Department of Neuropsychiatry, Kyorin University, School of Medicine, Tokyo, Japan.
Psychiatry Clin Neurosci. 2018 Sep;72(9):673-682. doi: 10.1111/pcn.12688. Epub 2018 Jul 4.
Sleep disturbances and circadian rhythm dysfunction have been widely demonstrated in patients with bipolar disorder (BD). Irregularity of the sleep-wake rhythm, eveningness chronotype, abnormality of melatonin secretion, vulnerability of clock genes, and the irregularity of social time cues have also been well-documented in BD. Circadian rhythm dysfunction is prominent in BD compared with that in major depressive disorders, implying that circadian rhythm dysfunction is a trait marker of BD. In the clinical course of BD, the circadian rhythm dysfunctions may act as predictors for the first onset of BD and the relapse of mood episodes. Treatments focusing on sleep disturbances and circadian rhythm dysfunction in combination with pharmacological, psychosocial, and chronobiological treatments are believed to be useful for relapse prevention. Further studies are therefore warranted to clarify the relation between circadian rhythm dysfunction and the pathophysiology of BD to develop treatment strategies for achieving recovery in BD patients.
睡眠障碍和昼夜节律紊乱在双相情感障碍（BD）患者中得到了广泛证实。睡眠-觉醒节律不规则、晚型生物钟、褪黑素分泌异常、时钟基因易感性以及社会时间线索的不规则在 BD 中也有很好的记录。与重性抑郁障碍相比，BD 中昼夜节律紊乱更为突出，这意味着昼夜节律紊乱是 BD 的特征性标志物。在 BD 的临床病程中，昼夜节律紊乱可能作为 BD 首发和情绪发作复发的预测因子。因此，结合药物、心理社会和生物节律治疗，关注睡眠障碍和昼夜节律紊乱的治疗被认为有助于预防复发。因此，有必要进一步研究以阐明昼夜节律紊乱与 BD 病理生理学之间的关系，从而为 BD 患者的康复制定治疗策略。
