Skip to main content Accesibility Help
×
×
Home

The association between sleep and cognitive abnormalities in bipolar disorder

  • A. J. Bradley (a1) (a2), K. N. Anderson (a3), P. Gallagher (a1) and R. H. McAllister-Williams (a1) (a4)
Abstract
Background

Bipolar disorder (BD) is associated with attentional and processing abnormalities. Such abnormalities are also seen in healthy subjects with sleep disruption. We hypothesised cognitive abnormalities in BD patients would be worse in those with objectively verified sleep abnormalities.

Methods

Forty-six BD patients and 42 controls had comprehensive sleep/circadian rhythm assessment over 21 days alongside mood questionnaires. Cognitive function was assessed with a range of tasks including Psychomotor Vigilance Test (PVT), Attention Network Task (ANT) and Digit Symbol Substitution Test (DSST). BD participants with normal and abnormal sleep were compared with age- and sex-matched controls.

Results

BD patients had longer response times and made more lapses (responses >500 ms) than controls on the PVT (both p < 0.001). However, patients with normal sleep patterns did not differ from controls while those with sleep abnormalities did (p < 0.001). An identical pattern of effects were seen with the ANT response times, with the abnormality in bipolar abnormal sleepers related to the executive attentional network. Similarly, patients made fewer correct responses on the DSST compared with the controls (p < 0.001). Bipolar normal sleepers did not differ while those with abnormal sleep did (p < 0.001). All these differences were seen in bipolar abnormal sleepers who were euthymic (p < 0.01) and across the main abnormal sleep phenotypes.

Conclusions

We confirm impairment in attention and processing speed in BD. Rather than sleep abnormalities exacerbating such dysfunction, the impairments were confined to bipolar abnormal sleepers, consistent with sleep disturbance being the main driver of cognitive dysfunction.

