Department of Psychology, Temple University, Philadelphia, PA, United States.
Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States.
J Affect Disord. 2022 Feb 1;298(Pt A):17-25. doi: 10.1016/j.jad.2021.08.155. Epub 2021 Oct 30.
Impulsivity and sleep and circadian rhythm disturbance are core features of bipolar spectrum disorders (BSDs) that are antecedents to onset and persist even between mood episodes; their pervasive presence in BSD suggests that they may be particularly relevant to understanding BSD onset and course. Considerable research demonstrates bidirectional associations between impulsivity and sleep disturbance in healthy individuals; thus, it is important to examine how these features interact to impact BSD symptomatology.
Young adults (N = 107, 55% female, M age = 21.82 years) at high risk for developing BSD (based on high self-reported reward sensitivity) or with recent-onset BSD participated in ecological momentary assessment (EMA) to examine relationships between impulsivity, sleep and circadian rhythm alterations, and mood symptoms in everyday life. Impulsivity was measured via self-report/behavioral task, sleep was measured via actigraphy, circadian rhythms were measured via dim light melatonin onset (DLMO) time, and mood symptoms were measured three times daily via self-report.
Multi-level modeling revealed that less total sleep time predicted increased next-day mood symptoms. Moreover, DLMO, total sleep time, and sleep onset latency moderated the relationship between impulsivity and EMA-assessed mood symptoms. Fewer minutes of sleep and later DLMO strengthened the positive relationship between impulsivity and mood symptoms.
Mood symptoms in our sample were mild; future studies should replicate findings in populations with more severe mood symptoms.
This multi-method assessment of dynamic relationships revealed novel associations between impulsivity, sleep and circadian rhythm disturbance, and symptoms within individuals at high-risk for or with recent-onset BSD.
冲动、睡眠和昼夜节律紊乱是双相谱系障碍（BSD）的核心特征，它们是发病的前兆，即使在情绪发作之间也会持续存在；它们在 BSD 中的普遍存在表明，它们可能与理解 BSD 的发病和病程特别相关。大量研究表明，冲动和睡眠障碍在健康个体之间存在双向关联；因此，重要的是要研究这些特征如何相互作用来影响 BSD 的症状。
有发展 BSD 高风险的年轻成年人（N=107，55%为女性，M 年龄=21.82 岁）或近期发病的 BSD 患者参与了生态瞬时评估（EMA），以研究冲动、睡眠和昼夜节律改变与日常生活中的情绪症状之间的关系。冲动通过自我报告/行为任务来测量，睡眠通过活动记录仪来测量，昼夜节律通过褪黑素起始时间（DLMO）来测量，情绪症状通过自我报告每天测量三次。
多层次模型显示，总睡眠时间减少预测次日情绪症状增加。此外，DLMO、总睡眠时间和睡眠潜伏期调节了冲动性与 EMA 评估的情绪症状之间的关系。睡眠时间较少和 DLMO 较晚加强了冲动性与情绪症状之间的正相关。
我们样本中的情绪症状较轻；未来的研究应该在情绪症状更严重的人群中复制这些发现。
这种对动态关系的多方法评估揭示了在有发展 BSD 高风险或近期发病的 BSD 患者个体中，冲动、睡眠和昼夜节律紊乱与症状之间的新关联。
