The relationship of chronotype with sleep quality, eating attitudes and cardiovascular risk in patients with bipolar disorder

Cardiovascular diseases (CVD) are the leading medical diseases that shorten life expectancy in patients with biolar disorder (BD). In recent years, the emphasis on circadian and chronobiological hypotheses in the etiology and course of some mental illnesses is remarkable. Clinical studies related to chronotype in patients with BD are limited. In this study, it was aimed to examine the patients with BD in the euthymic period in terms of sleep quality, eating attitudes and CVD risk characteristics according to their chronotype preferences. 78 patients followed up with a diagnosis of BD were included in our study. Sociodemographic and clinical data forms, Hamilton Depression Rating Scale (HAMD), Young Mania Rating Scale (YMRS), Functioning Assessment Short Test (FAST), Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ) and Eating Attitude Test-40 (EAT-40) was administered to the participants. In addition, metabolic syndrome (MetS) parameters were evaluated. In terms of cardiovascular risk, SCORE-2 (Systematic Coronary Risk Evaluation-2), presence of MetS, plasma atherogenicity index (PAI), Castelli-1 and 2 risk score and visceral adiposity index (VAI) were calculated. Statistical analyzes were performed using SPSS Statistics 25.0. According to the SAA questionnaire, the participants were divided into three chronotype groups as morningness (n=25, 32.1%), intermediate (n=26, 33.3%) and eveningness (n=27, 34.6%). It was observed that blood pressure values were measured higher in the evening group, and no difference was found in other anthropometric and physical examination measurements (p>0.05). It was observed that the HDL value was lower in the eveningness, and no significant difference was found in other biochemical parameters. Eveningness reported having poor sleep quality with a frequency of 89%. Daytime dysfunction, one of the dimensions related to sleep quality, was found to be weakly but positively related to CVD risk. Predisposition to eating disorders was detected in approximately 21% of the participants, although there was no significant difference between the chronotype groups in terms of eating disorders, it was observed that eveningness individuals had more unhealthy eating habits. MetS was found in approximately two out of every three patients in the evening group, one of the chronotype groups. Among other parameters related to CVD risk; No significant difference was observed between the groups in PAI, Castelli-1 and 2 scores, and VAI. In conclusion, in our study, findings indicating a more unfavorable clinical course, worse sleep quality, unhealthy eating habits and higher CVD risk were found in individuals with evening chronotype. We think that chronobiological treatment interventions targeting circadian regulation in eveningness individuals with BD will contribute to both the clinical course of BD and the reduction of accompanying CVDs. Chronotype studies may guide the identification of a more risky cardiometabolic group in people with BD. Keywords: Bipolar disorder, cardiovascular diseases, chronotype