Circadian rest-activity patterns in bipolar disorder and borderline personality disorder

Abstract

Bipolar disorder (BD) and borderline personality disorder (BPD) are two psychiatric disorders with overlapping features that can be challenging to separate diagnostically. Growing evidence suggests that circadian rhythm disturbances are associated with psychiatric illness, however circadian patterns of behaviour have not been elucidated in BPD or differentiated from BD. This study compared the circadian structure and timing of rest-activity patterns in BPD with BD and healthy volunteers. Participants with BD ( N = 31) and BPD ( N = 21) and healthy controls (HC, N = 35) wore an actigraph on their non-dominant wrist for 28 day periods as part of the Automated Monitoring of Symptom Severity (AMoSS) study. Non-parametric circadian rhythm analysis of rest-activity patterns and cosinor analysis of distal temperature rhythms were conducted to elucidate circadian function between groups. Covariates controlled for included employment status, BMI and gender. Compared with HC and BD, individuals with BPD showed significantly delayed phase of night-time rest patterns (“L5 onset”) (mean difference = 1:47 h, P < 0.001; mean difference = 1:38 h, P = 0.009, respectively), and relative to HC showed delayed daytime activity onset (“M10 onset”) (mean difference = 2:13 h, P = 0.048) and delayed temperature phase (mean difference = 1:22 h, P = 0.034). These findings suggest that delayed circadian function may be a clinically important phenotype in individuals with BPD. Future work should interrogate the causality of this association and examine interventions which target delayed circadian function in the treatment of BPD.

Actigraphic patterns, impulsivity and mood instability in bipolar disorder, borderline personality disorder and healthy controls

“…As the association with symptoms is at a within-group level, we suggest a greater reactivity to circadian misalignment and larger proportion of individuals with weak entrainment may drive findings rather than overt between-group differences. Our previous findings show a delayed rest-activity pattern in BPD relative to BD and HC through the later onset of L5 and M10 (23). Moreover, our classification analysis of actigraph parameters confirmed that later L5 onset discriminated BPD from BD and HC indicating good sensitivity and specificity.…”

“…Recently, we identified desynchronised patterns of heart rate, activity and sleep, in participants with BD and BPD (14) and correspondingly, reported an association between desynchrony and differential mood patterns (22). We also demonstrated that individuals with BPD exhibit rest-activity patterns that are suggestive of phase delayed circadian clock function compared with stable BD and healthy controls (23). Thus, sleep and circadian rhythm disruption may be longitudinally specific to BPD, because symptom severity is chronic, rather than intermittent, as in BD.…”

“…The data presented here consist of measurements from 87 participants with valid actigraphy recordings: 31 BD (mean age [SD] = 39.2 [12.2] years, 21 females), 21 BPD (34.1 [10.5] years, 19 females) and 35 healthy controls (HC) matched for age (39.5 [12.5] years, 24 females). Extensive demographic details of this sample and data quality control procedures for actigraph data processing have been described previously (23). Demographic and clinical features of the sample are presented in Table S1.…”

“…The actigraphs contained triaxial accelerometers, which recorded and logged movement throughout the monitoring period at a sampling frequency of 25 Hz. Groups did not differ in terms of actigraph compliance, season when recording took place or the proportion of weekdays or weekend days in each record (23). Exported data were analysed using the validated GGIR dedicated package (25) for R version 3.4.2 (R Core Team, Vienna).…”

Remote Monitoring for Understanding Mechanisms and Prediction in Psychiatry

“…Inspection of correlation coefficients controlling for gender and employment status revealed strong associations between sleep/circadian rhythm parameters and symptoms of impulsivity and mood instability in BPD which were not seen in the other groups. The findings suggest that disturbances initiating/maintaining sleep may be an exacerbating factor for borderline psychopathology and that stabilisation and consolidation of rest-activity rhythms might be considered a treatment target [22][23][24]. In depressed patients the measurement of HRV as an index of vagal function have been proposed as a mediator of the relationship between low mood and cardiovascular disease [25].…”