0644 Poor Sleep Quality Predicts Worse Mood Symptoms in Adolescents with Bipolar Disorder: A Longitudinal Randomized Controlled Trial

Abstract

Abstract Introduction Adolescents with bipolar disorder are at ultra-high risk of suicide and poor psychosocial functioning. Sleep is impaired during periods of depression, mania, and euthymia in adults with bipolar disorder and may be a transdiagnostic risk factor for new onset of mood symptoms. Sleep worsens during adolescence, but less is known about the interrelationships between poor sleep and mood symptoms in adolescents with bipolar disorder. Methods Participants included adolescents with bipolar disorder (n=75, 12-18 years, 65 females) who consented to a randomized controlled trial of Dialectical Behavior Therapy (DBT) vs. Standard of Care (SOC; other evidence-based psychotherapy approaches) at a specialty psychiatric clinic. Participants completed seven assessment visits, five during the year-long treatment period (baseline, 3-months, 6-months, 9-months, 12-months) and two during the post-treatment follow-up (18-months, 24-months). During each visit, participants completed the Pittsburgh Sleep Quality Index (PSQI) and a semi-structured interview to obtain weekly clinician-rated mood symptom ratings for depression, hypomania, and suicidal ideation. Results Most participants (75.9%) had a PSQI score >5 at baseline, reflecting poor sleep quality (M=8.86, SD=4.30). Sleep quality improved between baseline and 3-months (Mdiff=-2.01, p=.006) and remained stable thereafter but did not differ between treatment groups. Lag analyses examined whether sleep quality predicted the next month’s average mood symptom ratings. Across treatment group, sleep quality at 6-months predicted next month depression, hypomania, and suicidal ideation severity (ps<.032). For DBT, sleep quality at baseline predicted next month suicidal ideation severity (p=.047), and sleep quality at 9-months predicted next month hypomania severity (p=.003). For SOC, sleep quality at 6-months predicted next month depression severity (p=.027), and sleep quality at 9-months predicted next month suicidal ideation severity (p=.005). Worse sleep quality predicted worse future mood symptoms for all significant lagged effects. Conclusion Sleep quality is poor among adolescents with bipolar disorder. Sleep quality predicted future mood symptoms, suggesting that poor sleep may causally contribute to worse mood symptoms, particularly mid to late treatment. Thus, poor sleep could be a critical therapeutic target in future treatments to further improve mood symptoms in this population. Support (if any) R01 MH100056.