Copyright
Corresponding author
Author for correspondence: R. H. McAllister-Williams, E-mail: hamish.mcallister-williams@ncl.ac.uk
References
Hide All
American Academy of Sleep Medicine (2014) International Classification of Sleep Disorders. Darien, Illinois: American Academy of Sleep Medicine.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV). Washington, DC: American Psychiatric Association.
Beck, AT, Ward, CH, Mendelson, M, Mock, J and Erbaugh, J (1961) An inventory for measuring depression. Archives of General Psychiatry 4, 561571, Available at http://www.sciencedirect.com/science/article/B6WVB-4F9MR49-1SB/2/ae36a31f5817e3647fa0ff86fab4a2ea.
Bora, E (2018) Neurocognitive features in clinical subgroups of bipolar disorder: a meta-analysis. Journal of Affective Disorders 229, 125134, Available from: PM:29306692.
Bourne, C, Aydemir, O, Balanza-Martinez, V, Bora, E, Brissos, S, Cavanagh, JT, Clark, L, Cubukcuoglu, Z, Dias, VV, Dittmann, S, Ferrier, IN, Fleck, DE, Frangou, S, Gallagher, P, Jones, L, Kieseppa, T, Martinez-Aran, A, Melle, I, Moore, PB, Mur, M, Pfennig, A, Raust, A, Senturk, V, Simonsen, C, Smith, DJ, Bio, DS, Soeiro-de-Souza, MG, Stoddart, SD, Sundet, K, Szoke, A, Thompson, JM, Torrent, C, Zalla, T, Craddock, N, Andreassen, OA, Leboyer, M, Vieta, E, Bauer, M, Worhunsky, PD, Tzagarakis, C, Rogers, RD, Geddes, JR and Goodwin, GM (2013) Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis. Acta Psychiatrica Scandinavica 128, 149162, Available from: PM:23617548.
Bradley, AJ, Webb-Mitchell, R, Hazu, A, Slater, N, Middleton, B, Gallagher, P, McAllister-Williams, H and Anderson, KN (2017) Sleep and circadian rhythm disturbance in bipolar disorder. Psychological Medicine 47, 16781689, Available from: PM:28173893.
Bucks, RS, Olaithe, M and Eastwood, P (2013) Neurocognitive function in obstructive sleep apnoea: a meta-review. Respirology 18, 6170, Available from: PM:22913604.
Buysse, DJ, Reynolds, CF III, Monk, TH, Berman, SR and Kupfer, DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research 28, 193213, Available from: PM:2748771.
Dinges, DF and Powell, JW (1985) Microcomputer analyses of performance on a portable, simple visual RT task during sustained operations. Behavior Research Methods 17, 652655.
Fan, J, McCandliss, BD, Sommer, T, Raz, A and Posner, MI (2002) Testing the efficiency and independence of attentional networks. Journal of Cognitive Neuroscience 14, 340347.
Gallagher, P, Gray, JM, Watson, S, Young, AH and Ferrier, IN (2014) Neurocognitive functioning in bipolar depression: a component structure analysis. Psychological Medicine 44, 961974, Available from: PM:23800475.
Gallagher, P, Nilsson, J, Finkelmeyer, A, Goshawk, M, Macritchie, KA, Lloyd, AJ, Thompson, JM, Porter, RJ, Young, AH, Ferrier, IN, McAllister-Williams, RH and Watson, S (2015) Neurocognitive intra-individual variability in mood disorders: effects on attentional response time distributions. Psychological Medicine 45, 29852997, Available from: PM:26073667.
Giglio, LM, Magalhaes, PV, Kapczinski, NS, Walz, JC and Kapczinski, F (2010) Functional impact of biological rhythm disturbance in bipolar disorder. Journal of Psychiatric Research 44, 220223, Available from: PM:19758600.
Hamilton, M (1967) Development of a rating scale for primary depressive illness. British Journal of Social & Clinical Psychology 6, 278296.
Harvey, AG, Schmidt, DA, Scarna, A, Semler, CN and Goodwin, GM (2005) Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. American Journal of Psychiatry 162, 5057.
Johns, MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14, 540545, Available from: PM:1798888.
Kanady, JC, Soehner, AM, Klein, AB and Harvey, AG (2017) The association between insomnia-related sleep disruptions and cognitive dysfunction during the inter-episode phase of bipolar disorder. Journal of Psychiatric Research 88, 8088, Available from: PM:28088728.
Kaplan, KA, Gruber, J, Eidelman, P, Talbot, LS and Harvey, AG (2011) Hypersomnia in inter-episode bipolar disorder: does it have prognostic significance?. Journal of Affective Disorders 132, 438444, Available from: PM:21489637.
Kaplan, KA, Talbot, LS, Gruber, J and Harvey, AG (2012) Evaluating sleep in bipolar disorder: comparison between actigraphy, polysomnography, and sleep diary. Bipolar Disorder 14, 870879, Available from: PM:23167935.
Keller, MB (2003) Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond. Journal of the American Medical Association 289, 31523160, Available from: PM:12813121.
Kushida, CA, Littner, MR, Morgenthaler, T, Alessi, CA, Bailey, D, Coleman, J Jr, Friedman, L, Hirshkowitz, M, Kapen, S, Kramer, M, Lee-Chiong, T, Loube, DL, Owens, J, Pancer, JP and Wise, M (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep, 28, 499521, Available from: PM:16171294.
Lacouture, Y and Cousineau, D (2008) How to use MATLAB to fit the ex-Gaussian and other probability functions to a distribution of response times. Methods for Psychology 4, 3545.
Lezak, MD, Howieson, DB and Loring, DW (2004) Neuropsychological Assessment. Oxford, UK: Oxford University Press.
Lim, J and Dinges, DF (2008) Sleep deprivation and vigilant attention. Annals of the New York Academy of Sciences 1129, 305322, Available from: PM:18591490.
Melo, MC, Garcia, RF, Linhares Neto, VB, Sa, MB, de Mesquita, LM, de Araujo, CF and de Bruin, VM (2016) Sleep and circadian alterations in people at risk for bipolar disorder: a systematic review. Journal of Psychiatric Research 83, 211219, Available from: PM:27661417.
Nelson, HE (1982) The National Adult Reading Test (NART): Test Manual. Windsor, England: NFER Publishing Co.
Pariante, CM, Alhaj, HA, Arulnathan, VE, Gallager, P, Hanson, A, Massey, AE and McAllister-Williams, RH (2012) Central glucocorticoid receptor-medicated effects of the antidepressant citalopram in humans: a study using EEG and cognitive testing. Psychoneuroendocrinology 37, 618628.
Perneger, TV (1998) What's wrong with Bonferroni adjustments. British Medical Journal 316, 12361238, Available from: PM:9553006.
Ratcliff, R (1979) Group reaction time distributions and an analysis of distribution statistics. Psychological Bulletin 86, 446461, Available from: PM:451109.
Robinson, LJ, Thompson, JM, Gallagher, P, Goswami, U, Young, AH, Ferrier, IN and Moore, PB (2006) A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. Journal of Affective Disorders 93, 105115, Available from: PM:16677713.
Samame, C, Martino, DJ and Strejilevich, SA (2014) Longitudinal course of cognitive deficits in bipolar disorder: a meta-analytic study. Journal of Affective Disorders 164, 130138, Available from: PM:24856566.
Schmiedek, F, Oberauer, K, Wilhelm, O, Suss, HM and Wittmann, WW (2007) Individual differences in components of reaction time distributions and their relations to working memory and intelligence. Journal of Experimental Psychology: General 136, 414429, Available from: PM:17696691.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R and Dunbar, GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59(suppl. 20), 2233, Available from: PM:9881538.
Soreca, I, Buttenfield, JA, Hall, MH and Kupfer, DJ (2015) Screening for obstructive sleep apnea in patients with bipolar I disorder: comparison between subjective and objective measures. Bipolar Disorder 17, 345348, Available from: PM:25187351.
Thompson, JM, Gallagher, P, Hughes, JH, Watson, S, Gray, JM, Ferrier, IN and Young, AH (2005) Neurocognitive impairment in euthymic patients with bipolar affective disorder. British Journal of Psychiatry 186, 3240.
van Hees, VT, Sabia, S, Anderson, KN, Denton, SJ, Oliver, J, Catt, M, Abell, JG, Kivimaki, M, Trenell, MI and Singh-Manoux, A (2015) A novel, open access method to assess sleep duration using a wrist-worn accelerometer. PLoS ONE 10, e0142533, Available from: PM:26569414.
Van Someren, EJ, Swaab, DF, Colenda, CC, Cohen, W, McCall, WV and Rosenquist, PB (1999) Bright light therapy: improved sensitivity to its effects on rest-activity rhythms in Alzheimer patients by application of nonparametric methods. Chronobiology International 16, 505518, Available from: PM:10442243.
Walters, AS, LeBrocq, C, Dhar, A, Hening, W, Rosen, R, Allen, RP and Trenkwalder, C (2003) Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Medicine 4, 121132, Available from: PM:14592342.
Wechsler, D (1981) WAIS-R Manual, Wechsler Adult Intelligence Scale-Revised. Cleveland, OH: Psychological Corp.
Williams, JB, Kobak, KA, Bech, P, Engelhardt, N, Evans, K, Lipsitz, J, Olin, J, Pearson, J and Kalali, A (2008) The GRID-HAMD: standardization of the Hamilton Depression Rating Scale. International Clinical Psychopharmacology 23, 120129.
Young, RC, Biggs, JT, Ziegler, VE and Meyer, DA (1978) A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429435, Available from: PM:728692.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed