Association of functioning and quality of life with objective and subjective measures of sleep and biological rhythms in major depressive and bipolar disorder

Abstract

Objective: Disruptions in biological rhythms and sleep are a core aspect of mood disorders, with sleep and rhythm changes frequently occurring prior to and during mood episodes. Wrist-worn actigraphs are increasingly utilized to measure ambulatory activity rhythm and sleep patterns. Methods: A comprehensive study using subjective and objective measures of sleep and biological rhythms was conducted in 111 participants (40 healthy volunteers [HC], 38 with major depressive disorder [MDD] and 33 with bipolar disorder [BD]). Participants completed 15-day actigraphy and first-morning urine samples to measure 6-sulfatoxymelatonin levels. Sleep and biological rhythm questionnaires were administered: Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), Munich Chronotype Questionnaire (MCTQ), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Actigraph data were analyzed for sleep and daily activity rhythms, light exposure and likelihood of transitioning between rest and activity states. Results: Mood groups had worse subjective sleep quality (PSQI) and biological rhythm disruption (BRIAN) and higher objective mean nighttime activity than controls. Participants with BD had longer total sleep time, higher circadian quotient and lower 6-sulfatoxymelatonin levels than HC group. The MDD group had longer sleep onset latency and higher daytime probability of transitioning from rest to activity than HCs. Mood groups displayed later mean timing of light exposure. Multiple linear regression analysis with BRIAN scores, circadian quotient, mean nighttime activity during rest and daytime probability of transitioning from activity to rest explained 43% of variance in quality-of-life scores. BRIAN scores, total sleep time and probability of transitioning from activity to rest explained 52% of variance in functioning (all p < 0.05). Conclusions: Disruption in biological rhythms is associated with poorer functioning and quality of life in bipolar and MDD. Investigating biological rhythms and sleep using actigraphy variables, urinary 6-sulfatoxymelatonin and subjective measures provide evidence of widespread sleep and circadian system disruptions in mood disorders.

Similarities of Aspects of Biological Rhythms between Major Depression and Bipolar II Disorder Compared to Bipolar I Disorder: A Finding from the Early-Onset Mood Disorder Cohort

“…Additionally, integrated insights give an understanding of how biological rhythm disturbances affect a variety of conditions and biological functions such as—monoamine signaling of mood disorders, the immune system, hypothalamic–pituitary–adrenal (HPA) axis regulation, metabolic peptides, cellular processes (redox, mitochondria, apoptosis, neurogenesis) [9], cerebral parenchyma, suprachiasmatic nucleus [10], and regulation of the biological clock through epigenetic control [11]. Researchers have made an effort, through a variety of measurements and actigraphy, to evaluate biological rhythms in subjects with mood disorders objectively [12,13]. In addition, studies show that correction of biological rhythms through light therapy, behavior modification, and pharmacological agents (such as melatonin) reduces the duration of mood-related symptoms and the severity of other symptoms [14,15], improving the overall quality of life [16].…”

Association between emotional functioning and biological rhythm disruptions in patients with schizophrenia

“…Regarding our literature search, no study was conducted with the BRIAN questionnaire in patients with schizophrenia. The BRIAN was developed with a focus on biological rhythm in patients with the mood disorder [24] and showed promising validity with the objective parameters of circadian rhythmicity, including actigraphy records [43] and level of urinary 6-sulfatoxymelatonin [44]. It also suggested that and subjective measures (BRIAN) provide extensive evidence of sleep and biological rhythm system disruptions in mental disorders [44].…”

“…The BRIAN was developed with a focus on biological rhythm in patients with the mood disorder [24] and showed promising validity with the objective parameters of circadian rhythmicity, including actigraphy records [43] and level of urinary 6-sulfatoxymelatonin [44]. It also suggested that and subjective measures (BRIAN) provide extensive evidence of sleep and biological rhythm system disruptions in mental disorders [44]. Also, the BRIAN appears to be a feasible tool to evaluate all domain of biological rhythms, due to the other scales that only indirectly measure biological rhythm by testing seasonality or chronotype or subjective quality of sleep [45].…”

Measuring circadian function in bipolar disorders: Empirical and conceptual review of physiological, actigraphic, and self‐report approaches

“…For example, Lam et al 29 and Kennedy et al 30 studied BD subjects in various mood states (depressed, manic, and euthymic) and reported reduced nighttime serum melatonin concentrations compared to healthy control subjects. The study by Kennedy et al found no significant differences depending on mood state and no significant differences in urinary aMT6s levels between BD and healthy control participants, whereas Slyepchenko et al 31 found lower levels of urinary aMT6s levels in BD participants. Nurnberger et al 32 found euthymic patients with BD type I disorder to have lower serum melatonin during dark conditions including a later peak compared to healthy control subjects.…”