Gershon Anda, Do Dennis, Satyanarayana Satyanand, Shah Saloni, Yuen Laura D, Hooshmand Farnaz, Miller Shefali, Wang Po W, Ketter Terence A
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States.
J Affect Disord. 2017 Aug 15;218:374-379. doi: 10.1016/j.jad.2017.05.015. Epub 2017 May 8.
Abnormal sleep duration (ASD, <6 or ≥9h) is common in bipolar disorder (BD), and often persists beyond acute mood episodes. Few longitudinal studies have examined the ASD's impact upon BD illness course. The current study examined the longitudinal impact of ASD upon bipolar depressive recurrence/recovery.
Outpatients referred to the Stanford BD Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation at baseline, and with the Clinical Monitoring Form at monthly follow-ups for up to two years of naturalistic treatment. Prevalence and clinical correlates of ASD in 93 recovered (euthymic ≥8 weeks) and 153 depressed BD patients were assessed. Kaplan-Meier analyses (Log-Rank tests) assessed relationships between baseline ASD and longitudinal depressive severity, with Cox Proportional Hazard analyses assessing potential mediators.
ASD was only half as common among recovered versus depressed BD outpatients, but was significantly associated with hastened depressive recurrence (Log-Rank p=0.007), mediated by lifetime anxiety disorder and attenuated by lifetime history of psychosis, and had only a non-significant tendency towards association with delayed depressive recovery (Log-Rank p=0.07). In both recovered and depressed BD outpatients, baseline ASD did not have significant association with any baseline BD illness characteristic.
Self-reported sleep duration. Limited generalizability beyond our predominately white, female, educated, insured American BD specialty clinic sample.
Baseline ASD among recovered BD patients may be a risk marker for hastened depressive recurrence, suggesting it could be an important therapeutic target between mood episodes.
异常睡眠时长（ASD，<6小时或≥9小时）在双相情感障碍（BD）中很常见，且常常在急性情绪发作后仍持续存在。很少有纵向研究探讨ASD对BD病程的影响。本研究考察了ASD对双相抑郁复发/康复的纵向影响。
2000年至2011年期间转诊至斯坦福双相情感障碍诊所的门诊患者在基线时采用双相情感障碍系统治疗增强项目（STEP - BD）情感障碍评估量表进行评估，并在长达两年的自然主义治疗期间每月随访时使用临床监测表进行评估。评估了93名康复（心境正常≥8周）和153名抑郁的BD患者中ASD的患病率及其临床相关因素。采用Kaplan - Meier分析（对数秩检验）评估基线ASD与纵向抑郁严重程度之间的关系，采用Cox比例风险分析评估潜在的中介因素。
与抑郁的BD门诊患者相比，康复患者中ASD的发生率仅为一半，但与抑郁复发加速显著相关（对数秩检验p = 0.007），由终生焦虑障碍介导，并因终生精神病病史而减弱，且与抑郁恢复延迟仅存在非显著的关联趋势（对数秩检验p = 0.07）。在康复和抑郁的BD门诊患者中，基线ASD与任何基线BD疾病特征均无显著关联。
睡眠时长为自我报告。在我们以白人、女性、受过教育、有保险的美国双相情感障碍专科诊所样本之外，普遍适用性有限。
康复的BD患者中的基线ASD可能是抑郁复发加速的风险标志物，表明它可能是情绪发作间期的一个重要治疗靶点。
