Adjunctive dietary intervention for bipolar disorder: a randomized, controlled, parallel-group, modified double-blinded trial of a high n-3 plus low n-6 diet

OBJECTIVE

To investigate the preliminary efficacy of a high n-3 plus low n-6 (H3-L6) dietary intervention in improving mood stability in Bipolar Disorder (BD) when compared to dietary intervention with usual U.S. levels of n-6 and n-3 polyunsaturated fatty acid (PUFA) intakes (control diet, CD).

METHODS

This 2-arm, parallel-group, randomized, modified double-blind, controlled 48-week study of 12-week intensive diet intervention in subjects with BD was conducted at a single suburban-rural site in the mid-Atlantic region. Participants with DSM-IV TR BD I or II with hypomanic or depressive symptoms were randomized, stratified on gender (N = 82). The intervention included the provision of group-specific study foods and dietary counseling. Variability of mood symptoms was measured by a twice-daily, 12-week ecological momentary analysis (EMA) paradigm, and group differences were analyzed using multilevel models. Circulating n-3 and n-6 fatty acids were measured at baseline and after 4, 8, and 12 weeks of diet exposure.

RESULTS

All 82 randomized participants were included in biochemical analyses. Seventy participants completed at least 2 EMA surveys and were included in primary EMA analyses. Variability in mood, energy, irritability, and pain as measured using EMA was reduced in the H3-L6 group compared to the CD group. No significant differences in mean ratings of mood symptoms, or any other symptom measures, were detected. The dietary intervention effect on target PUFAs significantly differed by the group over time.

CONCLUSIONS

A dietary intervention adjunctive to usual care showed preliminary efficacy in improving variability in mood symptoms in participants with BD.

TRIAL REGISTRATION

ClinicalTrials.Gov NCT02272010.

1107 Arousal And Sleepiness In Opioid Use Disorder Compared To Insomnia Disorder With And Without Comorbid Psychiatric Conditions

Introduction

Insomnia is frequent in opioid use disorder patients on buprenorphine (OUDB) and increases risk of relapse. There is lack of data evaluating specific differences in hyperarousal and daytime sequelae between OUDBs as compared to individuals with insomnia disorder without (ID) or with comorbid psychiatric conditions (CID).

Methods

We studied 112 patients with ID (47.8±16.3y, 55% female, 13% minority) and 148 with CID (44.7±15.6y, 69% female, 16% minority) evaluated at the Behavioral Sleep Medicine program of Penn State Hershey Sleep Research & Treatment Center and 71 OUDB (37.8±11.2y, 51% female, 16% minority) evaluated at the Recovery, Advocacy, Empowerment and Service program and WellSpan Internal Medicine clinics (York, PA). Subjects completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress (FIRST), Arousal Predisposition Scale (APS), Pre-sleep Arousal cognitive (PSAS-C) and somatic (PSAS-S) Scale, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and Epworth Sleepiness Scale (ESS). Excessive daytime sleepiness (EDS) was defined as an ESS score ≥ 10. MANCOVA included age, sex, race/ethnicity and depression as covariates, while logistic regression further included ISI, APS and PSAS-S.

Results

No differences across groups were observed in PSAS-C or DBAS scores. Subjects with CID and OUDB had significantly higher PSAS-S (15.7±0.5 and 16.4±0.7, respectively) and APS (35.6±0.6 and 36±1, respectively) scores as compared to the ID group (14.2±0.6 and 33.2±0.7, respectively). Subjects with OUDB had significantly higher ESS score (9.8±0.6) as compared to the ID or CID groups (6.2±0.5 and 6.4±0.4, respectively). The odds of EDS were 2.7 times (95%CI=1.2-6.1) higher in the OUDB group as compared to the ID group.

Conclusion

OUDB may present with similar phenotypic insomnia symptoms as patients with ID or CID but report more sleep-disturbing somatic symptoms and EDS. These data have important implications for tailoring behavioral and pharmacological treatments of insomnia to this specific patient population.

