Hostname: page-component-89b8bd64d-9prln Total loading time: 0 Render date: 2026-05-07T16:59:09.876Z Has data issue: false hasContentIssue false
  • English
  • Français

Poor subjective sleep quality and trait impulsivity in patients with bipolar disorder

Published online by Cambridge University Press:  06 May 2024

Mao-Hsuan Huang Open the ORCID record for Mao-Hsuan Huang [Opens in a new window] ,
Yi-Hsuan Kuan ,
Yee-Lam E. Chan ,
Wei-Chung Mao  and
Tung-Ping Su
Mao-Hsuan Huang
Affiliation:
Department of Psychiatry, YuanShan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan Institute of Brain Science, National Yang Ming Chao Tung University, Taipei, Taiwan
Yi-Hsuan Kuan
Affiliation:
Institute of Brain Science, National Yang Ming Chao Tung University, Taipei, Taiwan
Yee-Lam E. Chan
Affiliation:
Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
Wei-Chung Mao
Affiliation:
Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
Tung-Ping Su*
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan Institute of Brain Science, National Yang Ming Chao Tung University, Taipei, Taiwan Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
*
Corresponding author: Tung-Ping Su; Email: tomsu0402@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Sleep disturbance and impulsivity are key components of mood vulnerability in bipolar disorder (BD), but few studies have assessed the association between these two symptoms among patients with BD.

Methods

Forty-seven euthymic patients with bipolar I disorder (BDI) or bipolar II disorder (BDII) and 58 age- and sex-matched healthy controls were enrolled in this cross-sectional study. Trait impulsivity was measured using the Barratt Impulsiveness Scale Version 11 (BIS-11), which yielded 3 second-order factors: attention, motor, and non-planning. Subjective sleep quality was assessed using the self-reported Pittsburgh Sleep Quality Index (PSQI). General linear models (GLMs) were used to assess the associations between subjective poor sleep and trait impulsivity with multiple testing corrections.

Results

Patients with BD scored higher in BIS-11 and PSQI than healthy controls. PSQI total scores positively correlated with BIS-11 total scores, while sleep disturbance and daytime dysfunction were associated with attentional impulsiveness after controlling for covariates. Participants with higher PSQI total scores (>10) had higher scores in BIS-11 total, attention, and non-planning than those with low PSQI scores (≤5).

Conclusion

These findings support the hypothesis that poor sleep quality might lead to impulsivity and add to the growing evidence that improving sleep quality may be a therapeutic target for patients with BD.

