Toward a Digital Future in Bipolar Disorder Assessment: A Systematic Review of Disruptions in the Rest-Activity Cycle as Measured by Actigraphy

Abstract

BackgroundDisruptions in rest and activity patterns are core features of bipolar disorder (BD). However, previous methods have been limited in fully characterizing the patterns. There is still a need to capture dysfunction in daily activity as well as rest patterns in order to more holistically understand the nature of 24-h rhythms in BD. Recent developments in the standardization, processing, and analyses of wearable digital actigraphy devices are advancing longitudinal investigation of rest-activity patterns in real time. The current systematic review aimed to summarize the literature on actigraphy measures of rest-activity patterns in BD to inform the future use of this technology.MethodsA comprehensive systematic review using PRISMA guidelines was conducted through PubMed, MEDLINE, PsycINFO, and EMBASE databases, for papers published up to February 2021. Relevant articles utilizing actigraphy measures were extracted and summarized. These papers contributed to three research areas addressed, pertaining to the nature of rest-activity patterns in BD, and the effects of therapeutic interventions on these patterns.ResultsSeventy articles were included. BD was associated with longer sleep onset latency and duration, particularly during depressive episodes and with predictive value for worsening of future manic symptoms. Lower overall daily activity was also associated with BD, especially during depressive episodes, while more variable activity patterns within a day were seen in mania. A small number of studies linked these disruptions with differential patterns of brain functioning and cognitive impairments, as well as more adverse outcomes including increased suicide risk. The stabilizing effect of therapeutic options, including pharmacotherapies and chronotherapies, on activity patterns was supported.ConclusionThe use of actigraphy provides valuable information about rest-activity patterns in BD. Although results suggest that variability in rhythms over time may be a specific feature of BD, definitive conclusions are limited by the small number of studies assessing longitudinal changes over days. Thus, there is an urgent need to extend this work to examine patterns of rhythmicity and regularity in BD. Actigraphy research holds great promise to identify a much-needed specific phenotypic marker for BD that will aid in the development of improved detection, treatment, and prevention options.

The Actigraphy-Based Identification of Premorbid Latent Liability of Schizophrenia and Bipolar Disorder

“…1.: 2_thrd;2.: 3_thrd; 3.: L5; 4.: zero_ratio; 5.: frg_index; 6.: length_of sleep_in_minutes; 7.: IS; CTF: Cyclothymia Factor; PSF: Positive Schizotypy Factor. Berle et al, 2010 [ 27 ], Castro et al, 2015 [ 18 ], Dennison et al, 2021 [ 22 ], Meyer et al, 2020 [ 14 ], Murray et al, 2020 [ 23 ], Panchal et al, 2022 [ 24 ], Reinertsen et al, 2018 [ 25 ], Scott et al, 2017 [ 15 ], Wee et al, 2019 [ 26 ], Jones et al, 2005 [ 28 ].…”

“…Recent actigraphy studies indicate the disturbance of sleep and circadian rhythm both in schizophrenia and bipolar disorder [ 14 , 22 , 23 , 24 , 25 , 26 ]. In terms of circadian rhythm parameters, schizophrenia and bipolar patients have lower motor activity compared with healthy controls [ 14 , 22 , 26 ].…”

“…In terms of circadian rhythm parameters, schizophrenia and bipolar patients have lower motor activity compared with healthy controls [ 14 , 22 , 26 ]. The manic phase of bipolar disorder is associated with more disorganized and complex activity patterns, especially in the morning, and with phase advance [ 24 ]. The depressive phase is characterized by higher minute-to-minute variability in activity pattern, and phase delay [ 23 , 24 ].…”

“…The manic phase of bipolar disorder is associated with more disorganized and complex activity patterns, especially in the morning, and with phase advance [ 24 ]. The depressive phase is characterized by higher minute-to-minute variability in activity pattern, and phase delay [ 23 , 24 ]. In the case of schizophrenia, more severe positive symptoms were associated with less structured movement patterns, and more severe negative symptoms were associated with lower motor activity [ 26 ].…”

Actigraphic Correlates of Neuropsychiatric Disability in Adult Patients with Focal Epilepsy

“…While initially conceived to monitor the quantity and timing of sleep, continuous several day-long actigraphy data can capture changes in 24h patterns of activity, termed rest-activity rhythms (RARs). RAR distortions have been described and meta-analyzed for studies employing subjects with major depression 30 , bipolar 31 and anxiety disorders 32 . Among parametric techniques designed to analyze/model RARs, standard cosine approaches have now been largely replaced by sigmoidally transformed cosine models 33 (“extended cosinor analysis/ECA”), to accommodate the more square features of human RARs.…”