Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies

Nov 29, 2014Acta psychiatrica Scandinavica

Sleep patterns in people recovering from bipolar disorder: a combined analysis of movement-tracking studies

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Abstract

Remitted bipolar disorder cases (N=202) show significant differences in sleep parameters compared to controls (N=210).

Sleep latency is longer in remitted bipolar disorder cases, with a standardized mean difference of 0.51.
Sleep duration is significantly reduced in remitted bipolar disorder cases, showing a standardized mean difference of 0.57.
Wake after sleep onset is increased in remitted bipolar disorder cases, with a standardized mean difference of 0.28.
Sleep efficiency is lower in remitted bipolar disorder cases, indicated by a standardized mean difference of -0.38.
Moderate heterogeneity was noted for sleep duration and sleep efficiency, both with I2 values of 44%.
Larger differences in sleep duration may be associated with greater age differences between groups and lower residual depressive symptoms.

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OBJECTIVE: Sleep dysregulation is highly prevalent in bipolar disorders (BDs), with previous actigraphic studies demonstrating sleep abnormalities during depressive, manic, and interepisode periods. We undertook a meta-analysis of published actigraphy studies to identify whether any abnormalities in the reported sleep profiles of remitted BD cases differ from controls.

METHOD: A systematic review identified independent studies that were eligible for inclusion in a random effects meta-analysis. Effect sizes for actigraphy parameters were expressed as standardized mean differences (SMD) with 95% confidence intervals (95% CI).

RESULTS: Nine of 248 identified studies met eligibility criteria. Compared with controls (N=210), remitted BD cases (N=202) showed significant differences in SMD for sleep latency (0.51 [0.28-0.73]), sleep duration (0.57 [0.30-0.84]), wake after sleep onset (WASO) (0.28 [0.06-0.50]) and sleep efficiency (-0.38 [-0.70-0.07]). Moderate heterogeneity was identified for sleep duration (I2=44%) and sleep efficiency (I2=44%). Post hoc meta-regression analyses demonstrated that larger SMD for sleep duration were identified for studies with a greater age difference between BD cases and controls (β=0.22; P=0.03) and non-significantly lower levels of residual depressive symptoms in BD cases (β=-0.13; P=0.07).

CONCLUSION: This meta-analysis of sleep in remitted bipolar disorder highlights disturbances in several sleep parameters. Future actigraphy studies should pay attention to age matching and levels of residual depressive symptoms.

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Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies

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