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Hennion V, Scott J, Martinot V, Benizri C, Marie-Claire C, Bellivier F, Etain B. Associations between actigraphy estimates of sleep and circadian rhythmicity and psychotropic medications in bipolar disorders: An exploratory study. J Affect Disord 2024; 348:224-228. [PMID: 38159652 DOI: 10.1016/j.jad.2023.12.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Disturbances in sleep and circadian rhythmicity (CR) are frequent in individuals with bipolar disorders (BD). Very few studies explored the associations between psychotropic medications and these disturbances in euthymic BD. Therefore, we aimed at exploring the associations between several classes of medications (lithium, sedative/non-sedative Atypical Antipsychotics (AAP), anticonvulsants, antidepressants, benzodiazepines) and sleep disturbances and CR dimensions in a sample of euthymic individuals with BD. METHODS We included euthymic adults with BD type 1 or 2 assessed with 21 days of actimetry. We used a Principal Component Analysis (PCA) of sleep and CR estimates to generate dimensions to be studied in association with the current use of psychotropic medications, with adjustments for potential confounding factors. RESULTS We included individuals with BD-1 (n = 116) or BD-2 (n = 37). The PCA led to four dimensions of sleep and CR estimates. Benzodiazepines were associated with better sleep quality (pcorrected = 0.032). Aripiprazole was associated with less robust CR (pcorrected = 0.016), but with earlier peak of activity patterns (pcorrected = 0.020). Sedative AAPs were associated with better sleep quality, which was no longer significant after correction. We found no association between lithium or anticonvulsants and CR. LIMITATIONS The cross-sectional design and the possible non-representativeness of the sample were limitations of our study. CONCLUSIONS In euthymic individuals with BD, benzodiazepines may have a positive effect on sleep quality, while aripiprazole may have mixed effects on CR (less robust but with earlier peak of activity patterns). No association with lithium or anticonvulsants observed. Further studies are warranted to replicate and extend these results.
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Affiliation(s)
- Vincent Hennion
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, Paris, France.
| | - Jan Scott
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Victoire Martinot
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, Paris, France
| | - Chloé Benizri
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Établissement de SantÉ Mentale de Paris et Ivry-sur-Seine, Groupe MGEN, Paris, France
| | - Cynthia Marie-Claire
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France
| | - Frank Bellivier
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, Paris, France
| | - Bruno Etain
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, Paris, France
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2
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Gross G, Maruani J, Vorspan F, Benard V, Benizri C, Brochard H, Geoffroy PA, Kahn JP, Yeim S, Leboyer M, Bellivier F, Etain B. Association between coffee, tobacco, and alcohol daily consumption and sleep/wake cycle: an actigraphy study in euthymic patients with bipolar disorders. Chronobiol Int 2020; 37:712-722. [PMID: 32048536 DOI: 10.1080/07420528.2020.1725542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/03/2020] [Accepted: 01/26/2020] [Indexed: 01/17/2023]
Abstract
Individuals with bipolar disorder (BD) have higher than average rates of coffee, tobacco and alcohol use. These substances may have deleterious effects on sleep quality and quantity, which may destabilize sleep/wake cycles and negatively impact the clinical course and prognosis of BD. The use of these substances may also be perceived as a self-medication attempt, for example, to induce sleep or to increase vigilance during the day. The objective of the current study was to investigate associations between the self-reported daily use of coffee, tobacco, and alcohol, and objective measures of sleep and activity patterns in adult individuals with BD. A sample of 147 euthymic individuals with BD were assessed for daily coffee, tobacco and alcohol consumption and 21 days of actigraphy monitoring. Actigraphic measures of sleep quantity and daytime activity were compared between groups classified as coffee+/coffee-, tobacco+/tobacco- and alcohol+/alcohol-, defined according to their current daily use. Then, we examined potential correlations between sleep/wake cycle parameters and the amount of daily consumption of each substance. Multivariable analyses identified associations between the use of coffee, tobacco, and alcohol and several sleep and activity parameters, such as between coffee, alcohol, and the relative amplitude of activity (respectively, p = .003 and p = .005), between alcohol and M10 onset (onset time of the 10 most active hours during the 24-h cycle) (p = .003), and between coffee and sleep duration (p = .047). This study supports the hypothesis that there is a relationship, whose direction would be bidirectional, between the daily use of these substances and the sleep/wake cycle in euthymic individuals with BD. These preliminary results require replications in other retrospective and prospective samples. They may have a clinical impact on psycho-education strategies to be proposed to individuals with BD.
