SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science IX. Psychiatric and Behavioral Disorders and Sleep
0750
SLEEP AND CIRCADIAN ALIGNMENT IN BIPOLAR
DISORDER
Levenson JC 1,2 , Frank E 1,2 , Hasler BP 1 , Buysse DJ 1 , Monk TH 1 ,
Lotrich F 1 , Kupfer DJ 1 , Buttenfield J 1 , Wallace ML 1
1
Department of Psychiatry, University of Pittsburgh Medical Center,
Pittsburgh, PA, USA, 2 Department of Psychology, University of
Pittsburgh, Pittsburgh, PA, USA
Introduction: Neural circuitry regulating the circadian and sleep-wake
systems may be dysregulated in individuals with bipolar disorder, which
may result in sleep-circadian misalignment. The Phase Angle Difference
(PAD) between Dim Light Melatonin Onset (DLMO) and the midpoint
of sleep is a robust measure of sleep-circadian alignment. To our knowledge
PAD has not been assessed previously in individuals with bipolar
disorder. We evaluated the presence of circadian misalignment among
this population using PAD.
Methods: We examined the timing of sleep over 5 to 6 days using sleep
diary and wrist actigraphy in 10 euthymic individuals with a lifetime
diagnosis of bipolar I disorder. The following night, salivary melatonin
was sampled every half hour from 4:30pm until 2 hours after habitual
bedtime, from which DLMO was calculated. PAD was calculated as the
difference between DLMO and the average midpoint of sleep.
Results: Data for one participant was not considered valid. Of the
remaining 2 males and 7 females, most showed relatively normal
DLMO (median= 21:16). PAD values ranged from 05:35h to 09:04h
(mean=06:42). Three participants had PAD values that deviated from
the benchmark “normal” value of 6 hours by at least 60 minutes. Furthermore,
we observed marked night to night variability in the timing of
sleep, both with respect to sleep onset times (mean= 24:01h, SD= 1:14h)
and sleep offset times (mean=7:45h, SD=1:12h). The average withinsubject
variability in sleep onset and sleep offset times was 1:02h and
00:55h respectively.
Conclusion: It is feasible to measure PAD in euthymic patients with
bipolar I disorder, and some individuals show evidence of circadian
misalignment. Within-subject variability of sleep measures also suggests
circadian instability. Safe, controlled experimental challenges to
the circadian system may further elucidate the nature of circadian dysregulation
in bipolar patients.
0751
SLEEP IN BIPOLAR DISORDER: AN EXAMINATION OF
SLEEP DISTURBANCE ACROSS THE COURSE OF THE
ILLNESS
Kanady JC, Soehner A, Eidelman P, Lee J, Hein K, Harvey AG
Clinical Science, University of California, Berkeley, Berkeley, CA,
USA
Introduction: Evidence is accruing that sleep may be an important but
understudied mechanism of bipolar disorder. First, sleep disturbance is
symptom of mood episodes and sleep disturbance persists during the
inter-episode period. Second, sleep disturbance is a common prodrome
of mania and depression. Third, sleep deprivation triggers the onset of
hypo/mania in a large proportion of bipolar patients. Despite the severity
and prevalence of bipolar disorder and the unequivocal role of sleep,
very little is known about the course of the disorder and related sleep disturbance.
This study aims to elucidate the prevalence of intra and interepisode
sleep disturbance across the course of bipolar disorder.
Methods: Twenty-four patients with a diagnosis of bipolar disorder and
co-occurring sleep complaints (age: 37.0±12.4 years; 8 males) were administered
a modified NIMH-Life Chart. The Life Chart documented
the number and duration of individual mood episodes and intra and inter-episode
sleep disturbance. The types of sleep disturbance examined
were insomnia, hypersomnia, delayed sleep phase, reduced sleep need
and irregular sleep patterns.
Results: Participants reported experiencing mood episodes for an average
of 16.3±9.2 years with an total of 3.9±4.5 manic episodes (duration:
4.5±3.7 months) and 6.3±6.8 depressive episodes (duration: 6.8±6.7
months). Seventy-one percent of manic episodes included reduced sleep
need. Fifty-eight percent of depressive episodes included insomnia and
56% included hypersomnia. The most common sleep disturbance experienced
during the interepisode period was insomnia and this was reported
by 79% of the participants interviewed. The other inter-episode sleep
disturbances reported were: 58% hypersomnia, 4% reduced sleep need,
29% delayed sleep phase and 25% irregular sleep patterns. Twenty-nine
percent of participants reported that their sleep disturbance preceded
their diagnosis of bipolar disorder.
Conclusion: Sleep disturbance is a prevalent and complex feature of bipolar
disorder. The type and prevalence of sleep disturbance experienced
varies across individuals.
Support (If Any): R34MH080958
SLEEP, Volume 34, Abstract Supplement, 2011
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