Sleep disturbance may impact treatment outcome in bipolar disorder: A preliminary investigation in the context of a large comparative effectiveness trial.
Sleep disturbance may impact treatment outcome in bipolar disorder: A preliminary investigation in the context of a large comparative effectiveness trial.
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DOI：
10.1016/j.jad.2017.08.056
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发表时间：
2018
影响因子：
6.6
通讯作者：
L. Sylvia;Weilynn C. Chang;M. Kamali;M. Tohen;G. Kinrys;T. Deckersbach;J. Calabrese;M. Thase;N. Reilly-Harrington;W. Bobo;J. Kocsis;M. McInnis;C. Bowden;T. Ketter;E. Friedman;R. Shelton;S. McElroy;K. Gao;D. Rabideau;A. Nierenberg
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文献类型：
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作者：
L. Sylvia;Weilynn C. Chang;M. Kamali;M. Tohen;G. Kinrys;T. Deckersbach;J. Calabrese;M. Thase;N. Reilly-Harrington;W. Bobo;J. Kocsis;M. McInnis;C. Bowden;T. Ketter;E. Friedman;R. Shelton;S. McElroy;K. Gao;D. Rabideau;A. Nierenberg
背景：双相情感障碍患者在情绪发作期间和发作之间会出现睡眠障碍。然而，睡眠对不同药物治疗的影响尚未得到充分探索。本文的目的是在奎硫平和锂的随机有效性试验中探讨基线睡眠不良对结果的潜在影响。方法双相选择研究是一项为期6个月、平行组、多地点随机对照试验。双相情感障碍患者（N = 482； 59%为女性，年龄18-70岁）接受喹硫平或锂治疗。患者也可以接受辅助的个性化治疗，这是根据需要在治疗中添加指南，基于经验的药物。药物变化记录为必要的临床调整（NCA）。Fisher精确检验、混合回归模型和mann - whitneyu检验被用来评估人口学和临床特征，以及睡眠障碍是否会预测结果。结果63%的患者存在基线睡眠障碍。有睡眠障碍的个体有更严重的双相情感障碍，更严重的抑郁、躁狂、焦虑、易怒和精神病，持续反应的可能性更小（17%比29%；调整后RR: 0.55, 95% CI: 0.38-0.78, p = 0.0006），并且有更多的nca（中位数0.71比0.59,p = 0.03）。局限性我们的研究结果受限于我们如何定义睡眠障碍，以及如何用一项非睡眠特定测量来评估睡眠障碍的严重程度。结论基线睡眠障碍与更严重的双相症状和更差的6个月预后相关。需要进一步研究改善双相情感障碍患者的睡眠，特别是社会心理干预的作用。
BackgroundBipolar patients experience sleep disturbances during and between mood episodes. Yet the impact of sleep on treatment with different medications has not been fully explored. The purpose of this paper is to explore the potential impact of poor sleep at baseline on outcomes in a randomized effectiveness trial of quetiapine and lithium.MethodsThe Bipolar CHOICE study was a 6-month, parallel group, multisite randomized controlled trial. Participants with bipolar disorder (N = 482; 59% female and age 18–70 years) received quetiapine or lithium. Patients were allowed to also receive adjunctive personalized treatments, which were guideline-informed, empirically-based medications added to treatment as needed. Medication changes were recorded as necessary clinical adjustments (NCA). Fisher's exact tests, mixed-regression models, and Mann-WhitneyUtests were used to assess demographic and clinical characteristics as well as whether sleep disturbance would predict outcomes.Results63% of patients had baseline sleep disturbance. Individuals with sleep disturbance had worse bipolar illness severity, greater severity of depression, mania, anxiety, irritability, and psychosis, were less likely to have sustained response (17% vs. 29%; adjusted RR: 0.55, 95% CI: 0.38–0.78, p = 0.0006) and had more NCAs (median 0.71 vs. 0.59, p = 0.03).LimitationsOur findings were limited by how we defined sleep disturbance, and by how severity of sleep disturbance was assessed with one item with a non-sleep specific measure.ConclusionsBaseline sleep disturbance was associated with more severe bipolar symptoms and worse 6-month outcomes. Further research is warranted on improving sleep in bipolar disorder, especially the role of psychosocial interventions.