Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
Centre for Affective Disorders, IoPPN, Kings College, London, UK.
Psychol Med. 2022 Sep;52(12):2281-2289. doi: 10.1017/S0033291720004171. Epub 2020 Nov 13.
Despite its pivotal role in prophylaxis for bipolar-I-disorders (BD-I), variability in lithium (Li) response is poorly understood and only a third of patients show a good outcome. Converging research strands indicate that rest-activity rhythms can help characterize BD-I and might differentiate good responders (GR) and non-responders (NR).
Seventy outpatients with BD-I receiving Li prophylaxis were categorized as GR or NR according to the ratings on the retrospective assessment of response to lithium scale (Alda scale). Participants undertook 21 consecutive days of actigraphy monitoring of sleep quantity (SQ), sleep variability (SV) and circadian rhythmicity (CR).
Twenty-five individuals were categorized as GR (36%). After correcting statistical analysis to minimize false discoveries, four variables (intra-daily variability; median activity level; amplitude; and relative amplitude of activity) significantly differentiated GR from NR. The odds of being classified as a GR case were greatest for individuals showing more regular/stable CR (1.41; 95% confidence interval (CI) 1.08, 2.05; < 0.04). Also, there was a trend for lower SV to be associated with GR (odds ratio: 0.56; 95% CI 0.31, 1.01; < 0.06).
To our knowledge, this is the largest actigraphy study of rest-activity rhythms and Li response. Circadian markers associated with fragmentation, variability, amount and/or amplitude of day and night-time activity best-identified GR. However, associations were modest and future research must determine whether these objectively measured parameters, singly or together, represent robust treatment response biomarkers. Actigraphy may offer an adjunct to multi-platform approaches aimed at developing personalized treatments or stratification of individuals with BD-I into treatment-relevant subgroups.
尽管锂（Li）在预防双相情感障碍 I 型（BD-I）中起着关键作用，但 Li 反应的变异性仍知之甚少，只有三分之一的患者有良好的疗效。越来越多的研究表明，静息-活动节律可以帮助描述 BD-I，并可能区分良好反应者（GR）和非反应者（NR）。
根据锂反应评估回顾量表（Alda 量表）的评分，将 70 名接受 Li 预防治疗的 BD-I 门诊患者分为 GR 或 NR。参与者进行了 21 天连续的活动记录仪监测睡眠量（SQ）、睡眠变异性（SV）和昼夜节律（CR）。
25 人被归类为 GR（36%）。经过统计学分析校正以最小化假发现，有四个变量（日内变异性；中位数活动水平；振幅；和活动的相对振幅）显著区分了 GR 和 NR。表现出更规律/稳定的 CR 的个体被归类为 GR 病例的可能性最大（1.41；95%置信区间（CI）1.08，2.05；<0.04）。此外，SV 较低与 GR 相关的趋势（比值比：0.56；95%CI 0.31，1.01；<0.06）。
据我们所知，这是最大的关于静息-活动节律和 Li 反应的活动记录仪研究。与碎片化、变异性、白天和夜间活动的量和/或振幅相关的昼夜节律标志物最能识别 GR。然而，关联是适度的，未来的研究必须确定这些客观测量的参数，单独或组合，是否代表稳健的治疗反应生物标志物。活动记录仪可能为多平台方法提供补充，旨在为 BD-I 患者开发个性化治疗或分层为与治疗相关的亚组。
