Chronotype and circadian rhythm in bipolar disorder: a systematic review

Summary Despite a complex relationship between mood, sleep and rhythm, the impact of circadian disruptions on bipolar disorder (BD) has not been clarified. The purpose of this systematic review was to define current evidence regarding chronotype and circadian rhythm patterns in BD patients. Forty-tw...

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Bibliographic Details
Published in:Sleep medicine reviews 2017-08, Vol.34, p.46-58
Main Authors: Aguiar Melo, Matias Carvalho, Cristino Abreu, Rafael Leônidas, Linhares Neto, Vicente Bezerra, Carvalhedo de Bruin, Pedro Felipe, Sales de Bruin, Veralice Meireles
Format: Article
Language:English
Subjects:
Bipolar disorder
Bipolar Disorder - complications
Chronobiology
Chronobiology Disorders - etiology
Chronotype
Circadian rhythm
Circadian Rhythm - physiology
Depression
Humans
Hydrocortisone
Melatonin - analysis
Neurology
Sleep - physiology
Sleep Medicine
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Summary:Summary Despite a complex relationship between mood, sleep and rhythm, the impact of circadian disruptions on bipolar disorder (BD) has not been clarified. The purpose of this systematic review was to define current evidence regarding chronotype and circadian rhythm patterns in BD patients. Forty-two studies were included, involving 3,432 BD patients. Disruption of the biological rhythm was identified, even in drug-naïve BD patients and independently of mood status. Daily profiles of melatonin levels and cortisol indicated a delayed phase. Depression was more frequently associated with circadian alterations than euthymia. Few studies evaluated mania, demonstrating irregular rhythms. Evening type was more common in BD adults. Studies about the influence of chronotype on depressive symptoms showed conflicting results. Only one investigation observed the influences of chronotype in mania, revealing no significant association. Effects of psychoeducation and lithium on rhythm in BD patients were poorly studied, demonstrating no improvement of rhythm parameters. Studies about genetics are incipient. In conclusion, disruption in circadian rhythm and eveningness are common in BD. Prospective research evaluating the impact of circadian disruption on mood symptoms, metabolism, seasonality, age influence and the effects of mood stabilizers are needed.
ISSN:1087-0792
1532-2955
DOI:10.1016/j.smrv.2016.06.007