Université de Paris, Paris, France.
Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, DMU Neurosciences, GHU Lariboisière - Saint Louis - Fernand Widal, Paris, France.
Bipolar Disord. 2022 May;24(3):286-297. doi: 10.1111/bdi.13122. Epub 2021 Sep 19.
Chronobiological models postulate that abnormalities in circadian rest/activity rhythms (CRAR) are core phenomena of bipolar disorders (BDs). We undertook a meta-analysis of published studies to determine whether self- or observer ratings of CRAR differentiate BD cases from comparators (typically healthy controls [HCs]).
We undertook systematic searches of four databases to identify studies for inclusion in random effects meta-analyses and meta-regression analyses. Effect sizes (ES) for pooled analyses of self- and observer ratings were expressed as standardized mean differences with 95% confidence intervals (CIs).
The 30 studies meeting eligibility criteria included 2840 cases and 3573 controls. Compared with HC, BD cases showed greater eveningness (ES: 0.33; 95% CI: 0.12-0.54), lower flexibility of rhythms (ES: 0.36; 95% CI: 0.06-0.67), lower amplitude of rhythms (ES: 0.55; 95% CI: 0.39-0.70) and more disturbances across a range of CRAR (ES of 0.78-1.12 for general and social activities, sleep and eating patterns). Between study heterogeneity was high (I > 70%) and evidence indicated a potential publication bias for studies using the Biological Rhythms Interview of Assessment in Neuropsychiatry. Meta-regression analyses suggested significantly larger ES were observed in studies using observer ratings or including BD cases with higher levels of depressive symptoms.
This meta-analysis demonstrates that BD is associated with higher levels of self- or observer-rated CRAR disturbances compared with controls. However, further studies should examine the respective performance of individual instruments when used alone or in combination, to clarify their applicability and utility in clinical practice.
时间生物学模型假设昼夜节律（CRAR）异常是双相障碍（BD）的核心现象。我们对已发表的研究进行了荟萃分析，以确定自我或观察者评估的 CRAR 是否能区分 BD 病例与对照组（通常为健康对照[HC]）。
我们对四个数据库进行了系统搜索，以确定符合纳入条件的研究进行随机效应荟萃分析和荟萃回归分析。自我和观察者评分的汇总分析的效应大小（ES）表示为标准化均数差，置信区间（CI）为 95%。
符合入选标准的 30 项研究包括 2840 例病例和 3573 例对照。与 HC 相比，BD 病例表现出更明显的晚型倾向（ES：0.33；95%CI：0.12-0.54）、节律灵活性更低（ES：0.36；95%CI：0.06-0.67）、节律振幅更低（ES：0.55；95%CI：0.39-0.70）以及更广泛的 CRAR 紊乱（一般和社会活动、睡眠和饮食模式的 ES 为 0.78-1.12）。研究间异质性很高（I > 70%），并且有证据表明使用神经精神病学生物节律评估访谈的研究存在潜在的发表偏倚。荟萃回归分析表明，使用观察者评分或纳入抑郁症状水平较高的 BD 病例的研究观察到的 ES 显著更大。
这项荟萃分析表明，与对照组相比，BD 患者的 CRAR 紊乱程度更高，无论是自我评估还是观察者评估。然而，进一步的研究应该检查单独或组合使用时各个工具的性能，以阐明它们在临床实践中的适用性和实用性。
