Rest-activity rhythm profiles associated with manic-hypomanic and depressive symptoms

Abstract

Rest-activity rhythm (RAR) disturbances are associated with mood disorders. But there remains a need to identify the particular RAR profiles associated with psychiatric symptom dimensions. Establishing such profiles would support the development of tools that track the 24-h sleep-wake phenotypes signaling clinical heterogeneity. We used data-driven clustering to identify RAR profiles in 145 adults aged 36-82 years (mean = 60, standard deviation = 9). Then we evaluated psychiatric symptom dimensions (including positive and negative affect, depressive, manic-hypomanic, panic-agoraphobic, and substance use symptoms) associated with these empirically-derived RAR profiles. Clustering identified three sub-groups characterized, on average, by: (1) earlier and more robust RARs ("earlier/robust," n = 55, 38%); (2) later and irregular RARs ("later/irregular," n = 31, 21%); and (3) later RARs and a narrower active period ("later/narrower," n = 59, 41%). Compared with the "earlier/robust" group: the "later/irregular" group had higher levels of lifetime manic-hypomanic symptoms (β (standard error) = 0.80 (0.22) higher standardized symptom units, p = 0.0004) and lifetime depression symptoms (β (standard error) = 0.73 (0.21) higher standardized symptom units, p = 0.0009); the "later/narrower" group had more lifetime depression symptoms (β (standard error) = 0.48 (0.18) higher standardized symptom units, p = 0.0076). These associations persisted after adjustments for sleep continuity and duration, suggesting that RARs are distinct behavioral correlates of clinical heterogeneity. Longitudinal studies are needed to confirm whether RAR characteristics contribute to the risk of manic and/or depressive episodes, and whether they reflect the consequences of psychiatric disturbance (e.g., on quality of life or disability). Opportunities to monitor or intervene on objectively-assessed RARs could facilitate better mental health related outcomes.

Characterizing Behavioral Activity Rhythms in Older Adults Using Actigraphy

“…Impacted BAR robustness as well as BAR fragmentation seem to be associated with depressive symptoms, yet these associations are minimized when adjusting for covariates of lifestyle and health factors [27,31,70]. While rarely reported, mesor was also a strong predictor of depressive symptoms in older adults [28]. This is expected as reduced activity is commonly shown to be associated with more depressive symptomology [71,72].…”

“…BAR can be summarized according to an observable behavioral phenomenon with a diurnal pattern having four major characteristics: (1) a period of quiescence (usually sleep), (2) a period of increased activity in the morning following waking up, (3) a relative higher (even though changing) period of wakeful activity during the day, and (4) a period of "winding down" or decreasing activity as the next quiescent period (i.e., sleep) approaches ( Figure 1). Parametric [36], non-parametric [37], and a combination of both approaches [28,38] have been used to process the raw actigraphy data and to characterize BAR shape, rhythmicity, robustness, timing, and regularity.…”

“…The literature linking circadian rhythm disturbances to mood disorders is vast [66][67][68]. Studies have demonstrated an important link between BAR disturbances and depression in older adults [28,54,69]. For example, Smagula et al [28] showed a negative relationship between BAR robustness and amplitude with depressive symptoms in 2892 community-dwelling older men.…”

“…Studies have demonstrated an important link between BAR disturbances and depression in older adults [28,54,69]. For example, Smagula et al [28] showed a negative relationship between BAR robustness and amplitude with depressive symptoms in 2892 community-dwelling older men. Similar findings were reported in Maglione et al [69] using a cross-sectional sample of 3020 community-dwelling older women (average age of 82.5).…”

24-h Activity Rhythms and Health in Older Adults

“…Bipolar disorders, in which the depressive episodes are accompanied by manic episodes, have also been related to disturbances in the 24-h activity rhythm. Associations seem to be state-dependent, with depressive episodes being accompanied by a phase delay and manic episodes being accompanied by a phase advance [61,62]. However, the disturbances in the 24-h activity rhythms might not only be a state marker as the phase advance of 24-h activity rhythms and lower mesor may persist after successful treatment of bipolar disorder [44].…”