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Sleep quality in bipolar disorder


Sleep and mood are intimately related. Alterations in sleep timing or duration are observed in depressed and manic patients and may precipitate episodes of bipolar disorder. Bipolar patients often complain about the quality of their sleep, delay in start sleeping, fragmented sleep, difficulty to maintain enthusiasm, and using sleep-inducing medications. The mechanisms of interaction between affect and sleep, though, are still unknown.


The objective of this study is to evaluate relations between sleep quality and both depressive and manic symptoms and functionality in patients with bipolar disorder.


A cross-sectional evaluation of bipolar outpatients (DSM-5 criteria) were conducted between March 2017 and January 2018, as part of a larger study, which is investigating response predictors to the disease. Individuals completed the Hamilton Depression Scale (HAM-D), Young Mania Rating Scale (YMRS), Functional Assessment Scale (FAST), and The Pittsburgh Sleep Quality index (PSQI) in the initial interviews, and those questionnaires will be repeated regularly throughout 94 weeks. Response of the scales had a maximum time-lapse of 30 days. Only responses from the first wave have been included so far. Ethics Committee approved the study.


Thirty-two patients met inclusion and exclusion criteria (unstable clinical status, current substance use). The mean age was 44.7 years (27 - 62) and 53% (n=17) were women. Data were not normally distributed, so the non-parametric Spearman´s correlation was conducted between numeric variables. The only significant correlation was between PSQI and FAST (rs=0.44, p=0.03).


Sleep quality is an important component of quality of life and, in this study, related significantly with functionality. However, it did not relate to depressive or manic symptoms. This result stresses the importance of maintaining good sleep habits in bipolar patients.


Sleep quality, PSQI, Bipolar disorder


Área Clínica


Universidade Federal do Paraná - Parana - Brasil


André Hideki Braga, Fernanda Thays Mukae Iqueuti, Marina Lumi Higa, Pedro Henrique Pereira Alvim, Mariana Richartz Schwind, Eduardo Alves Guilherme, Dirceu Zorzetto Filho, João Guilherme Fiorani Borgio