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Affiliation(s)
- Grégory Gross
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris, France
- Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy , Laxou, France
- Faculté de Médecine, Université de Lorraine , France
| | - Julia Maruani
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris (APHP) , Paris, France
- Université de Paris , Paris, France
| | - Florence Vorspan
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris (APHP) , Paris, France
- Université de Paris , Paris, France
| | - Victoire Benard
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris, France
- Université de Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives , Lille, France
- Université de Lille, CHRU Lille, Clinique de Psychiatrie, Unité CURE , Lille, France
- Université de Lille, Hôpital Fontan CHRU , Lille, France
| | - Chloé Benizri
- INSERM U955, Equipe Psychiatrie Translationnelle , Créteil, France
| | - Héléna Brochard
- Pôle sectoriel, Centre Hospitalier Fondation Vallée , Gentilly, France
| | - Pierre-Alexis Geoffroy
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris, France
- Université de Paris , Paris, France
- Département de psychiatrie et de médecine addictologique, Assistance Publique des Hôpitaux de Paris (APHP), Centre Hospitalo-Universitaire Bichat-Claude Bernard , Paris, France
| | - Jean-Pierre Kahn
- Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy , Laxou, France
- Faculté de Médecine, Université de Lorraine , France
- Clinique soins-études, Fondation Santé des Etudiants de France , Vitry-le-François, France
- Fondation FondaMental , Créteil, France
| | - Sunthavy Yeim
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris (APHP) , Paris, France
- Université de Paris , Paris, France
| | - Marion Leboyer
- INSERM U955, Equipe Psychiatrie Translationnelle , Créteil, France
- Fondation FondaMental , Créteil, France
- Faculté de Médecine, Université Paris Est Créteil , Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie , Créteil, France
| | - Frank Bellivier
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris (APHP) , Paris, France
- Université de Paris , Paris, France
- Fondation FondaMental , Créteil, France
| | - Bruno Etain
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris (APHP) , Paris, France
- Université de Paris , Paris, France
- Fondation FondaMental , Créteil, France
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Caruso D, Meyrel M, Krane-Gartiser K, Benard V, Benizri C, Brochard H, Geoffroy PA, Gross G, Maruani J, Prunas C, Yeim S, Palagini L, Dell’Osso L, Leboyer M, Bellivier F, Etain B. Eveningness and poor sleep quality contribute to depressive residual symptoms and behavioral inhibition in patients with bipolar disorder. Chronobiol Int 2019; 37:101-110. [DOI: 10.1080/07420528.2019.1685533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Danila Caruso
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Manon Meyrel
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Karoline Krane-Gartiser
- Department of Mental Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | - Victoire Benard
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | - Chloé Benizri
- INSERM U955, Equipe Psychiatrie Translationnelle, Créteil, France
| | - Héléna Brochard
- Pôle sectoriel, Centre Hospitalier Fondation Vallée, Gentilly, France
| | - Pierre-Alexis Geoffroy
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
- Département de psychiatrie et d’addictologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Gregory Gross
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | - Julia Maruani
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
| | - Cecilia Prunas
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Sunthavy Yeim
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Marion Leboyer
- Université Paris Est Créteil, Faculté de Médecine, Creteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d’Addictologie, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
- Fondation FondaMental, Créteil, France
| | - Bruno Etain
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
- Fondation FondaMental, Créteil, France
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4
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Prunas C, Krane-Gartiser K, Nevoret C, Benard V, Benizri C, Brochard H, Faedda G, Geoffroy PA, Gross G, Katsahian S, Maruani J, Yeim S, Leboyer M, Bellivier F, Scott J, Etain B. Does childhood experience of attention-deficit hyperactivity disorder symptoms increase sleep/wake cycle disturbances as measured with actigraphy in adult patients with bipolar disorder? Chronobiol Int 2019; 36:1124-1130. [PMID: 31169034 DOI: 10.1080/07420528.2019.1619182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Childhood attention-deficit hyperactivity disorder (ADHD) is a common precursor of adult bipolar disorders (BD). Furthermore, actigraphy studies demonstrate that each disorder may be associated with abnormalities in sleep and activity patterns. This study investigates whether the presence or absence of self-reported childhood experiences of ADHD symptoms is associated with different sleep and activity patterns in adults with BD. A sample of 115 euthymic adult patients with BD was assessed for childhood ADHD symptoms using the Wender Utah Rating Scale (WURS) and then completed 21 days of actigraphy monitoring. Actigraphic measures of sleep quantity and variability and daytime activity were compared between BD groups classified as ADHD+ (n = 24) or ADHD- (n = 91), defined according to established cutoff scores for the WURS; then we examined any associations between sleep-wake cycle parameters and ADHD dimensions (using the continuous score on the WURS). Neither approach revealed any statistically significant associations between actigraphy parameters and childhood ADHD categories or dimensions. We conclude that the sleep and activity patterns of adult patients with BD do not differ according to their self-reported history of ADHD symptoms. We discuss the implications of these findings and suggest how future studies might confirm or refute our findings.
