Sleep complaint as a biomarker of bipolar disorder in children and adolescent

Abstract

Depressive episodes are common healthy problem and patients with (BD) bipolar disorder have higher risk of suicidal than healthy individuals. Poor quality of sleep in depressive disorders is an important marker of response to treatment and to risk of recurrence. However, the association between sleep duration and subsequent mood is less consistent for depression than for mania or hypomania. The aim of this study was assessing sleep complaints in children and adolescents with BD, and analyzing differences between their depressive episode and mania episode in a transversal study of children and adolescents with BD. Our sample includes 72 children (10 ± 2y) and adolescents (15 ± 2y) with BD. The data were obtained from two research databases of patients consecutively referred for BD treatment in an outpatient clinic at the Child and Adolescent Affective Disorder Program at the Institute of Psychiatry – Sao Paulo University in Brazil. We obtained signed consent forms from legal guardians. Depressive psychopathology was ascertained by face-to-face clinical interview and with the DSM-IV version of the Diagnostic Interview for Children and Adolescent DSM IV version – DICA IV. Sleep disturbance was defined as sleep complaints (SC) noted, during a manic and a depressive episode. we considered four disturbances: Initial Insomnia (II), Night Awakening (NA); Early Awakening (EA), Hypersomnia (Hy). The data were analyzed by Chi-Square tests. There were 22 girls and 50 boys: 42% of patient had sleep-disordered- breathing. The occurrence of SC was higher during mania than during depression (66.4% versus 52.3%, respectively). II and EA correlated with depressive episode while; NA and Hy with mania episode ( p < 0.05). The time in bed was higher during depression ( p = 0.01), and patients with Night Awakening had higher chances to develop mania. The total sleep time was shorter in child group than in an adolescent group ( p < 0.05), but the complaint of non-restaurative sleep was significant higher in adolescents, particularly during mania episode ( p = 0.048). Sleep complaints may be used as a predictor of the occurrence of a specific episode in bipolar disorder. More investigation on the sleep changes in young individuals with bipolar disorders is needed. I would love to thank the Institute of Psychiatry at University of Sao Paulo Medical School, Brazil.