Ferrand Lisa, Hennion Vincent, Godin Ophelia, Bellivier Frank, Scott Jan, Etain Bruno
Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, 75006 Paris, France.
AP-HP.Centre, DMU Psychiatrie et Addictologie, Université de Paris, 75006 Paris, France.
J Clin Med. 2022 Apr 14;11(8):2204. doi: 10.3390/jcm11082204.
Bipolar disorder (BD) is characterized by recurrent mood episodes. It is increasingly suggested that disturbances in sleep-wake cycles and/or circadian rhythms could represent valuable predictors of recurrence, but few studies have addressed this question. Euthymic individuals with BD (n = 69) undertook 3 weeks of actigraphy recording and were then followed up for a median duration of 3.5 years. Principal component analyses were used to identify core dimensions of sleep quantity/variability and circadian rhythmicity. Associations between clinical variables and actigraphy dimensions and time to first recurrence were explored using survival analyses, and then using area under the curve (AUC) analyses (early vs. late recurrence). Most participants (64%) experienced a recurrence during follow-up (median survival time: 18 months). After adjusting for potential confounding factors, an actigraphy dimension comprising amplitude and variability/stability of circadian rhythms was a significant predictor of time to recurrence ( = 0.009). The AUC for correct classification of early vs. late recurrence subgroups was only 0.64 for clinical predictors, but combining these variables with objectively measured intra-day variability improved the AUC to 0.82 ( = 0.04). Actigraphy estimates of circadian rhythms, particularly variability/stability and amplitude, may represent valid predictive markers of future BD recurrences and could be putative targets for future psychosocial interventions.
双相情感障碍（BD）的特征是反复出现情绪发作。越来越多的研究表明，睡眠-觉醒周期和/或昼夜节律紊乱可能是复发的重要预测指标，但很少有研究探讨过这个问题。69名处于双相情感障碍缓解期的个体进行了为期3周的活动记录仪记录，随后进行了为期3.5年的中位数随访。主成分分析用于确定睡眠量/变异性和昼夜节律性的核心维度。使用生存分析，然后使用曲线下面积（AUC）分析（早期复发与晚期复发），探讨临床变量与活动记录仪维度以及首次复发时间之间的关联。大多数参与者（64%）在随访期间复发（中位生存时间：18个月）。在调整潜在混杂因素后，一个包含昼夜节律振幅和变异性/稳定性的活动记录仪维度是复发时间的显著预测指标（P = 0.009）。临床预测指标对早期复发与晚期复发亚组正确分类的AUC仅为0.64，但将这些变量与客观测量的日内变异性相结合可将AUC提高至0.82（P = 0.04）。活动记录仪对昼夜节律的估计，特别是变异性/稳定性和振幅，可能是未来双相情感障碍复发的有效预测指标，并且可能是未来心理社会干预的假定目标。
