Heartbeat Complexity Modulation in Bipolar Disorder during Daytime and Nighttime

Mimma Nardelli,Gilles Bertschy,Enzo Pasquale Scilingo,Antonio Lanata,Gaetano Valenza

doi:10.1038/s41598-017-18036-z

Mimma Nardelli, Gilles Bertschy + Show 3 more

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https://doi.org/10.1038/s41598-017-18036-z

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Abstract

This study reports on the complexity modulation of heartbeat dynamics in patients affected by bipolar disorder. In particular, a multiscale entropy analysis was applied to the R-R interval series, that were derived from electrocardiographic (ECG) signals for a group of nineteen subjects comprised of eight patients and eleven healthy control subjects. They were monitored using a textile-based sensorized t-shirt during the day and overnight for a total of 47 diurnal and 27 nocturnal recordings. Patients showed three different mood states: depression, hypomania and euthymia. Results show a clear loss of complexity during depressive and hypomanic states as compared to euthymic and healthy control states. In addition, we observed that a more significant complexity modulation among healthy and pathological mood states occurs during the night. These findings suggest that bipolar disorder is associated with an enhanced sleep-related dysregulation of the Autonomic Nervous System (ANS) activity, and that heartbeat complex dynamics may serve as a viable marker of pathological conditions in mental health.

Highlights

Bipolar disorder is recognized as a chronic illness with a lifetime prevalence of 1–3% and is considered one of the world’s ten most disabling conditions[1,2]
We have been inspired by a study showing a significant increase of Heart Rate Variability (HRV) regularity in patients with major depression with respect to the healthy controls, as quantified through MultiScale Entropy (MSE) indices on data gathered from nighttime recordings[43]
We investigated how heartbeat complex dynamics is affected by pathological mood states in bipolar disorder during the day and night

Summary

Introduction

Bipolar disorder is recognized as a chronic illness with a lifetime prevalence of 1–3% and is considered one of the world’s ten most disabling conditions[1,2]. The diagnosis of bipolar disorder is based on clinical observation of a patient’s behavioral mood episodes, according to standardized criteria described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)[7] and the tenth edition of the International Classification of Diseases (ICD-10)[8]. These criteria differentiate the diagnosis according to the presence, sequence and history of critical mood episodes. Due to possible comorbid somatic diseases, such as cardiovascular diseases[10,11,12], obesity[13], metabolic syndromes, hyperlipidemia, hypertension and diabetes[14], so far neither biological markers nor physiological correlates have been found to be specific and sensitive enough for current clinical practice[15]

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