Support

Junior Faculty Development Program, Penn State College of Medicine

0585 C-Reactive Protein Improves the Ability to Detect Cardiometabolic Risk in Mild-to-Moderate Sleep Apnea

Introduction

Mild-to-moderate obstructive sleep apnea (OSA) affects 15-40% of the adult general population. However, it remains unclear when and how best to treat mild-to-moderate OSA. It has been shown that mild-to-moderate OSA in general random samples is associated with incident hypertension. The aim of this study was to compare the relative utility of apnea/hypopnea index (AHI) versus a biomarker of inflammation, C-reactive protein (CRP), in identifying the presence and severity of hypertension and insulin resistance (IR).

Methods

A clinical sample of 148 adults (53.79±12.45) with mild-to-moderate OSA (AHI between 5 and 29 events per hour) underwent 8-hour polysomnography, a clinical history and physical examination, including measures of blood pressure, body mass index (BMI), fasting blood glucose, insulin and CRP plasma levels. Hypertension was defined by previous diagnosis, past or present treatment, or blood pressure ≥140/90. IR was defined by homeostatic model assessment. Individuals with diabetes and/or on diabetes medication were excluded from analyses with IR. All analyses were conducted controlling for age, gender and BMI.

Results

CRP levels (OR=2.62, 95% CI=1.35-5.04, p=0.004), age (OR=1.75, 95% CI=1.11-2.75, p=0.016), and BMI (OR=2.74, 95% CI=1.20-6.26, p=0.017) were independently associated with greater odds for hypertension, whereas AHI (OR=1.33, 95% CI=0.61-2.92, p=0.477) was not. Additionally, CRP levels (β=0.21; p=0.04) and BMI (β=0.24; p=0.02) were independently associated with higher IR, while AHI (β=-0.03; p=0.75) was not. There was a trend for this association to be stronger in non-obese patients.

Conclusion

These preliminary findings suggest that including a measure of inflammation improves the ability for clinicians to detect cases of mild-to-moderate OSA with true cardiometabolic risk. CRP may be a simple, easy-to-use biomarker that can improve prognosis assessment and clarify which treatment option is best for patients with mild-to-moderate OSA.

Support

Department of Psychiatry, Penn State College of Medicine

0458 Smoking and Caffeine Consumption Differ Between Insomnia Phenotypes Based on Objective Sleep Duration

Introduction

The insomnia with short sleep phenotype (ISS), in contrast to the normal sleep phenotype (INS), is characterized by physiological hyperarousal including activation of the stress system and cardiometabolic morbidity. The aim of this study was to assess whether these two insomnia phenotypes differ in terms of the use of two common stimulants (i.e., caffeine and nicotine).

Methods

Data from the Penn State Adult Cohort (N=1741) was used in this study (52.2% women, 48.8±13.6 years). A 1-night, 8-hour, polysomnography (PSG) was used to classify subjects into normal (≥6h) and short (<6h) sleep duration groups. Self-reported sleep difficulty was defined based on three levels of severity as normal sleep (n=1022), poor sleep (n=520) and insomnia (n=199). Self-reported heavy caffeine use was defined as ≥3 cups daily and heavy smoking as ≥20 cigarettes daily. Multinomial logistic regression analyses were conducted adjusting for covariates such as age, gender, and race.

Results

Compared to normal sleepers, ISS (OR=0.55, 95% CI=0.31-0.97, p=0.04), but not INS (OR=0.92, 95% CI=0.52-1.64, p=0.77), was associated with significantly less heavy caffeine use. In contrast, INS (OR=2.20, 95% CI=1.10-4.40, p=0.03), but not ISS (OR=0.95, 95% CI=0.41-2.17, p=0.90), was associated with significantly more heavy smoking.

Conclusion

These results indicate that the use of common stimulants (i.e., smoking cigarettes and drinking caffeine) is higher in the INS phenotype than the ISS phenotype. Individuals with the ISS phenotype may be using less caffeine and tobacco to avoid further stimulation of the already hyperaroused physiologic system, which may result in worsening of their insomnia. In the INS phenotype, changes in health behaviors should be an important part of a multidimensional approach to treatment.

Support

American Heart Association (14SDG19830018), National Institutes of Health (R01HL51931, R01HL40916)