Department of Psychiatry, Okehazama Hospital, Aichi, Japan.
Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan.
Transl Psychiatry. 2021 Oct 13;11(1):525. doi: 10.1038/s41398-021-01652-9.
A significant proportion of patients with bipolar disorder experience mood episode relapses. We examined whether circadian activity rhythms were associated with mood episode relapses in patients with bipolar disorder. This prospective cohort study included outpatients with bipolar disorder who participated in a study titled "Association between the Pathology of Bipolar Disorder and Light Exposure in Daily Life (APPLE) cohort study." The participants' physical activity was objectively assessed using a wrist-worn accelerometer over 7 consecutive days for the baseline assessment and then at the 12-month follow-up for mood episode relapses. The levels and timing of the circadian activity rhythms were estimated using a cosinor analysis and a nonparametric circadian rhythm analysis. Of the 189 participants, 88 (46%) experienced mood episodes during follow-up. The Cox proportional hazards model adjusting for potential confounders showed that a robust circadian activity rhythm, including midline-estimating statistic of rhythm (MESOR) and amplitude by cosinor analysis and 10 consecutive hours with the highest amplitude values (M10) by the nonparametric circadian rhythm analysis, was significantly associated with a decrease in mood episode relapses (per counts/min, hazard ratio [95% confidence interval]: MESOR, 0.993 [0.988-0.997]; amplitude, 0.994 [0.988-0.999]; and M10, 0.996 [0.993-0.999]). A later timing of the circadian activity rhythm (M10 onset time) was significantly associated with an increase in the depressive episode relapses (per hour; 1.109 [1.001-1.215]). We observed significant associations between circadian activity rhythms and mood episode relapses in bipolar disorder.
相当比例的双相情感障碍患者会经历心境发作复发。我们研究了昼夜节律活动节律是否与双相情感障碍患者的心境发作复发有关。这项前瞻性队列研究纳入了参加“双相情感障碍的病理学与日常生活中的光照暴露之间的关联（APPLE）队列研究”的门诊双相情感障碍患者。使用腕戴式加速度计在基线评估时连续 7 天、在 12 个月随访时（为了观察心境发作复发情况）对参与者的身体活动进行客观评估。使用正弦分析和非参数昼夜节律分析来估计昼夜节律活动节律的水平和时间。在 189 名参与者中，88 名（46%）在随访期间经历了心境发作。在调整了潜在混杂因素的 Cox 比例风险模型中，稳健的昼夜节律活动节律（包括正弦分析的中值估计节律（MESOR）和振幅，以及非参数昼夜节律分析中最高振幅值的 10 个连续小时（M10））与心境发作复发减少显著相关（每计数/分钟，风险比[95%置信区间]：MESOR，0.993[0.988-0.997]；振幅，0.994[0.988-0.999]；M10，0.996[0.993-0.999]）。昼夜节律活动节律的时间越晚（M10 起始时间），与抑郁发作复发增加显著相关（每小时增加 1.109[1.001-1.215]）。我们观察到昼夜节律活动节律与双相情感障碍的心境发作复发之间存在显著关联。
