Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
J Psychiatr Res. 2018 Jul;102:238-244. doi: 10.1016/j.jpsychires.2018.04.015. Epub 2018 Apr 21.
Rest-activity rhythm (RAR) disturbances are associated with mood disorders. But there remains a need to identify the particular RAR profiles associated with psychiatric symptom dimensions. Establishing such profiles would support the development of tools that track the 24-h sleep-wake phenotypes signaling clinical heterogeneity. We used data-driven clustering to identify RAR profiles in 145 adults aged 36-82 years (mean = 60, standard deviation = 9). Then we evaluated psychiatric symptom dimensions (including positive and negative affect, depressive, manic-hypomanic, panic-agoraphobic, and substance use symptoms) associated with these empirically-derived RAR profiles. Clustering identified three sub-groups characterized, on average, by: (1) earlier and more robust RARs ("earlier/robust," n = 55, 38%); (2) later and irregular RARs ("later/irregular," n = 31, 21%); and (3) later RARs and a narrower active period ("later/narrower," n = 59, 41%). Compared with the "earlier/robust" group: the "later/irregular" group had higher levels of lifetime manic-hypomanic symptoms (β (standard error) = 0.80 (0.22) higher standardized symptom units, p = 0.0004) and lifetime depression symptoms (β (standard error) = 0.73 (0.21) higher standardized symptom units, p = 0.0009); the "later/narrower" group had more lifetime depression symptoms (β (standard error) = 0.48 (0.18) higher standardized symptom units, p = 0.0076). These associations persisted after adjustments for sleep continuity and duration, suggesting that RARs are distinct behavioral correlates of clinical heterogeneity. Longitudinal studies are needed to confirm whether RAR characteristics contribute to the risk of manic and/or depressive episodes, and whether they reflect the consequences of psychiatric disturbance (e.g., on quality of life or disability). Opportunities to monitor or intervene on objectively-assessed RARs could facilitate better mental health related outcomes.
休息-活动节律（RAR）紊乱与情绪障碍有关。但仍需要确定与精神症状维度相关的特定 RAR 特征。建立这些特征将有助于开发跟踪 24 小时睡眠-觉醒表型以指示临床异质性的工具。我们使用数据驱动的聚类方法在 145 名年龄在 36-82 岁的成年人（平均年龄 60 岁，标准差 9 岁）中识别 RAR 特征。然后，我们评估了与这些经验衍生的 RAR 特征相关的精神症状维度（包括正性和负性情绪、抑郁、躁狂-轻躁狂、惊恐-广场恐怖和物质使用症状）。聚类确定了三个亚组，平均而言，这些亚组的特征为：（1）RAR 更早且更强（“更早/更强”，n=55，38%）；（2）RAR 更晚且不规则（“更晚/不规则”，n=31，21%）；和（3）RAR 更晚且活跃期更窄（“更晚/更窄”，n=59，41%）。与“更早/更强”组相比：“更晚/不规则”组有更高水平的终生躁狂-轻躁狂症状（β（标准误差）=0.80（0.22）更高的标准化症状单位，p=0.0004）和终生抑郁症状（β（标准误差）=0.73（0.21）更高的标准化症状单位，p=0.0009）；“更晚/更窄”组有更多的终生抑郁症状（β（标准误差）=0.48（0.18）更高的标准化症状单位，p=0.0076）。这些关联在调整了睡眠连续性和时长后仍然存在，表明 RAR 是临床异质性的独特行为相关因素。需要进行纵向研究以确认 RAR 特征是否会增加躁狂和/或抑郁发作的风险，以及它们是否反映了精神障碍的后果（例如，对生活质量或残疾的影响）。监测或干预客观评估的 RAR 的机会可能会促进更好的心理健康相关结果。
