Circadian Rhythm Sleep-Wake Disorders Predict Shorter Time to Relapse of Mood Episodes in Euthymic Patients With Bipolar Disorder: A Prospective 48-Week Study.
Circadian Rhythm Sleep-Wake Disorders Predict Shorter Time to Relapse of Mood Episodes in Euthymic Patients With Bipolar Disorder: A Prospective 48-Week Study.
复制标题
DOI：
10.4088/jcp.17m11565
复制
发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Y. Takaesu;Y. Inoue;Kotaro Ono;Akiko Murakoshi;K. Futenma;Y. Komada;Takeshi Inoue
中科院分区：
文献类型：
--
作者：
Y. Takaesu;Y. Inoue;Kotaro Ono;Akiko Murakoshi;K. Futenma;Y. Komada;Takeshi Inoue
目的昼夜节律紊乱在双相情感障碍（BD）中较为常见，并在BD的情绪调节障碍中起重要作用。然而，没有研究调查昼夜节律功能障碍是否会影响BD的临床过程。本研究的目的是检验昼夜节律功能障碍可能是胸腺功能正常的BD患者复发的预测因子这一假设。方法2014年8月至2015年4月，根据精神疾病诊断和统计手册第五版（DSM-5）的标准诊断的104例情感正常的BD门诊患者参加了这项前瞻性随访研究。在基线时，通过临床访谈确定双相情感障碍的人口统计学变量和临床描述性变量的数据。根据参与者4周的睡眠日志和国际睡眠障碍分类第三版（ICSD-3），对昼夜节律睡眠-觉醒障碍（CRSWD）进行诊断。在48周的研究期间，每4周使用蒙哥马利-艾斯伯格抑郁量表（MADRS）和杨氏躁狂量表（YMRS）评分评价受试者的BD症状。BD复发定义为评分高于临界点（MADRS评分≥ 13，YMRS评分≥ 7）。主要结果是情绪发作复发的时间。结果34名受试者在基线时符合CRSWD标准，最常见的是延迟睡眠-觉醒相障碍（n = 27）。在总共104例受试者中，51例（49.0%）在48周随访期间复发。多变量考克斯风险回归分析显示，在过去一年内有2次或2次以上的情绪发作和合并CRSWD与情绪发作复发的时间显著相关（P <0.001）。结论共病的CRSWD，主要是延迟睡眠-觉醒相障碍，可能是BD患者复发的重要预测因素。
OBJECTIVE Circadian rhythm dysfunction has been considered to be common in bipolar disorder (BD) and plays an important role in mood dysregulation in this disorder. However, no study has investigated whether circadian rhythm dysfunction would affect the clinical course of BD. The aim of this study was to test the hypothesis that circadian rhythm dysfunction could be a predictor of relapse in euthymic BD patients. METHODS One hundred four euthymic outpatients with BD diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), participated in this prospective follow-up study from August 2014 to April 2015. At baseline, data on demographic variables and clinical descriptive variables of bipolar disorder were ascertained via clinical interviews. The diagnoses of circadian rhythm sleep-wake disorders (CRSWDs) were made based on participants' sleep logs for 4 weeks and according to the International Classification of Sleep Disorders, Third Edition (ICSD-3). The BD symptoms of the subjects were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores every 4 weeks throughout the 48-week study period. Relapse of BD was defined as scores higher than the cutoff points (MADRS score ≥ 13 and YMRS score ≥ 7). The primary outcome was time to relapse of mood episodes. RESULTS Thirty-four subjects met criteria for CRSWD at baseline, most frequently delayed sleep-wake phase disorder (n = 27). Of the total 104 subjects, 51 (49.0%) experienced relapse during the 48-week follow-up period. Multivariate Cox hazard regression analyses revealed that 2 or more previous mood episodes within the past year and comorbidity of CRSWD were significantly associated with the time to relapse of mood episodes (P < .001). CONCLUSIONS Comorbid CRSWD, mainly delayed sleep-wake phase disorder, could be a significant predictor of relapse in BD patients.