Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders

Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders

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J Psychiatry Neurosci 2015;40(1):28-37

Rébecca Robillard, PhD; Daniel F. Hermens, PhD; Sharon L. Naismith, DPsych; Django White; Naomi L. Rogers, PhD; Tony K.C. Ip, BSc(Hons); Sharon J. Mullin, BSc, MBMSc; Gail A. Alvares, BSc(Hons); Adam J. Guastella, PhD; Kristie Leigh Smith, BSc(psyc), MBMSc; Ye Rong, PhD; Bradley Whitwell, DipAppSc, LLB; James Southan, MN (NP); Nick Glozier, MA, MBBS, MSc, MRCPsych, FRANZCP, PhD; Elizabeth M. Scott, MBBS; Ian B. Hickie, FRANZCP


Background: The nature of sleep-wake abnormalities in individuals with mental disorders remains unclear. The present study aimed to examine the differences in objective ambulatory measures of the sleep-wake and activity cycles across young people with anxiety, mood or psychotic disorders.

Methods: Participants underwent several days of actigraphy monitoring. We divided participants into 5 groups (control, anxiety disorder, unipolar depression, bipolar disorder, psychotic disorder) according to primary diagnosis.

Results: We enrolled 342 participants aged 12–35 years in our study: 41 healthy controls, 56 with anxiety disorder, 135 with unipolar depression, 80 with bipolar disorder and 30 with psychotic disorders. Compared with the control group, sleep onset tended to occur later in the anxiety, depression and bipolar groups; sleep offset occurred later in all primary diagnosis groups; the sleep period was longer in the anxiety, bipolar and psychosis groups; total sleep time was longer in the psychosis group; and sleep efficiency was lower in the depression group, with a similar tendency for the anxiety and bipolar groups. Sleep parameters were significantly more variable in patient subgroups than in controls. Cosinor analysis revealed delayed circadian activity profiles in the anxiety and bipolar groups and abnormal circadian curve in the psychosis group.

Limitations: Although statistical analyses controlled for age, the sample included individuals from preadolescence to adulthood. Most participants from the primary diagnosis subgroups were taking psychotropic medications, and a large proportion had other comorbid mental disorders.

Conclusion: Our findings suggest that delayed and disorganized sleep offset times are common in young patients with various mental disorders. However, other sleep-wake cycle disturbances appear to be more prominent in broad diagnostic categories.

Submitted Oct. 30, 2013; Revised Feb. 22, Apr. 27, 2014; Accepted May 1, 2014; Early-released Sept. 9, 2014.

Acknowledgements: This study was funded from a National Health and Medical Research Council (NHMRC) Australia Fellowship awarded to I.B. Hickie and supported by the Sydney University Research Networks. R. Robillard received a postdoctoral training award from the Fonds de la recherche en santé du Québec. D.F. Hermens has received honoraria for educational seminars from Janssen-Cilag and Eli Lilly and is currently supported by a grant from the NSW Health, Mental Health and Drug & Alcohol Office. S.L. Naismith is supported by an NHMRC Career Development Award. E.M. Scott is the (unpaid) Clinical Director of Headspace Services at the Brain and Mind Research Institute (BMRI), the (unpaid) Coordinator of the Youth Mental Health Research Program at the BMRI, and Deputy Director of St Vincent’s Private Hospital Young Adult Mental Health Unit. She has received honoraria for educational seminars related to the clinical management of depressive disorders supported by Servier and Eli Lilly pharmaceuticals. She has participated in a national advisory board for the antidepressant compound Pristiq, manufactured by Pfizer. I.B. Hickie is supported by a NHMRC Australia Fellowship (No. 464914). He was a director of Headspace: The National Youth Mental Health Foundation until January 2012. He is the executive director of the BMRI, which operates 2 early‐intervention youth services under contract to Headspace. He is a member of the new Australian National Mental Health commission and was previously the CEO of Beyondblue: The National Depression Initiative. He has led a range of community‐based and pharmaceutical industry–supported depression awareness and education and training programs. He has led depression and other mental health research projects that have been supported by a variety of pharmaceutical partners. Current investigator‐ initiated studies are supported by Servier and Pfizer. He has received honoraria for his contributions to professional educational seminars supported by the pharmaceutical industry (including Servier, Pfizer, AstraZeneca, and Eli Lilly. No other competing interests declared.

Affiliations: Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Brain & Mind Research Institute, Camperdown NSW, Australia (Robillard, Hermens, Naismith, White, Mullin, Alvares, Guastella, Smith, Withwell, Southan, Glozier, Scott, Hickie); Concord Medical School, The University of Sydney, Concord Centre for Cardiometabolic Health in Psychosis, Hospital Road, Concord NSW, Australia (Rogers, Ip).

Contributors: D. Hermens, N. Rogers, A. Guastella, N. Glozier, E. Scott and I. Hickie designed the study. R. Robillard, S. Naismith, D. White, N. Rogers, T. Ip, G. Alvares, A. Guastella, K. Smith, B. Whitwell, and J. Southan acquired the data, which R. Robillard, D. White, S. Mullin, K. Smith, Y. Rong and I. Hickie analyzed. R. Robillard wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/jpn.130247

Correspondence to: I.B. Hickie, Brain & Mind Research Institute, University of Sydney, Level 4, 94 Mallett St., Camperdown NSW 2050 Australia;