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. 2022 Feb 1;298(Pt A):17-25.
doi: 10.1016/j.jad.2021.08.155. Epub 2021 Oct 30.

Impulsivity and sleep and circadian rhythm disturbance predict next-day mood symptoms in a sample at high risk for or with recent-onset bipolar spectrum disorder: An ecological momentary assessment study

Madison K Titone  1 , Namni Goel  2 , Tommy H Ng  3 , Laura E MacMullen  4 , Lauren B Alloy  3
Affiliations

Impulsivity and sleep and circadian rhythm disturbance predict next-day mood symptoms in a sample at high risk for or with recent-onset bipolar spectrum disorder: An ecological momentary assessment study

Madison K Titone et al. J Affect Disord. .

Abstract

Background: Impulsivity and sleep and circadian rhythm disturbance are core features of bipolar spectrum disorders (BSDs) that are antecedents to onset and persist even between mood episodes; their pervasive presence in BSD suggests that they may be particularly relevant to understanding BSD onset and course. Considerable research demonstrates bidirectional associations between impulsivity and sleep disturbance in healthy individuals; thus, it is important to examine how these features interact to impact BSD symptomatology.

Methods: Young adults (N = 107, 55% female, M age = 21.82 years) at high risk for developing BSD (based on high self-reported reward sensitivity) or with recent-onset BSD participated in ecological momentary assessment (EMA) to examine relationships between impulsivity, sleep and circadian rhythm alterations, and mood symptoms in everyday life. Impulsivity was measured via self-report/behavioral task, sleep was measured via actigraphy, circadian rhythms were measured via dim light melatonin onset (DLMO) time, and mood symptoms were measured three times daily via self-report.

Results: Multi-level modeling revealed that less total sleep time predicted increased next-day mood symptoms. Moreover, DLMO, total sleep time, and sleep onset latency moderated the relationship between impulsivity and EMA-assessed mood symptoms. Fewer minutes of sleep and later DLMO strengthened the positive relationship between impulsivity and mood symptoms.

Limitations: Mood symptoms in our sample were mild; future studies should replicate findings in populations with more severe mood symptoms.

Conclusions: This multi-method assessment of dynamic relationships revealed novel associations between impulsivity, sleep and circadian rhythm disturbance, and symptoms within individuals at high-risk for or with recent-onset BSD.

Keywords: Bipolar disorder; Circadian rhythm; Depression; Impulsive behavior; Mania; Sleep.

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Figures

Figure 1.
Figure 1.
Plot of simple slopes with standard error bands for Balloon Analogue Risk Task score and 1) actigraphic total sleep time (TST) (top) and 2) actigraphic sleep onset latency (bottom) interacting to predict next-day hypomanic symptoms
Figure 2.
Figure 2.
Plot of simple slopes with standard error bands for Dim Light Melatonin Onset Time and 1) UPPS-P Negative Urgency score (top) and 2) UPPS-P Positive Urgency score (bottom) interacting to predict next-day depressive symptoms
See this image and copyright information in PMC

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