Evaluation of sleep parameters in the euthymic period of patients with bipolar di̇sorder

Introduction and Objective: Sleep disorders in bipolar disorder are not only specific to manic or depressive episodes, but also occur in the inter-episodic period. The deterioration in the sleep awakening cycle disrupts sleep quality; decreased treatment response, poor progression, increased morbidity, functionality and quality of life are adversely affected. The aim of this study was to investigate sleep parameters, effects sleep characteristics and quality on the clinic characteristics and functionalty in individuals who BPD euthymic period with subjective and objective tests. Method: 33 patients who BPD euthymic period that applied Recep Tayyip Erdoğan University Medical School sleep disorder center on between January 2016 and December 2018, PSG was performed and then applied to the psychiatry clinic between the same dates were included in the study. Patients were applied Structured Clinical Interview for Axis I disorders, Young Mania Rating Scale, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and Bipolar Disorder Functioning Questionnaire. Patients were compared in scale of sociodemographic and clinical variables and polysomnography data. Findings: Of the 33 patients (mean age: 40,5 ± 9,4 years) included in the study, the majority were woman (%57,6) , married (%66,7), primary school graduates (%42,4) and can work (%78,8). When the patients were evaluated in terms of the clinical features of BPD, the majority of patients were diagnosed with BPD 1 (%72,7). In the family history of mental illness, bipolar disorder (%36,4) was the most common and unipolar depression (%21,2) was the second most common disorder. More than half of the patients had seasonality (%60,6), psychotic symptoms (%54,5) and hospitalization history (%54,5). All patients in our study used mood stabilizers (MS). While %9,9 used only MS, %63,6 had a combination of MS and antipsychotic (AP), and %27,3 had a combination of MS, AP and antidepressants. Sleep quality was found to be poor in %45,5 of the patients. The sample group was divided into BPD 1 and BPD 2, no statistically significant relationship was found between the PSQI, ESS and ISI (p=0,509, p=1,162, p=0,190). A statistically significant difference was found between the BPD 1 and BPD 2 in the stigmatization subscale of the bipolar functionalty scale (p=0,014). There was a statistically significant difference between the two groups in terms of TRT, stage 3 alpha and REM alpha (p=0,034, p=0,007, p=0,011). The relationship between the drugs used in our sample and the polysomnographic was analyzed and there was no relationship between the drugs and NREM and REM stages, but NREM and REM sleep stages had arousals with stage 1 delta, stage 2 beta, stage 3 beta and REM beta waves and there was a significant difference (p=0,007). There was a significant difference in total functionality score and friendship subscale between the drugs used and the bipolar functionality scale (p=0,023, p=0,042). According to the PSQI, there was a significant difference in the relationship between the group poor sleep quality and the healty group in the friendship subscale (p=0,002). According to the ISI, it was found that there was a statistical significance between the group with insomnia and the healthy group in the bipolar functionality scale total score and the emotional functioning subscale (p=0,001, p=0,003). Conclusion: There are also changes in sleep parameters in BPD euthymic period such as sleep quality and functionalty deterioration which are indicated by subjective tests. Knowing the sleep changes that may be abiological marker in bipolar disorder, examining them in psychiatric interviews, treating with psychosocial approach or pharmacotherapy will prevent recurrence and relapse, improve clinical course and functionality.