Keywords

Attentionbipolar disordertrait impulsivitysleep disturbancesleep quality

Information

Type
Original Research
Information
CNS Spectrums , Volume 29 , Issue 4 , August 2024 , pp. 289 - 295
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Swann, AC, Dougherty, DM, Pazzaglia, PJ, et al. Increased impulsivity associated with severity of suicide attempt history in patients with bipolar disorder. Am J Psychiatry. 2005;162(9):1680–1687.10.1176/appi.ajp.162.9.1680CrossRefGoogle ScholarPubMed
Dervic, K, Garcia-Amador, M, Sudol, K, et al. Bipolar I and II versus unipolar depression: clinical differences and impulsivity/aggression traits. Eur Psychiatry. 2015;30(1):106–113.10.1016/j.eurpsy.2014.06.005CrossRefGoogle ScholarPubMed
Swann, AC, Pazzaglia, P, Nicholls, A, et al. Impulsivity and phase of illness in bipolar disorder. J Affect Disord. 2003;73(1–2):105–111.10.1016/S0165-0327(02)00328-2CrossRefGoogle ScholarPubMed
Fornaro, M, Orsolini, L, Marini, S, et al. The prevalence and predictors of bipolar and borderline personality disorders comorbidity: Systematic review and meta-analysis. J Affect Disord. 2016;195:105–118.10.1016/j.jad.2016.01.040CrossRefGoogle ScholarPubMed
Sepede, G, Chiacchiaretta, P, Gambi, F, et al. Bipolar disorder with and without a history of psychotic features: fMRI correlates of sustained attention. Prog Neuropsychopharmacol Biol Psychiatry. 2020;98:109817.10.1016/j.pnpbp.2019.109817CrossRefGoogle ScholarPubMed
Strakowski, SM, Fleck, DE, DelBello, MP, et al. Characterizing impulsivity in mania. Bipolar Disord. 2009;11(1):41–51.10.1111/j.1399-5618.2008.00658.xCrossRefGoogle ScholarPubMed
Muhtadie, L, Johnson, SL, Carver, CS, et al. A profile approach to impulsivity in bipolar disorder: the key role of strong emotions. Acta Psychiatr Scand. 2014;129(2):100–108.10.1111/acps.12136CrossRefGoogle ScholarPubMed
Huang, MH, Kuan, YH, Tu, PC, et al. Brain structural abnormalities and trait impulsivity in suicidal and non-suicidal patients with bipolar disorder. J Affect Disord. 2023;333:10–17.10.1016/j.jad.2023.04.050CrossRefGoogle ScholarPubMed
Harvey, AG, Schmidt, DA, Scarna, A, et al. Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. Am J Psychiatry. 2005;162(1):50–57.10.1176/appi.ajp.162.1.50CrossRefGoogle ScholarPubMed
Carr, O, Saunders, KEA, Bilderbeck, AC, et al. Desynchronization of diurnal rhythms in bipolar disorder and borderline personality disorder. Transl Psychiatry. 2018;8(1):79.10.1038/s41398-018-0125-7CrossRefGoogle ScholarPubMed
Alloy, LB, Urosevic, S, Abramson, LY, et al. Progression along the bipolar spectrum: a longitudinal study of predictors of conversion from bipolar spectrum conditions to bipolar I and II disorders. J Abnorm Psychol. 2012;121(1):16–27.10.1037/a0023973CrossRefGoogle ScholarPubMed
Yoo, SS, Gujar, N, Hu, P, et al. The human emotional brain without sleep: A prefrontal amygdala disconnect. Curr Biol. 2007;17(20):R877–R878.10.1016/j.cub.2007.08.007CrossRefGoogle ScholarPubMed
Telzer, EH, Fuligni, AJ, Lieberman, MD, et al. The effects of poor quality sleep on brain function and risk taking in adolescence. Neuroimage. 2013;71:275–283.10.1016/j.neuroimage.2013.01.025CrossRefGoogle ScholarPubMed
Gillett, G, Watson, G, Saunders, KE, et al. Sleep and circadian rhythm actigraphy measures, mood instability and impulsivity: A systematic review. J Psychiatr Res. 2021;144:66–79.10.1016/j.jpsychires.2021.09.043CrossRefGoogle ScholarPubMed
McGowan, NM, Coogan, AN. Sleep and circadian rhythm function and trait impulsivity: An actigraphy study. Psychiatry Res. 2018;268:251–256.10.1016/j.psychres.2018.07.030CrossRefGoogle ScholarPubMed
Russo, M, Mahon, K, Shanahan, M, et al. The relationship between sleep quality and neurocognition in bipolar disorder. J Affect Disord. 2015;187:156–162.10.1016/j.jad.2015.08.009CrossRefGoogle ScholarPubMed
Montgomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.10.1192/bjp.134.4.382CrossRefGoogle ScholarPubMed
Young, RC, Biggs, JT, Ziegler, VE, et al. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133:429–435.10.1192/bjp.133.5.429CrossRefGoogle ScholarPubMed
Cheng, CM, Chang, WH, Lin, YT, et al. Taiwan consensus on biological treatment of bipolar disorder during the acute, maintenance, and mixed phases: The 2022 update. Asian J Psychiatr. 2023;82:103480.10.1016/j.ajp.2023.103480CrossRefGoogle ScholarPubMed
Patton, JH, Stanford, MS, Barratt, ES. Factor structure of the Barratt impulsiveness scale. J Clin Psychol. 1995;51(6):768–774.10.1002/1097-4679(199511)51:6<768::AID-JCLP2270510607>3.0.CO;2-13.0.CO;2-1>CrossRefGoogle ScholarPubMed
Buysse, DJ, Reynolds, CF, 3rd, Monk, TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.10.1016/0165-1781(89)90047-4CrossRefGoogle ScholarPubMed
