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The characteristics of sleep in patients with manifest bipolar disorder, subjects at high risk of developing the disease and healthy controls

  • Biological Psychiatry - Original Article
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Abstract

Sleep is highly altered during affective episodes in patients with bipolar disorder. There is accumulating evidence that sleep is also altered in euthymic states. A deficit in sleep regulation may be a vulnerability factor with aetiological relevance in the development of the disease. This study aims to explore the objective, subjective and lifetime sleep characteristics of patients with manifest bipolar disorder and persons with an elevated risk of developing the disease. Twenty-two patients with bipolar I and II disorder, nine persons with an elevated risk of developing the disorder and 28 healthy controls were evaluated with a structured interview to characterize subjective and lifetime sleeping habits. In addition, participants wore an actimeter for six nights. Patients with bipolar disorder had longer sleep latency and duration compared with healthy controls as determined by actigraphy. The subjective and lifetime sleep characteristics of bipolar patients differed significantly from healthy controls. The results of participants with an elevated risk of developing the disorder had subjective and lifetime characteristics that were largely analogous to those of patients with manifest bipolar disorder. In particular, both groups described recurring insomnia and hypersomnia, sensitivity to shifts in circadian rhythm, difficulties awakening and prolonged sleep latency. This study provides further evidence that sleep and circadian timing are profoundly altered in patients with bipolar disorder. It may also tentatively suggest that sleep may be altered prior to the first manic episode in subjects at high risk.

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References

  • Annie V, Charles MM (2003) Actigraphy in the assessment of insomnia. Sleep 26(7):902–906

    Google Scholar 

  • Baldessarini RJ, Tondo L, Hennen J (2003) Treatment-latency and previous episodes: relationships to pretreatment morbidity and response to maintenance treatment in bipolar I and II disorders. Bipolar Disord 5(3):169–179

    Article  PubMed  Google Scholar 

  • Bauer M, Glenn T, Grof P, Rasgon N, Alda M, Marsh W, Sagduyu K, Schmid R, Adli M, Whybrow PC (2009) Comparison of sleep/wake parameters for self-monitoring bipolar disorder. J Affect Disord 116(3):170–175

    Article  PubMed  Google Scholar 

  • Benedetti F, Bernasconi A, Lorenzi C, Pontiggia A, Serretti A, Colombo C, Smeraldi E (2004a) A single nucleotide polymorphism in glycogen synthase kinase 3-beta promoter gene influences onset of illness in patients affected by bipolar disorder. Neurosci Lett 355(1–2):37–40

    Article  PubMed  CAS  Google Scholar 

  • Benedetti F, Serretti A, Colombo C, Lorenzi C, Tubazio V, Smeraldi B (2004b) A glycogen synthase kinase 3-beta promoter gene single nucleotide polymorphism is associated with age at onset and response to total sleep deprivation in bipolar depression. Neurosci Lett 368(2):123–126

    Article  PubMed  CAS  Google Scholar 

  • Berk M, Conus P, Lucas N, Hallam K, Malhi GS, Dodd S, Yatham LN, Yung A, McGorry P (2007) Setting the stage: from prodrome to treatment resistance in bipolar disorder. Bipolar Disord 9(7):671–678

    Article  PubMed  Google Scholar 

  • Breslau N, Roth T, Rosenthal L, Andreski P (1996) Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry 39(6):411–418

    Article  PubMed  CAS  Google Scholar 

  • Casper RC, Redmond DE Jr, Katz MM, Schaffer CB, Davis JM, Koslow SH (1985) Somatic symptoms in primary affective disorder: presence and relationship to the classification of depression. Arch Gen Psychiatry 42(11):1098–1104

    Article  PubMed  CAS  Google Scholar 

  • Conus P, Ward J, Lucas N, Cotton S, Yung AR, Berk M, McGorry PD (2010) Characterisation of the prodrome to a first episode of psychotic mania: results of a retrospective study. J Affect Disord 124(3):341–345

