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. 2025 Mar 15:373:364-373.
doi: 10.1016/j.jad.2024.12.098. Epub 2024 Dec 29.

Do sleep variables predict mood in bipolar disorder: A systematic review

Andrea Ulrichsen  1 , Anna Tröger  2 , Sameer Jauhar  3 , Emanuel Severus  4 , Michael Bauer  5 , Anthony Cleare  6
Affiliations
Free article

Do sleep variables predict mood in bipolar disorder: A systematic review

Andrea Ulrichsen et al. J Affect Disord. .
Free article

Abstract

Introduction: Most people with bipolar disorder (BD) experience sleep disturbances across mood states and many identify sleep changes before both depressive and manic episodes. Nearly half of all patients have multiple relapses of BD and identifying early warning signs of relapse, such as sleep changes, could benefit both patients and clinicians as a preventive strategy.

Methods: A systematic search of the databases Embase, APA PsychINFO, and MEDLINE was performed to identify studies that investigated the relationship between sleep changes and mood in BD. The review was registered with PROSPERO (CRD42023405950) and followed the PRISMA guidelines. Results were categorised based on the identified relationship between sleep changes and mood, e.g. sleep and depression correlation, and these are synthesised narratively. The Newcastle-Ottawa scale was used to assess the risk of bias (RoB).

Results: The systematic literature search yielded 7159 records. 17 publications were included, describing 13 studies. Nine categories were identified describing the relationship between sleep and mood (e.g. sleep-mood correlations and comparing BD and HC on sleep duration). Regardless of sleep assessment (e.g. actigraphy), study duration or mood outcome, changes towards longer sleep, earlier onset and later wake-up were mostly followed by depressive mood, and vice versa for mania. 14 papers had a "fair" RoB rating.

Discussion: Changes in sleep patterns appear to precede predictable mood changes in BD and could be used as early warning signs for patients and clinicians. The main limitation of the study is the high heterogeneity between study results, preventing the conduction of a meta-analysis.

Keywords: Bipolar disorder; Early warning signs; Mood; Prospective studies; Sleep; Systematic review.

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Conflict of interest statement

Declaration of competing interest Author MB has received grants from Deutsche Forschungsgemeinschaft (DFG), Bundesministerium für Bildung und Forschung (BMBF), European Commission, Sächsische Aufbaubank, as well as sat on advisory boards for MedEd-Link Inc. Janssen Global Services, LLC, Biogen, COMPASS Pathfinder Ltd., FoGes UG, GH Research, Janssen-Cilag, Livanova, Msd Sharp & Dohme, MINDFORCE, Novartis Switzerland, Sunovion, and finally received lecture fees from Janssen-Cilag, Biogen, and FoGes UG. Author AC has received grant funding from the MRC, ADM Protexin Ltd., NIHR, European Union Horizon Europe/Innovate UK, Beckley Psytech Ltd., and Wellcome Trust, has received payment or honoraria for presentations and/or consulting from Janssen, Otsuka, COMPASS Pathways Plc., Viatris and Medscape, and is President of the International Society for Affective Disorders. Author SJ has received honoraria for educational talks given for Boehringer-Ingelheim, Lundbeck, Sunovian and Janssen. He has been an advisor to LB pharmaceuticals. He has sat on a funding panel for the Wellcome Trust, and as expert advisor for a NICE Technology Appraisal. He is a member of Council for the British Association for Psychopharmacology (unpaid). Author ES has received a grant from “Bundesministerium für Bildung und Forschung (BMBF)”. The authors report no other conflicts of interest.

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