Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy.
Int J Environ Res Public Health. 2023 Feb 17;20(4):3566. doi: 10.3390/ijerph20043566.
The present study aimed at exploring whether lifetime post-traumatic stress spectrum symptoms are associated with chronotype in patients with bipolar disorder (BD). Moreover, we explored whether the chronotype can moderate the potential associations between lifetime post-traumatic stress spectrum symptoms and rest-activity circadian and sleep-related parameters. A total of 74 BD patients were administered the Trauma and Loss Spectrum Self-Report (TALS-SR) lifetime version for lifetime post-traumatic stress spectrum symptoms, the Pittsburgh Sleep Quality Index (PSQI) for self-reported sleep quality, and the Reduced Morningness-Eveningness Questionnaire (rMEQ) to discriminate evening chronotypes (ETs), neither chronotype (NT), and morning chronotype (MT). Actigraphic monitoring was used to objectively evaluate sleep and circadian parameters. Patients classified as ET reported significantly higher scores in the re-experiencing domain, as well as poorer sleep quality, lower sleep efficiency, increased wake after sleep onset, and delayed mid-sleep point compared with both NT and MT (-value ≤ 0.05). Moreover, ET presented significantly higher scores in the TALS-SR maladaptive coping domain than NT and lower relative amplitude than MT (-value ≤ 0.05). Moreover, higher TALS-SR total symptomatic domains scores were significantly correlated with poor self-reported sleep quality. Regression analyses showed that the PSQI score maintained the association with the TALS total symptomatic domains scores after adjusting for potentially confounding factors (age and sex) and that no interaction effect was observed between the chronotype and the PSQI. Conclusions: This exploratory study suggests that patients with BD classified as ET showed significantly higher lifetime post-traumatic stress spectrum symptoms and more disrupted sleep and circadian rhythmicity with respect to other chronotypes. Moreover, poorer self-reported sleep quality was significantly associated with lifetime post-traumatic stress spectrum symptoms. Further studies are required to confirm our results and to evaluate whether targeting sleep disturbances and eveningness can mitigate post-traumatic stress symptoms in BD.
本研究旨在探讨双相障碍（BD）患者的终身创伤后应激谱症状是否与昼夜类型有关。此外，我们还探讨了昼夜类型是否可以调节终身创伤后应激谱症状与休息-活动昼夜节律和睡眠相关参数之间的潜在关联。共有 74 名 BD 患者接受了创伤和丧失谱自我报告（TALS-SR）终身版，用于评估终身创伤后应激谱症状、匹兹堡睡眠质量指数（PSQI）用于自我报告的睡眠质量以及简化早晨-傍晚问卷（rMEQ）用于区分傍晚型（ET）、非昼夜型（NT）和早晨型（MT）。活动记录仪监测用于客观评估睡眠和昼夜节律参数。与 NT 和 MT 相比，被归类为 ET 的患者在再体验域中报告的得分明显更高，睡眠质量更差，睡眠效率更低，睡眠后醒来时间增加，睡眠中点延迟（-值≤0.05）。此外，ET 在 TALS-SR 适应不良应对域中的得分明显高于 NT，相对幅度明显低于 MT（-值≤0.05）。此外，TALS-SR 总症状域得分越高，与自我报告的睡眠质量差呈显著相关。回归分析表明，在调整潜在混杂因素（年龄和性别）后，PSQI 评分与 TALS 总分症状域评分保持关联，且昼夜类型与 PSQI 之间未观察到交互作用。结论：这项探索性研究表明，与其他昼夜类型相比，被归类为 ET 的 BD 患者表现出明显更高的终身创伤后应激谱症状和更严重的睡眠和昼夜节律紊乱。此外，自我报告的睡眠质量越差与终身创伤后应激谱症状显著相关。需要进一步的研究来证实我们的结果，并评估是否针对睡眠障碍和傍晚倾向可以减轻 BD 中的创伤后应激症状。