    Article  PubMed  Google Scholar 

  • Correll CU, Penzner JB, Lencz T, Auther A, Smith CW, Malhotra AK, Kane JM, Cornblatt BA (2007) Early identification and high-risk strategies for bipolar disorder. Bipolar Disord 9(4):324–338

    Article  PubMed  Google Scholar 

  • Correll CU, Penzner J, Auther A, Smith C, Kane JM, Cornblatt BA (2008) Does a prodrome exist in bipolar disorder? Early Interv in Psychiatry 2:A48

    Google Scholar 

  • Detre T, Himmelhoch J, Swartzbuch M, Anderson CM, Byck R, Kupfer DJ (1972) Hypersomnia and Manic-depressive disease. Am J Psychiatry 128(10):1303–1305

    PubMed  CAS  Google Scholar 

  • Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, Aptowicz C, Pack AI (1997) Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4–5 hours per night. Sleep 20(4):267–277

    PubMed  CAS  Google Scholar 

  • Duffy A, Alda M, Crawford L, Milin R, Grof P (2007) The early manifestations of bipolar disorder: a longitudinal prospective study of the offspring of bipolar parents. Bipolar Disord 9(8):828–838

    Article  PubMed  Google Scholar 

  • Ebisawa T, Uchiyama M, Kajimura N, Mishima K, Kamei Y, Katoh M, Watanabe T, Sekimoto M, Shibui K, Kim K, Kudo Y, Ozeki Y, Sugishita M, Toyoshima R, Inoue Y, Yamada N, Nagase T, Ozaki N, Ohara O, Ishida N, Okawa M, Takahashi K, Yamauchi T (2001) Association of structural polymorphisms in the human period3 gene with delayed sleep phase syndrome. EMBO Rep 2(4):342–346

    Article  PubMed  CAS  Google Scholar 

  • Eidelman P, Talbot L, Gruber J, Hairston I, Harvey AG (2010) Sleep architecture as correlate and predictor of symptoms and impairment in inter-episode bipolar disorder: taking on the challenge of medication effects. J Sleep Res 19(4):516–524

    Article  PubMed  Google Scholar 

  • First M, Spitzer R, Gibbon M, Williams J (1997) Structured clinical interview DSM-IV Axis 1 Disorders-Clinical Version American PSychiatric Publishing, Inc

  • Ford DE, Kamerow DB (1989) Epidemiologic-study of sleep disturbances and psychiatric-disorders—an opportunity for prevention. JAMA 262(11):1479–1484

    Article  PubMed  CAS  Google Scholar 

  • Fossion P, Staner L, Dramaix M, Kempenaers C, Kerkhofs M, Hubain P, Verbanck P, Mendlewicz J, Linkowski P (1998) Does sleep EEG data distinguish between UP, BPI or BPII major depressions?: an age and gender controlled study. J Affect Disord 49(3):181–187

    Article  PubMed  CAS  Google Scholar 

  • Hallam KT, Olver JS, Horgan JE, McGrath C, Norman TR (2005a) Low doses of lithium carbonate reduce melatonin light sensitivity in healthy volunteers. Int J Neuropsychopharmacol 8(2):255–259

    Article  PubMed  CAS  Google Scholar 

  • Hallam KT, Olver JS, Norman TR (2005b) Effect of sodium valproate on nocturnal melatonin sensitivity to light in healthy volunteers. Neuropsychopharmacology 30(7):1400–1404

    PubMed  CAS  Google Scholar 

  • Hallam KT, Begg DP, Olver JS, Norman TR (2009) Abnormal dose-response melatonin suppression by light in bipolar type I patients compared with healthy adult subjects. Acta Neuropsychiatrica 21(5):246–255

    Article  Google Scholar 

  • Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23(1):56–62

    Article  PubMed  CAS  Google Scholar 

  • Harvey AG, Schmidt DA, Scarna A, Semler CN, Goodwin GM (2005) Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. Am J Psychiatry 162(1):50–57

