Sleep in remitted bipolar disorder: A naturalistic case-control study using actigraphy

Mar 25, 2014Journal of affective disorders

Sleep patterns in people recovered from bipolar disorder compared to others using wrist activity monitoring

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Abstract

Eighty-nine percent of participants were accurately classified as bipolar disorder cases or healthy controls based on sleep and circadian rhythm measures.

Significant differences were found between bipolar disorder cases and healthy controls in five items of the Pittsburgh Sleep Questionnaire Inventory and four actigraphy variables.
Actigraphy measures revealed notable variability in sleep patterns among bipolar disorder patients compared to healthy controls.
A combination of mean sleep duration, mean sleep latency, fragmentation index variability, and daytime dysfunction score were key in distinguishing between the two groups.
Potential confounding factors such as age, gender, mood symptoms, and body mass index were accounted for in the analysis.

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INTRODUCTION: Findings from actigraphic studies suggesting that sleep and circadian rhythms are disrupted in bipolar disorder (BD) patients have been undermined by methodological heterogeneity and the failure to adequately address potential confounders.

METHOD: Twenty-six euthymic BD cases and 29 healthy controls (HC), recruited from University Paris-Est and matched for age and gender, were compared on subjective (Pittsburgh Sleep Questionnaire Inventory; PQSI) and objective (mean scores and variability in actigraphy) measures of sleep as recorded by over 21 consecutive days.

RESULTS: Multivariate generalized linear modelling (GLM) revealed significant differences between BD cases and HC for five PSQI items (total score and four subscales), four actigraphy variables (mean scores) and five actigraphy variability measures. Backward stepwise linear regression (BSLR) indicated that a combination of four variables (mean sleep duration, mean sleep latency, variability of the fragmentation index over 21 days, and mean score on PSQI daytime dysfunction sub-scale) correctly classified 89% of study participants as cases or controls (Chi-square=39.81; df=6; p=0.001).

LIMITATIONS: The sample size (although larger than most actigraphy studies) and incomplete matching of cases and controls may have influenced our findings. It was not possible to control for potential effects of psychotropic medication or differences in employment status between groups.

CONCLUSIONS: When potential confounders of sleep and circadian profiles are adequately taken into account (particularly age, gender, daytime sleepiness, mood symptoms, body mass index, and risk of sleep apnoea), a selected subset of quantitative (mean scores) and qualitative (variability) features differentiated euthymic BD cases from HC.

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Sleep in remitted bipolar disorder: A naturalistic case-control study using actigraphy

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