Abstract

BackgroundEvidence suggests that patients with bipolar disorder (BD) experience biological rhythm disturbances; however, no studies have examined the impact of this disruption on quality of life (QOL). The aim of this study is to investigate the influence of biological rhythm, depressive symptoms, sleep quality, and sleep medication use on QOL in BD.MethodsEighty BD subjects (44 depressed and 36 euthymic) completed questionnaires assessing QOL (WHOQOL-BREF), biological rhythm disruption (BRIAN), depressive symptoms (MADRS), and sleep quality (PSQI). The impact of biological rhythm disturbance, depressive symptoms severity, sleep quality, and sleep medication use on QOL was determined with multiple regression analyses.ResultsBRIAN (β = −0.31, t = −2.73, p < 0.01), MADRS (β = −0.30, t = −2.93, p < 0.01), and sleep medication use (β = −0.45, t = −2.55, p < 0.05) were significant predictors of QOL in this model (F4, 75 = 20.28; p < 0.0001). The relationship of these factors with subdomains of QOL showed that poorer social QOL was associated with greater biological rhythm disturbance (β = −0.43, t = −3.66, p < 0.01) and sleep medication use (β = −0.49, t = −2.35, p < 0.01), providing support for the social rhythm theory of BD. Physical QOL was associated with depression (β = −0.30, t = −2.93, p < 0.01) and biological rhythm disruption (β = −0.31, t = −2.73, p < 0.01). Main limitations include the cross-sectional assessment and the lack of objective measures of biological rhythms in relation to QOL.ConclusionsDisruption in biological rhythm is associated with poor QOL in BD, independent of sleep disturbance, sleep medication use, and severity of depression. Treatment strategies targeting regulation of biological rhythms, such as sleep/wake cycles, eating patterns, activities, and social rhythms, are likely to improve QOL in this population.

Highlights

  • Evidence suggests that patients with bipolar disorder (BD) experience biological rhythm disturbances; no studies have examined the impact of this disruption on quality of life (QOL)

  • Multiple regression analyses indicated that Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), Montgomery-Åsberg depression rating scale (MADRS), Pittsburgh Sleep Quality Index (PSQI), and sleep medication use explained 49.4 % of the variance in total WHOQOL-BREF scores (F4,75 = 20.28; p < 0.0001)

  • BRIAN (β = −0.31, t = −2.73, p < 0.01), MADRS scores (β = −0.30, t = −2.93, p < 0.01), and sleep medication use (β = −0.45, t = −2.55, p < 0.05) were independent predictors of QOL, whereas PSQI scores were not associated with overall QOL (p > 0.05)

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Summary

Introduction

Evidence suggests that patients with bipolar disorder (BD) experience biological rhythm disturbances; no studies have examined the impact of this disruption on quality of life (QOL). The aim of this study is to investigate the influence of biological rhythm, depressive symptoms, sleep quality, and sleep medication use on QOL in BD.Author details: Journal instruction requires author’s email address; this was not provided for Cudney, Streiner, Minuzzi, Sassi. Please supply the correct email address of the said authorLauren Cudney: laurencudney@gmail.com David Streiner: streiner@mcmaster.ca Luciano Minuzzi: minuzzi@ mcmaster.ca Roberto Sassi: sassir@mcmaster.ca. Studies based on subjective measures of sleep quality showed that remitted BD subjects report many of the same disturbances as individuals with primary insomnia, such as decreased sleep efficiency, elevated sleep-related anxiety (Harvey et al 2005), and more daytime sleepiness (Amand et al 2013). Sleep disturbance is the most commonly reported prodromal symptom of mania and the sixth most prominent for depression (Jackson et al 2003)

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