    Article  PubMed  Google Scholar 

  • Hosteteter AM, Sussex JN, Egeland JA (1997) Prodromal symptoms in Amish adults diagnosed with bipolar I disorder. Am J Med Genet 74(6):589–590

    Google Scholar 

  • Hudson JI, Lipinski JF, Keck PEJ, Aizley HG, Lukas SE, Rothschild AJ, Waternaux CM, Kupfer DJ (1992) Polysomnographic characteristics of young manic patients: comparison with unipolar depressed patients and normal control subjects. Arch Gen Psychiatry 49(5):378–383

    Article  PubMed  CAS  Google Scholar 

  • Jones SH, Hare DJ, Evershed K (2005) Actigraphic assessment of circadian activity and sleep patterns in bipolar disorder. Bipolar Disord 7(2):176–186

    Article  PubMed  Google Scholar 

  • Jones SH, Tai S, Evershed K, Knowles R, Bentall R (2006) Early detection of bipolar disorder: a pilot familial high-risk study of parents with bipolar disorder and their adolescent children. Bipolar Disord 8(4):362–372

    Article  PubMed  Google Scholar 

  • Knowles JB, Cairns J, MacLean AW, Delva N, Prowse A, Waldron J, Letemendia FJ (1986) The sleep of remitted bipolar depressives: comparison with sex and age-matched controls. Can J Psychiatry 31(4):295–298

    PubMed  CAS  Google Scholar 

  • Leopold K, Ritter P, Correll CU, Marx C, Özgürdal S, Juckel G, Bauer M, Pfennig A (2012) Risk constellations prior to the development of bipolar disorders: rationale of a new risk assessment tool. J Affect Disord 136(3):1000–1010

    Article  PubMed  Google Scholar 

  • Lichtenstein P, Yip BH, Bjork C, Pawitan Y, Cannon TD, Sullivan PF, Hultman CM (2009) Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373(9659):234–239

    Article  PubMed  CAS  Google Scholar 

  • Lish JD, Dimemeenan S, Whybrow PC, Price RA, Hirschfeld RMA (1994) The National Depressive and Manic-Depressive Association (Dmda) survey of bipolar members. J Affect Disord 31(4):281–294

    Article  PubMed  CAS  Google Scholar 

  • Mansour HA, Monk TH, Nimgaonkar VL (2005) Circadian genes and bipolar disorder. Ann Med 37(3):196–205

    Article  PubMed  CAS  Google Scholar 

  • McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, Germano D, Bravin J, McDonald T, Blair A, Adlard S, Jackson H (2002) Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry 59(10):921–928

    Article  PubMed  Google Scholar 

  • Millar A, Espie CA, Scott J (2004) The sleep of remitted bipolar outpatients: a controlled naturalistic study using actigraphy. J Affect Disord 80(2–3):145–153

    Article  PubMed  Google Scholar 

  • Mullin BC, Harvey AG, Hinshaw SP (2011) A preliminary study of sleep in adolescents with bipolar disorder, ADHD, and non-patient controls. Bipolar Disord 13(4):425–432

    Article  PubMed  Google Scholar 

  • Murray G, Harvey A (2010) Circadian rhythms and sleep in bipolar disorder. Bipolar Disord 12(5):459–472

    Article  PubMed  Google Scholar 

  • Nievergelt CM, Kripke DF, Barrett TB, Burg E, Remick RA, Sadovnick AD, McElroy SL, Keck PE, Schork NJ, Kelsoe JR (2006) Suggestive evidence for association of the circadian genes PERIOD3 and ARNTL with bipolar disorder. Am J Med Genet Part B: Neuropsychiatr Genet 141B(3):234–241

