Abstract
BackgroundPoor sleep quality is known to precede the onset of mood episodes and to be associated with poor treatment outcomes in bipolar disorder (BD). We sought to identify modifiable factors that correlate with poor sleep quality in BD independent of residual mood symptoms.MethodsA retrospective analysis was conducted to assess the association between the Pittsburgh Sleep Quality Index and clinical variables of interest in euthymic patients with DSM-IV BD (n = 119) and healthy controls (HC; n = 136) participating in the Prechter Longitudinal Study of Bipolar Disorder. Multivariable linear regression models were constructed to investigate the relationship between sleep quality and demographic and clinical variables in BD and HC participants. A unified model determined independent predictors of sleep quality.Results and discussionEuthymic participants with BD and HC differed in all domains. The best fitting unified multivariable model of poor sleep quality in euthymic participants with BD included rapid cycling (β = .20, p = .03), neuroticism (β = .28, p = 2 × 10−3), and stressful life events (β = .20, p = .02). Poor sleep quality often persists during euthymia and can be a target for treatment. Clinicians should remain vigilant for treating subjective sleep complaints independent of residual mood symptoms in those sensitive to poor sleep quality, including individuals with high neuroticism, rapid cycling, and recent stressful life events. Modifiable factors associated with sleep quality should be targeted directly with psychosocial or somatic treatment. Sleep quality may be a useful outcome measure in BD treatment studies.
Highlights
Poor sleep quality is known to precede the onset of mood episodes and to be associated with poor treatment outcomes in bipolar disorder (BD)
We found that poor sleep quality was associated with stressful events in euthymic BD and social stress in the healthy control (HC) group, which has been found in general population samples (Fernandez-Mendoza et al 2010b; LeBlanc et al 2007)
Clinicians should remain vigilant for treating subjective sleep complaints independent of mood complaints in BD patients sensitive to poor sleep quality, including individuals with high neuroticism and rapid cycling
Summary
Poor sleep quality is known to precede the onset of mood episodes and to be associated with poor treatment outcomes in bipolar disorder (BD). These factors - aside from advancing age and menopausal status - are generally overrepresented in the BD population (Saunders et al 2008, 2012; Fagiolini et al 2002; Swartz and Fagiolini 2012; Prochaska et al 2011; Dickerson et al 2013) and may be determinants or correlates of sleep quality in the BD population Against this backdrop, we used data from the baseline visit of the Prechter Longitudinal Study of Bipolar Disorder to understand the effect of clinical features, personality traits, and life events on self-reported sleep quality in a sample of BD subjects who were euthymic and a sample of healthy control (HC) subjects. We hypothesized that factors in the domains of medical, substance use disorder, and anxiety disorder comorbidities; dimensional/personality traits; life story/trauma; and behavioral domain would show associations with sleep quality in the BD and HC samples similar to those in the general population, and we hypothesized that features of illness in the BD group such as history of suicide attempts, psychosis, mixed episodes, rapid cycling, and high number of episodes would be related to sleep quality
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