Study of the different sleep disturbances during the prodromal phase of depression and mania in bipolar disorders

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders Pub Date : 2024-04-23 DOI:10.1111/bdi.13429

Louise Basquin, Julia Maruani, Jeanne Leseur, Sibylle Mauries, Balthazar Bazin, Guillaume Pineau, Chantal Henry, Michel Lejoyeux, Pierre A. Geoffroy

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Abstract

Background

One of the challenges in bipolar disorder (BD) lies in early detection of the illness and its recurrences, to improve prognosis. Sleep disturbances (SD) have been proposed as reliable predictive markers of conversion. While preliminary studies have explored the relationship between SD and the onset of mood episodes, the results remain heterogeneous and a few have specifically examined patients' perception of prodromal symptoms and their progression until the episode occurs. Identifying prodromes represents a crucial clinical challenge, as it enables early intervention, thereby reducing the severity of BD. Therefore, the objective of this study is to better characterize and evaluate the progressive nature of SD as prodromal symptoms of mood episodes, and patients' perception of it.

Methods

Patients diagnosed with BD, either hospitalized or seeking treatment for a (hypo)manic or depressive episode benefited from standardized questionnaires, structured interviews, and self-report questionnaires to evaluate SD prior to the current episode, as well as sociodemographic and clinical information.

Results

Out of the 41 patients included, 59% spontaneously reported SD prior to the episode, appearing 90 days before depression and 35 days before mania (pre-indexed/spontaneous reports: 51.22% insomnia complaints, 4.88% hypersomnolence complaints, 7.32% parasomnias, 2.44% sleep movements). After inquiry about specific SD, the percentage of patients reporting prodromal SD increased significantly to 83%, appearing 210 days before depression and 112.5 days before mania (post-indexed reports: 75.61% presented with insomnia complaints appearing 150 days before depression and 20 days before mania, 46.34% had hypersomnolence complaints appearing 60 days before depression, 43.9% had parasomnias appearing 210 days before depression and 22.5 days before mania, 36.59% had sleep movements appearing 120 days before depression and 150 days before mania). Of note, bruxism appeared in 35% of patients before mania, and restless legs syndrome in 20% of patients before depression.

Conclusion

This study highlights the very high prevalence of SD prior to a mood episode in patients with BD with differences between depressive and manic episodes. The more systematic screening of sleep alterations of the prodromal phase improved the recognition and characterization of different symptoms onset by patients. This underscores the need for precise questioning regarding sleep patterns in patients, to better identify the moment of transition toward a mood episode, referred to as "Chronos syndrome". The study emphasizes the importance of educating patients about the disorder and its sleep prodromal symptoms to facilitate early intervention and prevent recurrences.

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研究双相情感障碍患者在抑郁症和躁狂症前驱期的不同睡眠障碍。

背景双相情感障碍（BD）的挑战之一在于早期发现疾病及其复发，以改善预后。睡眠障碍（SD）被认为是躁狂症转归的可靠预测指标。虽然已有初步研究探讨了睡眠障碍与情绪发作之间的关系，但研究结果仍不尽相同，只有少数研究专门探讨了患者对前驱症状的感知及其进展情况，直至情绪发作。识别前驱症状是一项重要的临床挑战，因为这有助于早期干预，从而减轻 BD 的严重程度。因此，本研究的目的是更好地描述和评估作为情绪发作前驱症状的 SD 的渐进性以及患者对其的感知。方法对确诊为 BD 的住院患者或因（低）躁狂或抑郁发作寻求治疗的患者进行标准化问卷调查、结构化访谈和自我报告问卷调查，以评估当前发作前的 SD 以及社会人口和临床信息。结果在纳入的 41 名患者中，59% 的患者在发病前自发报告了 SD，分别出现在抑郁前 90 天和躁狂前 35 天（指数化前/自发报告：失眠主诉占 51.22%，嗜睡主诉占 4.88%，寄眠占 7.32%，睡眠运动占 2.44%）。在对具体的自发性失眠进行询问后，报告前驱自发性失眠的患者比例大幅上升至 83%，出现在抑郁症前 210 天和躁狂症前 112.5 天（索引后报告：75.61%的患者在抑郁前150天和躁狂前20天出现失眠症状，46.34%的患者在抑郁前60天出现嗜睡症状，43.9%的患者在抑郁前210天和躁狂前22.5天出现寄生虫症状，36.59%的患者在抑郁前120天和躁狂前150天出现睡眠运动症状）。值得注意的是，35% 的患者在躁狂症前出现磨牙症，20% 的患者在抑郁症前出现不宁腿综合征。对前驱期睡眠改变进行更系统的筛查，提高了对患者发病时不同症状的识别和定性。这强调了对患者睡眠模式进行精确询问的必要性，以便更好地识别向情绪发作（即 "Chronos 综合征"）过渡的时刻。这项研究强调了对患者进行有关该疾病及其睡眠前驱症状的教育的重要性，以促进早期干预和防止复发。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bipolar Disorders 医学-精神病学

CiteScore

8.20

自引率

7.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.