Sleep impairment linked to bipolar disorder course in teens

By Mark Cowen, Senior MedWire Reporter

Sleep impairment plays a significant role in the course of bipolar disorder among adolescents, US study results suggest.

Jessica Lunsford-Avery (University of Colorado at Boulder) and colleagues found that sleep impairment was significantly and positively associated with mania and depression symptoms and psychosocial impairment over a 2-year follow-up period in young people with the mood disorder.

The team suggests that "psychosocial treatments focusing on sleep stabilization may prove effective in improving the prognosis of adolescent bipolar spectrum disorder-related sleep irregularities."

The findings come from a study of 53 adolescents with bipolar disorder, aged a mean of 14.6 years at baseline, who participated in a family focused treatment trial.

All of the participants were assessed at baseline and at regular intervals over a mean 83.9-week follow-up period using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Mania Rating Scale (MRS) and Depression Rating Scale (DRS).

They were also assessed at regular intervals using the Adolescent Sleep Habits Questionnaire (ASHQ) and the Adolescent Longitudinal Interval Follow-up Evaluation (A-LIFE) Psychosocial Scales.

The researchers note that the mean MRS score at baseline was 28.19, indicating clinically significant symptoms of mania; the mean DRS score was 22.46, indicating moderate levels of depression; and the mean ASHQ score was 43.76, indicating moderate levels of sleep impairment.

Mixed effects modeling revealed that ASHQ sleep disturbance scores significantly predicted MRS scores over time, such that as the level of sleep disturbance increased, mania severity also increased.

The team also found that ASHQ sleep scores significantly predicted DRS over the follow-up period, in that greater levels of sleep impairment were associated with more severe depressive symptoms.

Furthermore, after accounting for MRS and DRS scores, ASHQ sleep scores significantly predicted A-LIFE Psychosocial Scale scores over the study period, such that higher levels of sleep impairment were associated with more psychosocial impairment.

Lunsford-Avery et al conclude in Psychiatry Research: "The present study provides evidence for a robust link between sleep problems and mood symptoms and functioning in adolescents with bipolar spectrum disorder followed for up to 2 years."

They add that "given that an association between sleep disturbance, mood, and daytime functioning has been shown in most adolescents, including those recruited from community high school samples, the development and empirical evaluation of therapies targeting sleep may benefit not only adolescents with BSD, but also the larger pediatric population."

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