Lindner Center of HOPE, Mason, OH, USA.; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA..
Lindner Center of HOPE, Mason, OH, USA.; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Affect Disord. 2020 Apr 1;266:556-562. doi: 10.1016/j.jad.2020.01.151. Epub 2020 Jan 26.
Our aim was to investigate evening chronotype, a proxy marker of circadian system dysfunction, as a clinical subphenotype in bipolar disorder (BD).
In this cross-sectional study, 773 BD participants and 146 control subjects were evaluated using the Structured Clinical Interview for DSM-IV and a set of questionnaires. Chronotype was determined using item-5 from the reduced Morningness-Eveningness Questionnaire. Univariate analyses and regression models were used to compare evening and non-evening chronotype in BD and chronotype association with clinical variables.
Overall, 205 (27%) of BD patients reported an evening chronotype. Evening chronotype was higher in a matched sub-sample of BD patients (n = 150) than in controls (24% and 5% respectively, OR=5.4, p<0.01). Compared to those with non-evening chronotypes, BD patients with an evening chronotype were younger, had an earlier age of onset of BD, and had more prior depressive and manic episodes, higher rates of rapid cycling, past suicide attempts, more comorbid anxiety and substance use disorders. Multivariate regression showed age, prior suicide attempts, and co-occurring substance use disorder were associated with evening chronotype (OR range of 0.97 to1.59). Hypertension, migraine, asthma, and obstructive sleep apnea were significantly associated with evening chronotype (OR range of 1.56 to 2.0).
Limitations include a cross-sectional study design that precludes establishing causality. Analyses did not control for medication use. Younger participant age may prevent evaluation of associations with late-life illnesses.
Evening chronotype may be a discrete clinical subphenotype in BD and circadian dysfunction a shared pathophysiological mechanism between psychopathology and medical morbidity.
我们旨在研究夜间型，即生物钟紊乱的替代标志物，作为双相障碍（BD）的一种临床亚表型。
在这项横断面研究中，评估了 773 名 BD 患者和 146 名对照者，采用 DSM-IV 结构临床访谈和一套问卷。使用简化 Morningness-Eveningness 问卷的项目 5 确定了时间类型。使用单变量分析和回归模型比较了 BD 中的夜间和非夜间时间类型以及时间类型与临床变量的关联。
总体而言，205 名（27%）BD 患者报告了夜间时间类型。在与 BD 患者的匹配亚样本（n=150）中，夜间时间类型更高（分别为 24%和 5%，OR=5.4，p<0.01）。与非夜间时间类型的患者相比，BD 患者中具有夜间时间类型的患者更年轻，BD 发病年龄更早，先前抑郁和躁狂发作更多，快速循环率更高，过去自杀未遂次数更多，共患焦虑和物质使用障碍的发生率更高。多变量回归显示，年龄、既往自杀未遂和共患物质使用障碍与夜间时间类型相关（OR 范围为 0.97 至 1.59）。高血压、偏头痛、哮喘和阻塞性睡眠呼吸暂停与夜间时间类型显著相关（OR 范围为 1.56 至 2.0）。
限制包括一项排除因果关系的横断面研究设计。分析未控制药物使用。年轻的参与者年龄可能会阻止评估与老年疾病的关联。
夜间时间类型可能是 BD 的一种离散临床亚表型，而昼夜节律功能障碍是精神病理学和医学发病率之间的共同病理生理机制。
