Sleep patterns among bipolar disorder patients

Abstract

Background Bipolar disorder (BD) is a lifelong, potentially treatable psychiatric disorder with substantial morbidity and mortality. Sleep is a very important factor for the quality of life, risk for relapse, affective functioning, cognitive functioning, impulsivity, and general health. It is important to note that a bidirectional relationship likely exists between sleep disturbance and mood disorders, as symptoms of mood disorders may disrupt sleep, and disrupted sleep can increase symptoms of mood disorders. Moreover, the sources of inflammation and immune activation, which play a role in depression, may contribute to the inflammatory burden in patients with mania. Aim The aim of this study was to study the nature of sleep disturbance in bipolar patients and to detect the correlation between the severity of BD and sleep disturbance. Patients and methods In this case–control study, fifty BD patients (28 male patients and 22 female patients) and 20 age-matched controls were recruited for this study. Structured Clinical Interview for DSM-IV Axis I Disorders for diagnosis of BD; Beck Depression Inventory-II and Young Mania Rating Scale (YMRS) were used to assess the severity of BD. Assessment of sleep pattern was carried out by Pittsburgh Sleep Quality Index (PSQI), and C-reactive protein (CRP) was measured. Results In the current study, with regard to Beck scores before medication, there were inverse relations with YMRS and PSQI. These relations become direct after medication. As regards YMRS scores before medication, there was an inverse relation with Beck, direct relations with PSQI, which did not show any change after medication, except for sleep disturbance, which become an inverse relation. As regards PSQI’s total scores before medication, it showed an inverse relation with Beck, direct relations with YMRS and the relation with Beck scores became direct after medication. As regards CRP levels, there was a significant difference between cases before and after medication and significant difference between the case and control groups. Conclusion PSQI is a cheap valid test that can be used in Egypt to report sleep profile and abnormalities, to follow-up the patients and prevent relapse. Hence, bipolar patients with depressive symptoms improved and responded better on treatment, with better improvement in sleep profile than patients with manic symptoms. Moreover, a definite correlation between sleep disturbance and CRP levels could not be concluded.