    Article  CAS  Google Scholar 

  • Nurnberger JI Jr, Adkins S, Lahiri DK, Mayeda A, Hu K, Lewy A, Miller A, Bowman ES, Miller MJ, Rau NL, Smiley C, Davis-Singh D (2000) Melatonin suppression by light in euthymic bipolar and unipolar patients. Arch Gen Psychiatry 57(6):572–579

    Article  PubMed  CAS  Google Scholar 

  • Olvet DM, Stearns WH, McLaughlin D, Auther AM, Correll CU, Cornblatt BA (2010) Comparing clinical and neurocognitive features of the schizophrenia prodrome to the bipolar prodrome. Schizophr Res 123(1):59–63

    Article  PubMed  Google Scholar 

  • Pfennig A, Jabs B, Pfeiffer S, Weikert B, Leopold K, Bauer M (2011) Versorgungserfahrungen bipolarer Patienten in Deutschland: Befragung vor Einführung der S3-Leitlinie zur Diagnostik und Therapie bipolarer Störungen. Nervenheilkunde 5:333–340

    Google Scholar 

  • Pirovano A, Serretti A, Fontana V, Ploia C, Tubazio V, Catalano M, Smeraldi E (2004) Identification of two new variants in the circadian Clock gene. Am J Med Genet Part B-Neuropsychiatr Genet 130B(1):34

    Google Scholar 

  • Riemann D, Berger M, Voderholzer U (2001) Sleep and depression results from psychobiological studies: an overview. Biol Psychol 57:67–103

    Article  PubMed  CAS  Google Scholar 

  • Ritter PS, Marx C, Bauer M, Lepold K, Pfennig A (2011) The role of disturbed sleep in the early recognition of bipolar disorder: a systematic review. Bipolar Disord 13(3):227–237

    Article  PubMed  Google Scholar 

  • Rucklidge JJ (2008) Retrospective parent report of psychiatric histories: do checklists reveal specific prodromal indicators for postpubertal-onset pediatric bipolar disorder? Bipolar Disord 10(1):56–66

    Article  PubMed  Google Scholar 

  • Sadeh A (2011) The role and validity of actigraphy in sleep medicine: an update. Sleep med rev 15(4):259–267

    Article  PubMed  Google Scholar 

  • Sadeh A, Hauri PJ, Kripke DF, Lavie P (1995) The role of actigraphy in the evaluation of sleep disorders. Sleep 18(4):288–302

    PubMed  CAS  Google Scholar 

  • Sanchez-Ortuno MM, Edinger JD, Means MK, Almirall D (2010) Home is where sleep is: an ecological approach to test the validity of actigraphy for the assessment of insomnia. J Clin Sleep Med (official publication of the American Academy of Sleep Medicine) 6(1):21–29

    Google Scholar 

  • Sierra P, Livianos L, Rojo L (2005) Quality of life for patients with bipolar disorder: relationship with clinical and demographic variables. Bipolar Disord 7(2):159–165

    Article  PubMed  Google Scholar 

  • Sitaram N, Nurnberger JI Jr, Gershon ES, Gillin JC (1982) Cholinergic regulation of mood and REM sleep: potential model and marker of vulnerability to affective disorder. Am J Psychiatry 139(5):571–576

    PubMed  CAS  Google Scholar 

  • Sivertsen B, Omvik S, Havik OE, Pallesen S, Bjorvatn B, Nielsen GH, Straume S, Nordhus IH (2006) A comparison of actigraphy and polysomnography in older adults treated for chronic primary insomnia. Sleep 29(10):1353–1358

    PubMed  Google Scholar 

  • Soria V, Martinez-Amoros E, Escaramis G, Valero J, Perez-Egea R, Garcia C, Gutierrez-Zotes A, Puigdemont D, Bayes M, Crespo JM, Martorell L, Vilella E, Labad A, Vallejo J, Perez V, Menchon JM, Estivill X, Gratacos M, Urretavizcaya M (2010) Differential association of circadian genes with mood disorders: CRY1 and NPAS2 are associated with unipolar major depression and CLOCK and VIP with bipolar disorder. Neuropsychopharmacology 35(6):1279–1289

