, revealing no significant association. Effects of psychoeducation and lithium on rhythm in BD patients were poorly studied, demonstrating no improvement of rhythm parameters. Studies about genetics are incipient. In conclusion, disruption in circadian rhythm and eveningness are common in BD. Prospective research evaluating the impact of circadian disruption on mood symptoms, metabolism, seasonality, the influence of age and the effects of mood stabilizers are needed.

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Chronotype and circadian rhythm in bipolar disorder: A systematic review

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