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Affiliation(s)
- C Prunas
- a INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris , France.,b Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , University of Milan , Milan , Italy
| | - K Krane-Gartiser
- a INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris , France.,c Department of Mental Health, NTNU , Norwegian University of Science and Technology , Trondheim , Norway.,d Department of Psychiatry , St. Olav's University Hospital , Trondheim , Norway
| | - C Nevoret
- e INSERM, UMR_S 1138 , Université Paris Descartes, Sorbonne Universités, UPMC Université Paris 06, UMR_S 1138, Centre de Recherche des Cordeliers , Paris , France.,f Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou , Unité d'Épidémiologie et de Recherche Clinique , Paris , France.,g INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique , Paris , France
| | - V Benard
- a INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris , France
| | - C Benizri
- h INSERM U955, Equipe Psychiatrie Translationnelle , Créteil , France
| | - H Brochard
- i Pôle sectoriel, Centre Hospitalier Fondation Vallée , Gentilly , France
| | - G Faedda
- j Lucio Bini Mood Disorders Center , New York , NY , USA
| | - P A Geoffroy
- a INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris , France.,k Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance, Publique des Hôpitaux de Paris , Paris , France.,l Sorbonne Paris Cité , Université Paris Diderot , Paris , France
| | - G Gross
- a INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris , France
| | - S Katsahian
- e INSERM, UMR_S 1138 , Université Paris Descartes, Sorbonne Universités, UPMC Université Paris 06, UMR_S 1138, Centre de Recherche des Cordeliers , Paris , France.,f Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou , Unité d'Épidémiologie et de Recherche Clinique , Paris , France.,g INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique , Paris , France
| | - J Maruani
- k Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance, Publique des Hôpitaux de Paris , Paris , France
| | - S Yeim
- k Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance, Publique des Hôpitaux de Paris , Paris , France
| | - M Leboyer
- h INSERM U955, Equipe Psychiatrie Translationnelle , Créteil , France.,m Fondation FondaMental , Créteil , France.,n AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie , Créteil , France.,o Université Paris Est Créteil, Faculté de Médecine , Creteil , France
| | - F Bellivier
- a INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris , France.,k Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance, Publique des Hôpitaux de Paris , Paris , France.,l Sorbonne Paris Cité , Université Paris Diderot , Paris , France.,m Fondation FondaMental , Créteil , France
| | - J Scott
- c Department of Mental Health, NTNU , Norwegian University of Science and Technology , Trondheim , Norway.,l Sorbonne Paris Cité , Université Paris Diderot , Paris , France.,p Academic Psychiatry, Institute of Neuroscience , Newcastle University , UK.,q Centre for Affective Disorders , Institute of Psychiatry, Psychology and Neurosciences , London , UK
| | - B Etain
- a INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie , Paris , France.,k Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance, Publique des Hôpitaux de Paris , Paris , France.,l Sorbonne Paris Cité , Université Paris Diderot , Paris , France.,m Fondation FondaMental , Créteil , France.,q Centre for Affective Disorders , Institute of Psychiatry, Psychology and Neurosciences , London , UK
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5
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Krane-Gartiser K, Scott J, Nevoret C, Benard V, Benizri C, Brochard H, Geoffroy PA, Katsahian S, Maruani J, Yeim S, Leboyer M, Bellivier F, Etain B. Which actigraphic variables optimally characterize the sleep-wake cycle of individuals with bipolar disorders? Acta Psychiatr Scand 2019; 139:269-279. [PMID: 30689212 DOI: 10.1111/acps.13003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine which combination of objectively measured actigraphy parameters best characterizes the sleep-wake cycle of euthymic individuals with bipolar disorder (BD) compared with healthy controls (HC). METHODS Sixty-one BD cases and 61 matched HC undertook 21 consecutive days of actigraphy. Groups were compared using discriminant function analyses (DFA) that explored dimensions derived from mean values of sleep parameters (Model 1); variability of