Circadian Phase Preference in Pediatric Bipolar Disorder.

Kerri Kim,Mary Carskadon,Karen Seymour,Megan Puzia,Ezra Wegbreit,Alexandra Weissman,Daniel Dickstein,Grace Cushman

doi:10.3390/jcm3010255

Kerri Kim, Mary Carskadon + Show 6 more

Open Access

https://doi.org/10.3390/jcm3010255

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Abstract

Pediatric bipolar disorder (BD) rates have notably increased over the past three decades. Given the significant morbidity and mortality associated with BD, efforts are needed to identify factors useful in earlier detection to help address this serious public health concern. Sleep is particularly important to consider given the sequelae of disrupted sleep on normative functioning and that sleep is included in diagnostic criteria for both Major Depressive and Manic Episodes. Here, we examine one component of sleep—i.e., circadian phase preference with the behavioral construct of morningness/eveningness (M/E). In comparing 30 BD and 45 typically developing control (TDC) participants, ages 7–17 years, on the Morningness-Eveningness Scale for Children (MESC), no between-group differences emerged. Similar results were found when comparing three groups (BD−ADHD; BD+ADHD; TDC). Consistent with data available on circadian phase preference in adults with BD, however, we found that BD adolescents, ages 13 years and older, endorsed significantly greater eveningness compared to their TDC peers. While the current findings are limited by reliance on subjective report and the high-rate of comorbid ADHD among the BD group, this finding that BD teens demonstrate an exaggerated shift towards eveningness than would be developmentally expected is important. Future studies should compare the circadian rhythms across the lifespan for individuals diagnosed with BD, as well as identify the point at which BD youth part ways with their healthy peers in terms of phase preference. In addition, given our BD sample was overall euthymic, it may be that M/E is more state vs. trait specific in latency age youth. Further work would benefit from assessing circadian functioning using a combination of rating forms and laboratory-based measures. Improved understanding of sleep in BD may identify behavioral targets for inclusion in prevention and intervention protocols.

Highlights

The incidence of mania was once considered negligible in childhood and adolescence, rates of pediatric bipolar disorder (BD) have notably increased over the past three decades
Regardless of diagnostic group, Morningness-Eveningness Scale for Children (MESC) scores were negatively correlated with pubertal status (r = −0.33, p < 0.01) and age (r = −0.41, p < 0.01), indicating that as youth developed/aged, their preferences shifted towards greater eveningness
We found that BD teens, but not latency-age youth, are consistent with circadian phase data available for adults with BD as they reported significantly greater eveningness compared to typically developing control (TDC) teens

Summary

Introduction

The incidence of mania was once considered negligible in childhood and adolescence, rates of pediatric bipolar disorder (BD) have notably increased over the past three decades. The growing prevalence of pediatric BD is especially concerning given the significant morbidity and mortality associated with BD, including high rates of suicidality, academic and social impairment, lower perceived quality of life, and high health care expenditures [2,3,4]. Despite increasing data supporting pharmacological and psychotherapy treatment options for youth once diagnosed with BD, efforts are needed to identify factors useful in earlier detection to help address this serious public health concern. In a recent study of 82 youth diagnosed with BD, for example, nearly half of parents retrospectively reported sleep disruption (e.g., insomnia, parasomnias) as the first observed symptom [10].

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