    Article  PubMed  CAS  Google Scholar 

  • Talbot LS, Hairston IS, Eidelman P, Gruber J, Harvey AG (2009) The effect of mood on sleep onset latency and REM sleep in interepisode bipolar disorder. J Abnorm Psychol 118(3):448–458

    Article  PubMed  Google Scholar 

  • Thase ME, Himmelhoch JM, Mallinger AG, Jarrett DB, Kupfer DJ (1989) Sleep EEG and DST findings in anergic bipolar depression. Am J Psychiatry 146(3):329–333

    PubMed  CAS  Google Scholar 

  • Toh KL, Jones CR, He Y, Eide EJ, Hinz WA, Virshup DM, Ptacek LJ, Fu YH (2001) An hPer2 phosphorylation site mutation in familiar advanced sleep phase syndrome. Science 291(5506):1040–1043

    Article  PubMed  CAS  Google Scholar 

  • Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Aunola S, Cepaitis Z, Moltchanov V, Hakumäki M, Mannelin M, Martikkala V, Sundvall J, Uusitupa M (2001) Prevention of Type 2 Diabetes Mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344(18):1343–1350

    Article  PubMed  CAS  Google Scholar 

  • Walker MP, van der Helm E (2009) Overnight therapy? The role of sleep in emotional brain processing. Psychol Bull 135(5):731–748

    Article  PubMed  Google Scholar 

  • Wirz-Justice A (2006) Biological rhythm disturbances in mood disorders. Int Clin Psychopharmacol 21(Suppl 1):S11–S15

    Google Scholar 

  • Wirz-Justice A (2009) From the basic neuroscience of circadian clock function to light therapy for depression: on the emergence of chronotherapeutics. J Affect Disord 116(3):159–160

    Article  PubMed  Google Scholar 

  • Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP (2007) The human emotional brain without sleep—a prefrontal amygdala disconnect. Curr Biol 17(20):R877–R878

    Article  PubMed  CAS  Google Scholar 

  • Young RC, Biggs JT, Ziegler VE, Meyer DA (1978) A rating scale for mania: reliability, validity and sensitivity. Brit J Psychiatry 133:429–435

    Article  CAS  Google Scholar 

  • Zohar D, Tzischinsky O, Epstein R, Lavie P (2005) The effects of sleep loss on medical residents’ emotional reactions to work events: a cognitive-energy model. Sleep 28(1):47–54

    PubMed  Google Scholar 

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Acknowledgments

The study was supported by a grant from the medical faculty of the Technische Universität Dresden (MedDrive38).

Conflict of interest

Philipp S. Ritter, Carolin Marx, Natalia Lewtschenko, Steffi Pfeiffer report no conflict of interest. Karolina Leopold has received research support from Pfitzer. She has received speaking fees from AstraZeneca, Lilly, GlaxoSmithKline, Lundbeck, BMS and Otsuka, Pfizer und Jansen-Cilag. M. Bauer has received research support from the Stanley Medical Research Institute and NARSAD. He is an advisor to AstraZeneca, Lilly, Servier, Janssen-Cilag, Lundbeck and BMS & Otsuka and has received speaking fees from AstraZeneca,Lilly, GlaxoSmithKline, Lundbeck, BMS and Otsuka und Pfizer. A. Pfennig has received research support from GlaxoSmithKline and AstraZeneca. She has received speaking fees from AstraZeneca und Lilly.

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Ritter, P.S., Marx, C., Lewtschenko, N. et al. The characteristics of sleep in patients with manifest bipolar disorder, subjects at high risk of developing the disease and healthy controls. J Neural Transm 119, 1173–1184 (2012). https://doi.org/10.1007/s00702-012-0883-y

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  • DOI: https://doi.org/10.1007/s00702-012-0883-y

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