sleep parameters (2); daytime activity (3); and combined sleep and activity parameters (4). Exploratory within-group analyses examined characteristics associated with misclassification. RESULTS After controlling for depressive symptoms, the combined model (4) correctly classified 75% cases, while the sleep models (1 and 2) correctly classified 87% controls. The area under the curve favored the combined model (0.86). Age was significantly associated with misclassification among HC, while a diagnosis of BD-II was associated with an increased risk of misclassifications of cases. CONCLUSION Including sleep variability and activity parameters alongside measures of sleep quantity improves the characterization of cases of euthymic BD and helps distinguish them from HC. If replicated, the findings indicate that traditional approaches to actigraphy (examining mean values for the standard set of sleep parameters) may represent a suboptimal approach to understanding sleep-wake cycles in BD.
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Affiliation(s)
- K Krane-Gartiser
- Department of Mental Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Psychiatry, St. Olav's University Hospital, Trondheim, Norway.,INSERM U1144, Paris, France
| | - J Scott
- Department of Mental Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,Centre for Affective Disorders, Institute of Psychiatry, London, UK
| | - C Nevoret
- INSERM, UMR_S 1138, Université Paris Descartes, Sorbonne Universités, UPMC Université Paris 06, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, Module Épidémiologie Clinique, Paris, France
| | | | - C Benizri
- Equipe Psychiatrie Translationnelle, INSERM U955, Créteil, France
| | - H Brochard
- Equipe Psychiatrie Translationnelle, INSERM U955, Créteil, France.,Pôle sectoriel, Centre Hospitalier Fondation Vallée, Gentilly, France
| | - P A Geoffroy
- INSERM U1144, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Fondation FondaMental, Créteil, France
| | - S Katsahian
- INSERM, UMR_S 1138, Université Paris Descartes, Sorbonne Universités, UPMC Université Paris 06, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, Module Épidémiologie Clinique, Paris, France
| | - J Maruani
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France
| | - S Yeim
- Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France
| | - M Leboyer
- Equipe Psychiatrie Translationnelle, INSERM U955, Créteil, France.,Fondation FondaMental, Créteil, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.,Université Paris Est Créteil, Creteil, France
| | - F Bellivier
- INSERM U1144, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Fondation FondaMental, Créteil, France
| | - B Etain
- INSERM U1144, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,Centre for Affective Disorders, Institute of Psychiatry, London, UK.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Fondation FondaMental, Créteil, France
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Geoffroy PA, Micoulaud Franchi JA, Maruani J, Philip P, Boudebesse C, Benizri C, Yeim S, Benard V, Brochard H, Leboyer M, Bellivier F, Etain B. Clinical characteristics of obstructive sleep apnea in bipolar disorders. J Affect Disord 2019; 245:1-7. [PMID: 30359809 DOI: 10.1016/j.jad.2018.10.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/09/2018] [Accepted: 10/08/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is one of the leading non-psychiatric comorbidities in bipolar disorders (BD). We sought to explore associations between risk of OSA in BD, clinical characteristics alongside with both subjective sleep complaints and objective sleep abnormalities. METHODS Euthymic patients with BD (n = 144) were assessed over a three-week period, by actigraphy, clinical interviews and questionnaires. RESULTS Of the study sample, 32 (22%) individuals were at high risk of OSA (HR-OSA) and 112 (78%) had a low risk (LR-OSA), as assessed with the Berlin questionnaire. HR-OSA, compared to LR-OSA, were older (p = 0.031), had higher BMI (p < 0.0005), larger neck circumference (p = 0.002), and more residual depressive symptoms (p < 0.0005). HR-OSA was also associated with greater sleepiness (p = 0.003), poorer sleep quality (p = 0.003), insomnia complaints (p = 0.027), "languid" chronotype (p = 0.002), and higher actigraphy-derived fragmentation index (p = 0.015). Backward stepwise linear regression retained BMI and depressive symptoms (correct classification of 83% of participants). Classification increased up to 85.4% when adding sleepiness and languid-vigorous scales and up to 87.8% when adding fragmentation index. Combining ROC curve analysis and Youden Index provided best cut-offs (HR-OSA if cut-off greater than or equal to) of 29.84 for BMI (Sensibility(Se) = 0.47, Specificity(Spe) = 0.96) and 1.5 for MADRS total score (Se = 0.84, Spe = 0.58). LIMITATIONS No confirmation of OSA diagnosis with polysomnography. CONCLUSIONS Higher BMI and residual depressive symptoms are the two best independent predictors of OSA in BD. Such information contributes to improving the screening and management of OSA in BD. TRIAL NUMBER NCT02627404.
