Sleep Matters: Sleep Functioning and Course of Illness in Bipolar Disorder

Department of Psychology, Yale University, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 06/2011; 134(1-3):416-20. DOI: 10.1016/j.jad.2011.05.016
Source: PubMed


Few studies have prospectively examined the relationships of sleep with symptoms and functioning in bipolar disorder.
The present study examined concurrent and prospective associations between total sleep time (TST) and sleep variability (SV) with symptom severity and functioning in a cohort of DSM-IV bipolar patients (N = 468) participating in the National Institute of Mental Health Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), all of whom were recovered at study entry.
Concurrent associations at study entry indicated that shorter TST was associated with increased mania severity, and greater SV was associated with increased mania and depression severity. Mixed-effects regression modeling was used to examine prospective associations in the 196 patients for whom follow-up data were available. Consistent with findings at study entry, shorter TST was associated with increased mania severity, and greater SV was associated with increased mania and depression severity over 12 months.
These findings highlight the importance of disrupted sleep patterns in the course of bipolar illness.

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    • "Why would we see an effect of sex in the relationship of quality of sleep to outcome in bipolar disorder? Sleep abnormalities have been linked to poor outcome in bipolar disorder: in a one-year follow-up study from the STEP-BD cohort, Gruber et al. found lower total sleep time was associated with higher mania scores, but a relationship of total sleep time to depression scores was not found, however sleep variability was associated with depression scores over time (Gruber et al., 2011). Sex differences in outcomes, including an increased number of depressive episodes in women, have been shown in the STEP-BD cohort (Baldassano et al., 2005). "
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    ABSTRACT: Sleep disturbance is bi-directionally related to mood de-stabilization in bipolar disorder (BD), and sleep quality differs in men and women. We aimed to determine whether perception of poor sleep quality would have a different effect on mood outcome in men versus women. We assessed association between sleep quality (Pittsburgh Sleep Quality Index (PSQI)) at study intake and mood outcome over 2 years in subjects from the Prechter Longitudinal Study of Bipolar Disorder (N=216; 29.6% males). The main outcome measure was the severity, variability, and frequency of mood episodes measured by self-report over 2 years of follow-up. Multivariable linear regression models stratified by sex examined the relationship between PSQI with mood outcomes, while age, stressful life events, mood state and neuroticism at baseline were controlled. In women, poor sleep quality at baseline predicted increased severity (B=0.28, p<0.001) and frequency of episodes (B=0.32, p<0.001) of depression, and poor sleep quality was a stronger predictor than baseline depression; poor sleep quality predicted increased severity (B=0.19, p<0.05) and variability (B=0.20, p<0.05) of mania, and frequency of mixed episodes (B=0.27, p<0.01). In men, baseline depression and neuroticism were stronger predictors of mood outcome compared to poor sleep quality. We measured perception of sleep quality, but not objective changes in sleep. In a longitudinal study of BD, women reported poorer perceived sleep quality than men, and poor sleep quality predicted worse mood outcome in BD. Clinicians should be sensitive to addressing sleep complaints in women with BD early in treatment to improve outcome in BD. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Apr 2015 · Journal of Affective Disorders
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    • "the overall level of disruption caused by the event . It is likely that the occurrence of several different stressful events can highly disturb daily life and thus daily structure and social rhythms , while single life events might not have this disturbing effect . Since social rhythm disruptions are associated with manic and depressive symptoms ( Gruber et al . , 2011 ; Malkoff - Schwartz et al . , 2000 ) , this might be an additional explanation for the association we found between negative life events and mania . For positive life events not such a threshold effect was found . This may be due to the fact that positive life events are relatively underrepresented compared to the negative life events "
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    ABSTRACT: Background Life events are assumed to be triggers for new mood episodes in bipolar disorder (BD). However whether life events may also be a result of previous mood episodes is rather unclear. Method 173 bipolar outpatients (BD I and II) were assessed every three months for two years. Life events were assessed by Paykel׳s self-report questionnaire. Both monthly functional impairment due to manic or depressive symptomatology and mood symptoms were assessed. Results Negative life events were significantly associated with both subsequent severity of mania and depressive symptoms and functional impairment, whereas positive life events only preceded functional impairment due to manic symptoms and mania severity. These associations were significantly stronger in BD I patients compared to BD II patients. For the opposite temporal direction (life events as a result of mood/functional impairment), we found that mania symptoms preceded the occurrence of positive life events and depressive symptoms preceded negative life events. Limitations The use of a self-report questionnaire for the assessment of life events makes it difficult to determine whether life events are cause or consequence of mood symptoms. Second, the results can only be generalized to relatively stable bipolar outpatients, as the number of severely depressed as well as severely manic patients was low. Conclusions Life events appear to precede the occurrence of mood symptoms and functional impairment, and this association is stronger in BD I patients. Mood symptoms also precede the occurrence of life event, but no differences were found between BD I and II patients.
    Full-text · Article · Jun 2014 · Journal of Affective Disorders
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    • "For example, Giglio et al. [1] noted that bipolar disorder patients with sleep disturbance, although euthymic, exhibited worse functioning and quality of life compared with those without sleep disturbance. Gruber et al. [2] reported that shorter sleep duration was associated with greater severity of manic symptoms at baseline and across 12 mo, while higher sleep variability was associated with greater severity of both manic and depressive symptoms at baseline and across 12 mo in an interepisode sample. "
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    ABSTRACT: Over the past decade, researchers have shifted focus from the manic and depressive episodes to the interepisode period in the study of sleep-wake disturbance in bipolar disorder. The objective of this systematic review was to compile and synthesize studies that employed sleep diary, actigraphy, polysomnography, and questionnaires to compare sleep-wake patterns in people with interepisode bipolar disorder or high-risk individuals vs. normal controls and/or people with primary insomnia. We searched key databases until June 2013. Our search identified 21 eligible studies, yielding 24 sleep-wake variables. A total of 531 people with interepisode bipolar disorder, 157 high-risk individuals, 678 normal controls and 67 adults with primary insomnia were evaluated. Using a random-effects model, our analyses suggest that adults with interepisode bipolar disorder appear worse than normal controls in most variables and comparable to adults with primary insomnia in certain aspects. Sleep onset latency, wake after sleep onset, and variability of sleep-wake variables were most consistently impaired in interepisode bipolar disorder. In comparison with controls, high-risk individuals were found to have higher variability in sleep efficiency and lower relative amplitude. The findings provide a foundation for the search for candidate endophenotypes and the development of novel interventions for bipolar disorder.
    Full-text · Article · Jun 2014 · Sleep Medicine Reviews
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