Abstract
Sleep impairments are a hallmark of acute bipolar disorder (BD) episodes and are present even in the euthymic state. Studying healthy subjects who are vulnerable to BD can improve our understanding of whether sleep impairment is a predisposing factor. Therefore, we investigated whether vulnerability to BD, dimensionally assessed by the hypomanic personality scale (HPS), is associated with sleep disturbances in healthy subjects. We analyzed participants from a population-based cohort who had completed the HPS and had either a 7-day actigraphy recording or a Pittsburgh sleep quality index (PSQI) assessment. In addition, subjects had to be free of confounding diseases or medications. This resulted in 771 subjects for actigraphy and 1766 for PSQI analyses. We found strong evidence that higher HPS scores are associated with greater intraindividual sleep variability, more disturbed sleep and more daytime sleepiness. In addition, factor analyses revealed that core hypomanic features were especially associated with self-reported sleep impairments. Results support the assumption of disturbed sleep as a possibly predisposing factor for BD and suggest sleep improvement as a potential early prevention target.
Highlights
1234567890():,; 1234567890():,; 1234567890():,; 1234567890():,; Introduction Sleep disturbances and increased daytime sleepiness occur in bipolar disorder (BD), including in the euthymic state[1,2]
Daytime sleepiness has been characterized as the behavioral expression of an unstable central nervous system (CNS)-arousal;[14] and using electroencephalogram (EEG), unstable arousal has been demonstrated for BD, especially during mania[15,16,17,18]
Factorial structure of the hypomanic personality scale (HPS) In the Supplementum, factor analysis results are described in detail and compared to the available factor solutions reported in two younger non-German samples[51,68]
Summary
Sleep disturbances and increased daytime sleepiness occur in bipolar disorder (BD), including in the euthymic state[1,2]. Accumulating evidence suggests that impaired or reduced sleep and increased daytime sleepiness are symptoms of BD, but contribute to the disease process itself and to (hypo)manic behavior in particular. Experimental and longitudinal studies of patients, healthy subjects, and animals suggest that sleep deprivation can induce (hypo)mania[3,4,5,6,7,8,9]. The arousal regulation model of affective disorders and attention-deficit/hyperactivity disorder (ADHD)[15,17] takes into consideration this unstable arousal in BD (and ADHD) and suggests that hypoarousal can partly cause (hypo)manic behavior. The hyperactive and sensation-seeking behavior is seen as a compensatory arousal-stabilizing behavior, which can in turn increase sleep deficits, initiating a vicious circle contributing to mania[15,17,18]
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