The sleep phenotype of Borderline Personality Disorder: A systematic review and meta-analysis

Winsper, Catherine; Tang, Nicole K. Y.; Marwaha, Steven; Lereya, Suzet Tanya; Gibbs, Melanie; Thompson, Andrew; Singh, Swaran P.

doi:10.1016/j.neubiorev.2016.12.008

Cited by 51 publications

(55 citation statements)

References 75 publications

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“…Previous sleep investigations in BPD have used polysomnography, with a view to comparing BPD with mood disorder. Thus, a recent systematic review of the relevant literature highlighted the reduced sleep quality in BPD compared with healthy samples and the overlap with reported abnormalities in patients with mood disorder 8 . It correctly identified sleep disorder as a broadly neglected element of the management in BPD.…”

Section: Discussionmentioning

confidence: 99%

“…BPD resembles BD in that patients experience mood instability, but this variability of mood is greater 6 . Descriptions of sleep difficulties in BPD refer quite non-specifically to insomnia 8 . The BPD group were a relevant control group because the diagnoses are sometimes confused even though heritability and the clinical course are different from BD.…”

Section: Introductionmentioning

confidence: 99%

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Desynchronization of diurnal rhythms in bipolar disorder and borderline personality disorder

et al. 2018

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It has long been proposed that diurnal rhythms are disturbed in bipolar disorder (BD). Such changes are obvious in episodes of mania or depression. However, detailed study of patients between episodes has been rare and comparison with other psychiatric disorders rarer still. Our hypothesis was that evidence for desynchronization of diurnal rhythms would be evident in BD and that we could test the specificity of any effect by studying borderline personality disorder (BPD). Individuals with BD (n = 36), BPD (n = 22) and healthy volunteers (HC, n = 25) wore a portable heart rate and actigraphy device and used a smart-phone to record self-assessed mood scores 10 times per day for 1 week. Average diurnal patterns of heart rate (HR), activity and sleep were compared within and across groups. Desynchronization in the phase of diurnal rhythms of HR compared with activity were found in BPD (+3 h) and BD (+1 h), but not in HC. A clear diurnal pattern for positive mood was found in all subject groups. The coherence between negative and irritable mood and HR showed a four-cycle per day component in BD and BPD, which was not present in HC. The findings highlight marked de-synchronisation of measured diurnal function in both BD but particularly BPD and suggest an increased association with negative and irritable mood at ultradian frequencies. These findings enhance our understanding of the underlying physiological changes associated with BPD and BD, and suggest objective markers for monitoring and potential treatment targets. Improved mood stabilisation is a translational objective for management of both patient groups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Desynchronization of diurnal rhythms in bipolar disorder and borderline personality disorder

et al. 2018

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“…There is little or no previous relevant research in BPD. The most recent meta-analytic review of the literature examining sleep disturbance primarily identified acute polysomnography (PSG) recordings which are limited to single nights (30). These findings describe greater sleep onset latency, poor sleep efficiency and shorter sleep duration in BPD compared with controls (31)(32)(33).…”

Section: Discussionmentioning

confidence: 99%

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

McGowan

Goodwin

Bilderbeck

et al. 2020

Acta Psychiatr Scand

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Actigraphic patterns, impulsivity and mood instability in bipolar disorder, borderline personality disorder and healthy controls.Objectives: To differentiate the relation between the structure and timing of rest-activity patterns and symptoms of impulsivity and mood instability in bipolar disorder (BD), borderline personality disorder (BPD) and healthy controls (HC). Methods: Eighty-seven participants (31 BD, 21 BPD and 35 HC) underwent actigraph monitoring for 28 days as part of the Automated Monitoring of Symptom Severity (AMoSS) study. Impulsivity was assessed at study entry using the BIS-11. Mood instability was subsequently longitudinally monitored using the digital Mood Zoom questionnaire. Results: BPD participants show several robust and significant correlations between non-parametric circadian rest-activity variables and worsened symptoms. Impulsivity was associated with low interdaily stability (r = À0.663) and weak amplitude (r = À0.616). Mood instability was associated with low interdaily stability (r = À0.773), greater rhythm fragmentation (r = 0.662), weak amplitude (r = À0.694) and later onset of daily activity (r = 0.553). These associations were not present for BD or HCs. Classification analysis using actigraphic measures determined that later L5 onset reliably distinguished BPD from BD and HC but did not sufficiently discriminate between BD and HC. Conclusions: Rest-activity pattern disturbance indicative of perturbed sleep and circadian function is an important predictor of symptom severity in BPD. This appears to validate the greater subjective complaints of BPD individuals that are sometimes regarded as exaggerated by clinicians. We suggest that treatment strategies directed towards improving sleep and circadian entrainment may in the future be investigated in BPD. Significant Outcomes• Objectively determined rest-activity patterns are strongly correlated with worsened symptoms of impulsivity and longitudinally monitored mood instability in BPD.• Sleep and circadian features may impact on the chronicity of symptoms in BPD above BD and HCs.• Future studies targeting rest-activity pattern modification in BPD are indicated. Limitations• Sample heterogeneity present for gender and number of unemployed individuals. • Relative small sample size restricts stratification for medication and comorbid diagnoses.

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“…Research suggests that the association between sleep disturbances and suicidal ideation may be potentiated by Borderline Personality Disorder (BPD; Winsper & Tang, 2014;Winsper et al, 2017). Previous work, however, has returned contradictory results (e.g., Oltmanns & Oltmanns, 2015), and the temporal, within-person link of sleep and suicidal ideation in BPD has received limited clinical and research attention (Winsper & Tang, 2014; see Liu et al (2020) for a recent systematic review and meta-analysis of longitudinal studies).…”

Section: Sleep and Next-day Negative Affect And Suicidal Ideation In mentioning

confidence: 99%

Sleep and Next-Day Negative Affect and Suicidal Ideation in Borderline Personality Disorder

Kaurin¹,

Hisler²,

Dombrovski³

et al. 2020

Preprint

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Sleep disturbance is associated with elevated suicidal ideation and negative affect. To date, however, no study has investigated the temporal relationship between sleep and suicidality among those diagnosed with borderline personality disorder (BPD). This preregistered (https://osf.io/4vugk) study tested whether nightly sleep (self-reported sleep duration, sleep onset latency, and subjective leep quality) represents a (within-person) short-term risk factor for affective dysregulation and increases in suicide risk from day-to-day, as well as whether between-person differences in sleep, negative affect, and suicidality were associated. We used a 21-day ecological momentary assessment protocol in a sample of 142 people diagnosed with BPD, 98 of which had a history of serious suicide attempts, and 52 healthy controls. We found a within-person association between better subjective sleep quality and greater next day negative affect. At the between-person level, we found positive relationships between sleep latency and suicidal ideation, and a negative association between subjective sleep quality and negative affect. BPD severity did not significantly moderate the strength of any within-person associations, although BPD was positively associated with average levels of suicidal ideation, sleep latency, and negative affect, and negatively related to subjective sleep quality. These findings suggest that the association of sleep with suicidal ideation and BPD exists largely at the between-persons rather than the within-person level. Disturbed sleep, therefore, seems to largely coincide, rather than specifically contribute to the exacerbation of suicidal crises in BPD.

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The sleep phenotype of Borderline Personality Disorder: A systematic review and meta-analysis

Cited by 51 publications

References 75 publications

Desynchronization of diurnal rhythms in bipolar disorder and borderline personality disorder

Desynchronization of diurnal rhythms in bipolar disorder and borderline personality disorder

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

Sleep and Next-Day Negative Affect and Suicidal Ideation in Borderline Personality Disorder

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