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Affiliation(s)
- Pierre A Geoffroy
- Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris, cedex 10, France; Fondation FondaMental, Créteil 94000, France..
| | - Jean-Arthur Micoulaud Franchi
- Univ. Bordeaux, SANPSY, USR 3413 F-33000 Bordeaux, France; CNRS-SANPSY, USR 3413, F-33000 Bordeaux, France; Clinique du sommeil, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Julia Maruani
- Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris, cedex 10, France; Fondation FondaMental, Créteil 94000, France
| | - Pierre Philip
- Univ. Bordeaux, SANPSY, USR 3413 F-33000 Bordeaux, France; CNRS-SANPSY, USR 3413, F-33000 Bordeaux, France; Clinique du sommeil, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Carole Boudebesse
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France
| | - Chloé Benizri
- UFR des sciences de la santé Simone Veil, Université de Versailles Saint-Quentin, Université Paris-Saclay, France; Pôle de Psychiatrie, Centre Hospitalier de Versailles, France
| | - Sunthavy Yeim
- Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris, cedex 10, France
| | - Victoire Benard
- Univ. Lille, CHRU Lille, Clinique de Psychiatrie, Unité CURE, F-59000 Lille, France; Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Helena Brochard
- Pôle sectoriel, Centre Hospitalier Fondation Vallée, Gentilly, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil 94000, France.; Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Frank Bellivier
- Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris, cedex 10, France; Fondation FondaMental, Créteil 94000, France
| | - Bruno Etain
- Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris, cedex 10, France; Fondation FondaMental, Créteil 94000, France
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Benard V, Etain B, Vaiva G, Boudebesse C, Yeim S, Benizri C, Brochard H, Bellivier F, Geoffroy PA. Sleep and circadian rhythms as possible trait markers of suicide attempt in bipolar disorders: An actigraphy study. J Affect Disord 2019; 244:1-8. [PMID: 30290235 DOI: 10.1016/j.jad.2018.09.054] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/09/2018] [Accepted: 09/15/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The poor prognostic of Bipolar disorders (BD) is closely linked to deaths by suicide. Sleep and circadian abnormalities are observed during all phases of BD and are also associated with suicide attempt (SA). In this context, this study sought to identify specific sleep and circadian rhythms markers associated with suicidal attempt in euthymic patients with BD. METHODS The sample (N = 236) comprised 3 groups: 147 patients with BD including 57 with a history of SA and 90 without (NoSA), and 89 healthy controls (HC). All participants were recorded during 21 days with actigraphy. RESULTS SA was associated with women gender (p = 0.03), familial history of SA (p = 0.03), mixed episodes (p = 0.001), and benzodiazepines (p = 0.019). SA, compared to noSA, had a morning phase preference (p = 0.04), and were more vigorous on the circadian type inventory (p = 0.04), and tended to suffer more from insomnia (45% versus 25% respectively, p = 0.10). SA was also associated with an earlier onset of daily activity assessed with actigraphy (M10 onset: p = 0.01). Backward stepwise linear regression indicated that a combination of four variables (Gender, vigour, insomnia, M10onset) significantly differentiated patients with SA from NoSA (p = 0.03). LIMITATIONS Cross-sectional design, and no examination of suicidal behaviors' subgroups such as first attempters or repeaters, or violent suicide attempt. CONCLUSIONS Woman gender, vigorous circadian type, insomnia and an earlier daily activity appeared independently associated with SA in BD. If these biomarkers are confirmed in prospective studies, they should be screened and used to prevent suicide, with the development of personal and targeted chronobiological treatments.
