Hypersomnia and Bipolar Disorder: A systematic review and meta-analysis of proportion

Grigolon, Ruth Bartelli; Trevizol, Alisson Paulino; Cerqueira, Raphael O.; Lee, Yena; Mansur, Rodrigo B.; McIntyre, Roger S.; Brietzke, Elisa

doi:10.1016/j.jad.2018.12.030

Cited by 23 publications

(6 citation statements)

References 46 publications

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“…[4][5][6][7] Patients with a BD face problems with sleep latency, duration, wake after sleep onset, and sleep efficiency. 5 A third of patients with a BD suffer from insomnia, 8 and 40% report excessive daytime sleepiness, which is contrasted by a prevalence of 18% in the general population. 9 Accumulating evidence suggests a link between a circadian rhythm disruption, and vulnerability for BDs.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Inactograms and objective sleep measures as means to capture subjective sleep problems in patients with a bipolar disorder

et al. 2020

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Background Sleep problems are common in bipolar disorders (BDs). To objectively characterize these problems in BDs, further methodological development is needed to capture subjective insomnia. Aim To test psychometric properties of the Athens Insomnia Scale (AIS), and associations with actigraphy‐derived measures, applying modifications in actigraphy data processing to capture features of perturbed sleep in patients with a BD. Methods Seventy‐four patients completed the AIS and the Quick Inventory of Depressive Symptomatology, self‐report (QIDS‐SR‐16). Locomotor activity was continuously recorded by wrist actigraphy for ≥10 consecutive days. We computed the sleep onset/offset, the center of daily inactivity (CenDI), as a proxy for chronotype, and the degree of consolidation of daily inactivity (ConDI), as a proxy for sleep‐wake rhythm strength. Results AIS showed good psychometric properties (Cronbach's alpha = 0.84; test–retest correlation = 0.84, P<.001). Subjective sleep problems correlated moderately with a later sleep phase (CenDI with AIS rho = 0.34, P = .003), lower consolidation (ConDI with AIS rho = −0.22, P = .05; with QIDS‐SR‐16 rho = −0.27, P = .019), later timing of sleep offset (with AIS rho = 0.49, P = ≤.001, with QIDS‐SR‐16 rho = 0.36, P = .002), and longer total sleep (with AIS rho = 0.29, P = .012, with QIDS‐SR‐16 rho = 0.41, P = ≤.001). While AIS was psychometrically more solid, correlations with objective sleep were more consistent across time for QIDS‐SR‐16. Conclusions AIS and QIDS‐SR‐16 are suitable for clinical screening of sleep problems among patients with a BD. Subjective insomnia associated with objective measures. For clinical and research purposes, actigraphy and data visualization on inactograms are useful for accurate longitudinal characterization of sleep patterns.

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Section: Backg Rou N Dmentioning

confidence: 99%

Inactograms and objective sleep measures as means to capture subjective sleep problems in patients with a bipolar disorder

et al. 2020

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“…Most interestingly, hypersomnia is a common feature of depressive episodes in bipolar type 1 disorder (65)(66)(67), unlike in other depressions where patients most often exhibit insomnia. Like KLS, bipolar disorder is also associated with cognitive deficiencies, although these are milder (68,69) as compared to KLS patients.…”

Section: Discussionmentioning

confidence: 99%

Kleine Levin syndrome is associated with birth difficulties and genetic variants in the TRANK1 gene loci

