Boudebesse Carole, Geoffroy Pierre Alexis, Bellivier Frank, Henry Chantal, Folkard Simon, Leboyer Marion, Etain Bruno
INSERM , U955, Créteil , France .
Chronobiol Int. 2014 Jun;31(5):698-704. doi: 10.3109/07420528.2014.895742. Epub 2014 Mar 13.
Bipolar disorder (BD) is a chronic psychiatric condition characterized by recurrences of depressive and (hypo)manic episodes. Patients in remission report a wide range of sleep and circadian disturbances that correlate with several outcomes measures such as functioning or physical health. The most appropriate way to measure these abnormalities in clinical practice requires further investigation since the external validity of self-reports, as compared to more physiological measures (such as polysomnography or actigraphy), has been questioned. Despite the fact that questionnaires are inexpensive, fast and easy to use, they need to be validated against objective measures. This study aims to validate three sleep and circadian questionnaires, namely the Pittsburgh Sleep Quality Index (PSQI), the Composite Scale of Morningness (CSM) and the Circadian Type Inventory (CTI) - against actigraphy in BD patients in remission. Twenty-six carefully assessed BD patients in remission completed the PSQI, the CTI and the CSM, and wore an actigraph (AW7, Camntech) for 21 consecutive days. Phase preference assessed by the CSM strongly correlated with actigraphic phase markers (M10 onset ρ = -0.69 and L5 onset ρ = -0.63). Sleep duration and sleep latency assessed by the PSQI and by actigraphy were also highly correlated (ρ = -0.76; ρ = 0.50). Moderate correlation coefficients were observed between questionnaires and actigraphy for markers that explored the stability of rhythms, sleep quality, sleep latency and sleep disturbances (|ρ| > 0.40) although these were not significant after correcting for multiple testing. No correlation was observed between markers for the amplitude of rhythms. While the external validity of the CTI clearly requires further investigation, this study supported the external validity of the CSM and the PSQI for phase preference, sleep duration and latency. We conclude that the CSM and the PSQI could be useful in routine practice and research when actigraphy is not easily available.
双相情感障碍（BD）是一种慢性精神疾病，其特征为抑郁发作和（轻）躁狂发作反复出现。病情缓解的患者报告了广泛的睡眠和昼夜节律紊乱，这些紊乱与多种结局指标相关，如功能或身体健康。在临床实践中，测量这些异常的最合适方法仍需进一步研究，因为与更多生理测量方法（如多导睡眠图或活动记录仪）相比，自我报告的外部效度受到了质疑。尽管问卷调查成本低、速度快且易于使用，但仍需根据客观测量方法进行验证。本研究旨在针对病情缓解的BD患者，验证三份睡眠和昼夜节律问卷，即匹兹堡睡眠质量指数（PSQI）、晨型综合量表（CSM）和昼夜类型量表（CTI）——与活动记录仪测量结果进行对比。26名经过仔细评估且病情缓解的BD患者完成了PSQI、CTI和CSM问卷，并连续21天佩戴活动记录仪（AW7，Camntech）。CSM评估的相位偏好与活动记录仪的相位标记密切相关（M10开始ρ = -0.69，L5开始ρ = -0.63）。PSQI和活动记录仪评估的睡眠时间和睡眠潜伏期也高度相关（ρ = -0.76；ρ = 0.50）。对于探索节律稳定性、睡眠质量、睡眠潜伏期和睡眠障碍的标记物，问卷与活动记录仪之间观察到中等程度的相关系数（|ρ| > 0.40），尽管在进行多重检验校正后这些相关性并不显著。未观察到节律振幅标记物之间的相关性。虽然CTI的外部效度显然需要进一步研究，但本研究支持CSM和PSQI在相位偏好、睡眠时间和潜伏期方面的外部效度。我们得出结论，当活动记录仪不易获取时，CSM和PSQI在常规实践和研究中可能会有用。