Demos, KE, Hart, CN, Sweet, LH, et al. Partial sleep deprivation impacts impulsive action but not impulsive decision-making. Physiol Behav. 2016;164(Pt A):214–219.10.1016/j.physbeh.2016.06.003CrossRefGoogle Scholar
Dahl, RE, Lewin, DS. Pathways to adolescent health sleep regulation and behavior. J Adolesc Health. 2002;31(6 Suppl):175–184.10.1016/S1054-139X(02)00506-2CrossRefGoogle ScholarPubMed
Reynolds, CM, Gradisar, M, Kar, K, et al. Adolescents who perceive fewer consequences of risk-taking choose to switch off games later at night. Acta Paediatr. 2015;104(5):e222–e227.10.1111/apa.12935CrossRefGoogle ScholarPubMed
Kroese, FM, Evers, C, Adriaanse, MA, et al. Bedtime procrastination: A self-regulation perspective on sleep insufficiency in the general population. J Health Psychol. 2016;21(5):853–862.10.1177/1359105314540014CrossRefGoogle ScholarPubMed
Bauducco, SV, Salihovic, S, Boersma, K. Bidirectional associations between adolescents’ sleep problems and impulsive behavior over time. Sleep Med X. 2019;1:100009.10.1016/j.sleepx.2019.100009CrossRefGoogle ScholarPubMed
Van Veen, MM, Rutters, F, Spreen, M, et al. Poor sleep quality at baseline is associated with increased aggression over one year in forensic psychiatric patients. Sleep Med. 2020;67:1–6.10.1016/j.sleep.2019.11.1183CrossRefGoogle ScholarPubMed
Chai, XJ, Whitfield-Gabrieli, S, Shinn, AK, et al. Abnormal medial prefrontal cortex resting-state connectivity in bipolar disorder and schizophrenia. Neuropsychopharmacology. 2011;36(10):2009–2017.10.1038/npp.2011.88CrossRefGoogle Scholar
Tashjian, SM, Goldenberg, D, Galvan, A. Neural connectivity moderates the association between sleep and impulsivity in adolescents. Dev Cogn Neurosci. 2017;27:35–44.10.1016/j.dcn.2017.07.006CrossRefGoogle ScholarPubMed
Gujar, N, McDonald, SA, Nishida, M, et al. A role for REM sleep in recalibrating the sensitivity of the human brain to specific emotions. Cereb Cortex. 2011;21(1):115–123.10.1093/cercor/bhq064CrossRefGoogle ScholarPubMed
Chee, MW, Choo, WC. Functional imaging of working memory after 24 hr of total sleep deprivation. J Neurosci. 2004;24(19):4560–4567.10.1523/JNEUROSCI.0007-04.2004CrossRefGoogle ScholarPubMed
Thomas, M, Sing, H, Belenky, G, et al. Neural basis of alertness and cognitive performance impairments during sleepiness. I. Effects of 24 h of sleep deprivation on waking human regional brain activity. J Sleep Res. 2000;9(4):335–352.10.1046/j.1365-2869.2000.00225.xCrossRefGoogle Scholar
Drummond, SP, Brown, GG, Salamat, JS, et al. Increasing task difficulty facilitates the cerebral compensatory response to total sleep deprivation. Sleep 2004;27(3):445–451.Google ScholarPubMed
Chuah, YM, Venkatraman, V, Dinges, DF, et al. The neural basis of interindividual variability in inhibitory efficiency after sleep deprivation. J Neurosci. 2006;26(27):7156–7162.10.1523/JNEUROSCI.0906-06.2006CrossRefGoogle ScholarPubMed
Costanza, A, Vasileios, C, Ambrosetti, J, et al. Demoralization in suicide: A systematic review. J Psychosom Res. 2022;157:110788.10.1016/j.jpsychores.2022.110788CrossRefGoogle ScholarPubMed
Sylvia, LG, Janos, JA, Pegg, SL, et al. Pilot study of a brief sleep intervention for suicidal ideation in bipolar disorder. J Psychiatr Pract. 2021;27(2):109–114.10.1097/PRA.0000000000000528CrossRefGoogle ScholarPubMed
Soreca, I. Circadian rhythms and sleep in bipolar disorder: implications for pathophysiology and treatment. Curr Opin Psychiatry 2014;27(6):467–471.10.1097/YCO.0000000000000108CrossRefGoogle Scholar
van Dalfsen, JH, Markus, CR. The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: A systematic review. Sleep Med Rev. 2018;39:187–194.10.1016/j.smrv.2017.10.002CrossRefGoogle ScholarPubMed
Stanley, B, Michel, CA, Galfalvy, HC, et al. Suicidal subtypes, stress responsivity and impulsive aggression. Psychiatry Res. 2019;280:112486.10.1016/j.psychres.2019.112486CrossRefGoogle ScholarPubMed
Berardelli, I, Serafini, G, Cortese, N, et al. The involvement of hypothalamus-pituitary-adrenal (HPA) axis in suicide risk. Brain Sci. 2020;10(9):653.10.3390/brainsci10090653CrossRefGoogle ScholarPubMed
Hasler, BP, Wallace, ML, Graves, JL, et al. Circadian preference is associated with multiple domains of trait and state level impulsivity. Chronobiol Int. 2022;39(6):792–804.10.1080/07420528.2022.2035392CrossRefGoogle ScholarPubMed
Hasler, BP, Dahl, RE, Holm, SM, et al. Weekend-weekday advances in sleep timing are associated with altered reward-related brain function in healthy adolescents. Biol Psychol. 2012;91(3):334–341.10.1016/j.biopsycho.2012.08.008CrossRefGoogle ScholarPubMed
Zhang, R, Tomasi, D, Shokri-Kojori, E, et al. Sleep inconsistency between weekends and weekdays is associated with changes in brain function during task and rest. Sleep. 2020;43(10).10.1093/sleep/zsaa076CrossRefGoogle ScholarPubMed