Circadian Rhythm Sleep-Wake Disorders Predict Shorter Time to Relapse of Mood Episodes in Euthymic Patients With Bipolar Disorder

Takaesu, Yoshikazu; Inoue, Yuichi; Ono, Kotaro; Murakoshi, Akiko; Futenma, Kunihiro; Komada, Yoko; Inoue, Takeshi

doi:10.4088/jcp.17m11565

Cited by 41 publications

(18 citation statements)

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“…12 A recent study with a shorter duration (48 weeks) found a relationship between circadian dysfunction and shorter intercrisis period. 13 Although further research is necessary, strategies that contribute to circadian rhythm regulation may be able to improve the prognosis of BD patients.…”

Section: Discussionmentioning

confidence: 99%

Chronotype in bipolar disorder: an 18-month prospective study

Melo

Garcia²,

Araújo³

et al. 2020

Braz. J. Psychiatry

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Objective: Circadian dysregulation plays an important role in the etiology of mood disorders. Evening chronotype is frequent in these patients. However, prospective studies about the influence of chronotype on mood symptoms have reached unclear conclusions in patients with bipolar disorder (BD). The objective of this study was to investigate relationship between chronotype and prognostic factors for BD. Methods: At the baseline, 80 euthymic BD patients answered a demographic questionnaire and clinical scales to evaluate anxiety, functioning and chronotype. Circadian preference was measured using the Morningness-Eveningness Questionnaire, in which lower scores indicate eveningness. Mood episodes and hospitalizations were evaluated monthly for 18 months. Results: Among the BD patients, 14 (17.5%) were definitely morning type, 35 (43.8%), moderately morning, 27 (33.7%) intermediate (neither) and 4 (5%) moderately evening. Eveningness was associated with obesity or overweight (p = 0.03), greater anxiety (p = 0.002) and better functioning (p = 0.01), as well as with mood episodes (p = 0.04), but not with psychiatric hospitalizations (p = 0.82). This group tended toward depressive episodes (p = 0.06), but not (hypo)mania (p = 0.56). Conclusion: This study indicated that evening chronotype predicts a poor prognostic for BD. It reinforces the relevance of treating rhythm disruptions even during euthymia to improve patient quality of life and prevent mood episodes.

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Section: Discussionmentioning

confidence: 99%

Chronotype in bipolar disorder: an 18-month prospective study

Melo

Garcia²,

Araújo³

et al. 2020

Braz. J. Psychiatry

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“…A prospective cohort study of 104 euthymic patients with bipolar disorder reported that the comorbidity of circadian rhythm sleep-wake disorders, mainly delayed sleep-wake phase disorders, were significantly associated with the time to relapse of mood episodes. 25 In addition, our previous study revealed that a later timing of the circadian activity rhythm (10 consecutive hours with the highest amplitude values) was significantly associated with an increase in the depressive episode relapses. 9 Therefore, the present study supports these previous studies.…”

Section: Discussionmentioning

confidence: 92%

“…Interpersonal and social rhythm therapy, which addresses interpersonal problems and disrupted social rhythms, has been reported to be effective in the prevention of bipolar mood episodes 26 . Furthermore, the aforementioned prospective cohort study of patients with bipolar disorder reported that the comorbidity of circadian rhythm sleep–wake disorders, including irregular sleep–wake rhythm disorders, could be a significant predictor of relapse of mood episodes 25 . These previous studies and the present study suggest that the maintenance of consistency in day‐to‐day sleep/wake patterns might be useful as an adjunct therapy to prevent the recurrence or relapse of mood episodes in patients with bipolar disorder.…”

Section: Discussionmentioning

confidence: 99%

Circadian variability of objective sleep measures predicts the relapse of a mood episode in bipolar disorder: findings from the APPLE cohort

Esaki

Obayashi

Saeki

et al. 2023

Psychiatry Clin Neurosci

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Aim Sleep disturbance, a core feature of bipolar disorder, is closely associated with mood symptoms. We examined the association between actigraphy sleep parameters and mood episode relapses in patients with bipolar disorder. Methods This prospective cohort study analyzed 193 outpatients with bipolar disorder who participated in the Association between the Pathology of Bipolar Disorder and Light Exposure in Daily Life (APPLE) cohort study. The participants' sleep was objectively evaluated via actigraphy over seven consecutive days for the baseline assessment and then at the 2‐year follow‐up appointment for mood episode relapses. The actigraphy sleep parameters were presented using the mean and variability (standard deviation) of each sleep parameter for 7 days. Results Of the 193 participants, 110 (57%) experienced mood episodes during follow‐up. The participants with higher variability in total sleep time had a significantly shorter mean estimated time to mood episode relapses than those with lower variability (12.5 vs. 16.8 months; P < 0.001). The Cox proportional hazards model, when adjusted for potential confounders, demonstrated that variability in total sleep time was significantly associated with an increase in the mood episode relapses (per hour; hazard ratio [HR], 1.407; 95% confidence interval (CI), 1.057–1.873), mainly in the depressive episodes (per hour; HR, 1.477; 95% CI, 1.088–2.006). Conclusions Our findings suggest that consistency in sleep time might be useful, as an adjunct therapy, in preventing the recurrence or relapse of mood episodes in bipolar disorder.

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“…For instance, in borderline personality disorder the prevalence of DSWPD is shown to be significantly higher than in the wider population [ 127 – 129 ]. However, the presence of circadian disorders has also been shown to predict earlier symptom relapse in bipolar disorder [ 130 ]. It remains difficult to distinguish which is the cause and which the effect and so psychiatric disorders should be considered a correlation which could be a potential cause.…”

Section: Preamblementioning

confidence: 99%

Updates and confounding factors in delayed sleep–wake phase disorder

2023

Sleep Biol. Rhythms

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Delayed sleep–wake phase disorder (DSWPD) is a circadian rhythm sleep disorder characterised by a delay in the main sleep period, with patients experiencing difficulty getting to sleep and waking up at socially appropriate times. This often causes insomnia and compromised sleep, results in impairment to daytime function and is associated with a range of comorbidities. Besides interventions aimed at ameliorating symptoms, there is good evidence supporting successful phase advancement with bright light therapy or melatonin administration. However, no treatment to date addresses the tendency to phase delay, which is a common factor amongst the various contributing causes of DSWPD. Circadian phase markers such as core body temperature and circulating melatonin typically correlate well with sleep timing in healthy patients, but numerous variations exist in DSWPD patients that can make these unpredictable for use in diagnostics. There is also increasing evidence that, on top of problems with the circadian cycle, sleep homeostatic processes actually differ in DSWPD patients compared to controls. This naturally has ramifications for management but also for the current approach to the pathogenesis itself in which DSWPD is considered a purely circadian disorder. This review collates what is known on the causes and treatments of DSWPD, addresses the pitfalls in diagnosis and discusses the implications of current data on modified sleep homeostasis, making clinical recommendations and directing future research.

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Circadian Rhythm Sleep-Wake Disorders Predict Shorter Time to Relapse of Mood Episodes in Euthymic Patients With Bipolar Disorder

Abstract: Comorbid CRSWD, mainly delayed sleep-wake phase disorder, could be a significant predictor of relapse in BD patients.

Cited by 41 publications

References 0 publications

Chronotype in bipolar disorder: an 18-month prospective study

Chronotype in bipolar disorder: an 18-month prospective study

Circadian variability of objective sleep measures predicts the relapse of a mood episode in bipolar disorder: findings from the APPLE cohort

Updates and confounding factors in delayed sleep–wake phase disorder

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