Ambati

Hillary

Leu‐Semenescu

et al. 2021

Preprint

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Kleine-Levin Syndrome (KLS) is a rare disorder characterized by severe episodic hypersomnia, with cognitive impairment accompanied by apathy or disinhibition. Pathophysiology is unknown, although imaging studies indicate decreased activity in hypothalamic/thalamic areas during episodes. Familial occurrence is increased, and risk is associated with reports of a difficult birth. We conducted a worldwide case-control genome wide association study in 673 KLS cases collected over 14 years, and ethnically matched 15,341 control individuals. We found a strong genome-wide significant association (OR=1.48,rs71947865,p=8.6×10−9) with 20 single nucleotide polymorphisms encompassing a 35kb region located in the 3’ region of TRANK1 gene, previously associated with bipolar disorder and schizophrenia. Strikingly, KLS cases with TRANK1 rs71947865 variant had significantly increased reports of a difficult birth. As perinatal outcomes have dramatically improved over the last 40 years, we further stratified our sample by birth years and found that recent cases had a significantly reduced TRANK1 rs71947865 association. While theTRANK1 rs71947865 association did not replicate in the entire follow-up sample of 171 KLS cases, the TRANK1 rs71947865 was significantly associated with KLS in the subset follow-up sample of 59 KLS cases who reported birth difficulties (OR=1.54;p=0.01). Genetic liability of KLS as explained by polygenic risk scores was increased (pseudo r2=0.15;p<2.0×10−22 at p=0.5 threshold) in the follow-up sample. Pathway analysis of genetic associations identified enrichment of circadian regulation pathway genes in KLS cases. Our results suggest links between KLS, behavioral rhythmicity, and bipolar disorder, and indicates that the TRANK1 polymorphisms in conjunction with reported birth difficulties may predispose to KLS.Significance StatementGenetic markers in TRANK1 gene and its vicinity have been weakly associated with bipolar disorder and schizophrenia (10% increased risk). We found that the same polymorphisms are associated with Kleine-Levin Syndrome (50% increased risk), a rare sleep disorder characterized by recurrent episodes of severe hypersomnia and cognitive abnormalities. Response to lithium treatment are suggestive of a pathophysiological overlap between KLS and bipolar disorder. The study also shows that variants in the TRANK1 gene region may predispose to KLS when patients have had a difficult birth, suggesting that TRANK1 gene region modulate newborns’ response to brain injury, with consequences for mental and neurological health in adulthood. Another possibility may be that the polymorphism impact birth and KLS.

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“…However, >10 h of MSD did not decrease the incidence of LBW and SGA in women with appropriate gestational BWG, which implies that >10 h of MSD did not affect neonatal birth weight. This may be because >10 h of MSD might be affected by maternal diseases, conditions, and behaviors, such as depression, excessive mental stress, and use of sleeping pills, 24,47,48 which may potentially decrease the neonatal birth weight. [49][50][51] Moreover, because too long MSD may have other unfavorable effects including excessive BWG, 32,33 we do not suggest that pregnant women should have >10 h of sleep.…”

Section: Discussionmentioning

confidence: 99%

Maternal sleep duration and neonatal birth weight: The Japan Environment and Children’s Study

Murata

Kyozuka

Fukuda

et al. 2020

Preprint

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Objective: To evaluate the effect of maternal sleep duration (MSD) on low birth weight infants (LBW), small for gestational age infants (SGA), and macrosomia. Design: Prospective cohort study Setting: The Japan Environment and Children's Study (JECS) Population: Participants enrolled in JECS, with singleton pregnancies after 22 weeks, who gave birth between 2011 and 2014. Methods: Participants were categorized into five groups according to MSD during pregnancy: G1 (MSD <6.0 h), G2 (6.0-7.9 h), G3 (8.0-8.9 h), G4 (9.0-9.9 h), and G5 (10.0-12.0 h). Main outcome measures: The effect of MSD on the risk of LBW (<2,500 g and <1,500 g), SGA, and macrosomia (>4,000 g) with G2 as the reference, while adjusting for gestational excessive body weight gain (BWG). Analysis was also performed after stratification by gestational BWG. Results: We analyzed 82,171 participants. The adjusted odds ratios (aORs) of LBW <2,500 g in G4 and G5 and of SGA in G4 were 0.90 (95% confidence interval [CI], 0.83-0.99), 0.86 (95% CI, 0.76-0.99), and 0.91 (95% CI, 0.82-0.99), respectively, before adjusting for excessive gestational BWG. No significant association was observed between MSD and these outcomes after adjusting for excessive gestational BWG. Among women with appropriate gestational BWG, the aORs of LBW <2,500 g and SGA in G4 were 0.88 (95% CI, 0.80-0.97) and 0.87 (95% CI, 0.78-0.97), respectively. Conclusion: This study revealed that 9.0-9.9 h of MSD significantly decreased LBW <2,500 g and SGA in pregnant women with appropriate gestational BWG, relative to 6.0-7.9 h of MSD.

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Hypersomnia and Bipolar Disorder: A systematic review and meta-analysis of proportion

Cited by 23 publications

References 46 publications

Inactograms and objective sleep measures as means to capture subjective sleep problems in patients with a bipolar disorder

Inactograms and objective sleep measures as means to capture subjective sleep problems in patients with a bipolar disorder

Kleine Levin syndrome is associated with birth difficulties and genetic variants in the TRANK1 gene loci

Maternal sleep duration and neonatal birth weight: The Japan Environment and Children’s Study

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