Longitudinal sleep phenotypes among offspring of bipolar parents and community controls

Abstract

Background Sleep disturbances are a prominent feature of bipolar disorder (BP). However, it remains unclear how sleep phenotypes may evolve among at-risk youth, and their relevance to BP onset. Methods Pittsburgh Bipolar Offspring Study (BIOS) offspring (ages 10-18) and their parents completed assessments approximately every two years pertaining to current psychopathology and offspring sleep habits. A latent transition analysis (LTA) identified latent sleep groups within offspring based on their ratings of six sleep domains using the School Sleep Habits Survey. Demographic and clinical characteristics were compared between sleep groups. Logistic regression tested links between sleep group and BP onset at the subsequent assessment. Results The LTA model identified latent groups of good, poor, and variable sleepers. We observed an overall trend of good sleep becoming variable, and then poor, as youth age. Offspring in the poor sleep group were more likely to have psychopathology. Adjusting for age and depression, poor sleepers had nearly twice the odds of developing BP relative to good (OR=1.99, CI=0.45-8.91) or variable (OR=2.03, CI=0.72-5.72) sleepers. Limitations include the use of proximal sleep phenotypes to predict BP onset, and a self-report measure of sleep. Conclusions We found three non-overlapping sleep phenotype groups in a large sample of offspring of bipolar probands and offspring of demographically-matched community control parents. Clinicians should consider that youth will likely experience variable and/or poor sleep as they age, and that at-risk youth with poor sleep may be at increased risk of developing MDD and BP at their next assessment.

Longitudinal Associations Between Sleep Patterns and Psychiatric Symptom Severity in High-Risk and Community Comparison Youth

“…Because offspring received assistance completing the SSHS prior to age 10, only data collected between 10 and 18 years-old were included for this analysis. 17 Of the 782 in the sample (n=462 offspring of parents with BP; n=320 offspring of community comparison parents), 682 offspring between ages 10–18 years-old had completed an offspring- and parent-reported sleep assessment. Of those participants, 484 offspring (of 282 families) who had at least two sleep assessments between 10 and 18 were included in the analyses (267 offspring of 163 of parents with BP and 217 offspring of 119 community comparison parents).…”

“…Sleep predictor selection was comparable among the two offspring groups when considered separately. As in our previous reports, 16,17 the Baseline assessment was defined as the first available follow-up after age 10 at which sleep (offspring-reported and parent-reported) and psychiatric symptom measures were completed. Follow-up was defined as the last available follow-up assessment prior to age 18 at which sleep and psychiatric symptom measures were completed; this approach was used maximize sample size.…”

“…The Pittsburgh Bipolar Offspring Study (BIOS) includes detailed longitudinal assessments of psychiatric diagnoses, dimensional psychopathology, and sleep patterns in a cohort of offspring of parents with bipolar disorder (BP) and community comparison parents who are psychiatrically healthy or diagnosed with non-BP psychiatric disorders. Within the BIOS cohort, sleep patterns at baseline and the assessment proximal to conversion have been linked to future bipolar spectrum disorder onset (BPSD), 16,17 including sleep continuity disturbances, extreme early chronotype, and a poor sleep phenotype. However, nearly 75% of high-risk offspring develop at least one axis I disorder; and, for 67% this includes non-BP diagnoses such as major depressive disorder (MDD), anxiety disorders, attention deficit hyperactivity disorder (ADHD), and disruptive behavior disorders (DBDs).…”

Treatment of Psychiatric Symptoms Among Offspring of Parents With Bipolar Disorder

“…Offspring of parents with Bipolar Disorder also have a number of sleep disturbance symptoms, including excessive daytime sleepiness, headaches after awakening, and nightmares compared to youth offspring of parents without Bipolar Disorder [36]; poor sleeping high-risk youth are more likely to develop Bipolar Disorder compared to good or variable sleepers [37], with a potentially negative impact of shortened sleep duration on ventral striatum-insula brain connectivity during reward processing [38]. These studies suggest that sleep is an important early target for intervention in high-risk youth, but no studies to date have evaluated a sleep intervention in youth offspring of parents with Bipolar Disorder.…”

A systematic review on sleep alterations anticipating the onset of bipolar disorder

“…In the last years several new studies focused specifically on this topic, 4 reporting results on prospective follow-ups [32–35], whilst 11 presenting retrospective design. The onset of sleep problems in people who subsequently developed BD may long anticipate a full-blown BD, occurring during adolescence or pre-adolescence [1, 20, 31].…”