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Affiliation(s)
- V Benard
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille F-59000, France; Univ. Lille, CHRU Lille, Clinique de Psychiatrie, Unité CURE, Lille F-59000 France; Univ. Lille, Hôpital Fontan CHRU Lille F-59000, France
| | - B Etain
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France; Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; Fondation FondaMental, Créteil 94000, France
| | - G Vaiva
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille F-59000, France; Univ. Lille, CHRU Lille, Clinique de Psychiatrie, Unité CURE, Lille F-59000 France; Univ. Lille, Hôpital Fontan CHRU Lille F-59000, France
| | - C Boudebesse
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France
| | - S Yeim
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France
| | - C Benizri
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France
| | - H Brochard
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France
| | - F Bellivier
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France; Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; Fondation FondaMental, Créteil 94000, France
| | - P A Geoffroy
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France; Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; Fondation FondaMental, Créteil 94000, France.
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8
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Brochard H, Godin O, Geoffroy PA, Yeim S, Boudebesse C, Benizri C, Benard V, Maruani J, Leboyer M, Bellivier F, Etain B. Metabolic syndrome and actigraphy measures of sleep and circadian rhythms in bipolar disorders during remission. Acta Psychiatr Scand 2018; 138:155-162. [PMID: 29845615 DOI: 10.1111/acps.12910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study explored the correlations between sleep and circadian rhythm measures and the metabolic syndrome (MetS) components in remitted patients with bipolar disorder (BD). METHOD Euthymic patients with BD (n = 67) were recorded by 3 weeks with actigraphy. We used nonparametric correlations to study the links between the MetS parameters, atherogenic index of plasma (AIP), sleep efficacy, sleep latency, fragmentation index, and phase and amplitude of rhythms. We performed multivariable analyses to take into account potential confounding factors such as sleep apnea risk, antipsychotics use, and smoker status. RESULTS We found correlations between lower sleep efficiency and higher triglyceride levels (P = 0.002), lower M10 onset (beginning of the 10 most active hours during the 24-h cycle) and higher systolic blood pressure (P = 0.03), higher fragmentation index and higher systolic blood pressure (P = 0.009), lower sleep efficiency, higher fragmentation index, and higher AIP (respectively P = 0.02 and P = 0.04). These correlations mostly remained significant when adjusting for confounders, with the exception of M10 onset and systolic blood pressure. CONCLUSION Sleep efficiency and fragmentation index might contribute to the cardiovascular risk of patients with BD independently of major confounding factors. Although these associations did not imply causality, proposing interventions on sleep quality and circadian rhythm regularity might contribute to reduce cardiovascular risk in patients with BD.
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Affiliation(s)
- H Brochard
- Pôle sectoriel, Centre Hospitalier Fondation Vallée, Gentilly, France
| | - O Godin
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.,INSERM, UMR_S 1136, Paris, France.,Fondation FondaMental, Créteil, France
| | - P A Geoffroy
- Fondation FondaMental, Créteil, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,INSERM U1144, Paris, France
| | - S Yeim
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | - C Boudebesse
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France
| | - C Benizri
- Equipe Psychiatrie Translationnelle, INSERM U955, Créteil, France
| | | | - J Maruani
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.,Equipe Psychiatrie Translationnelle, INSERM U955, Créteil, France
| | - F Bellivier
- Fondation FondaMental, Créteil, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,INSERM U1144, Paris, France
| | - B Etain
- Fondation FondaMental, Créteil, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,INSERM U1144, Paris, France
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