The effect of poor sleep quality on mood outcome differs between men and women: A longitudinal study of bipolar disorder.
BACKGROUND
Sleep disturbance is bi-directionally related to mood de-stabilization in bipolar disorder (BD), and sleep quality differs in men and women. We aimed to determine whether perception of poor sleep quality would have a different effect on mood outcome in men versus women.


METHODS
We assessed association between sleep quality (Pittsburgh Sleep Quality Index (PSQI)) at study intake and mood outcome over 2 years in subjects from the Prechter Longitudinal Study of Bipolar Disorder (N=216; 29.6% males). The main outcome measure was the severity, variability, and frequency of mood episodes measured by self-report over 2 years of follow-up. Multivariable linear regression models stratified by sex examined the relationship between PSQI with mood outcomes, while age, stressful life events, mood state and neuroticism at baseline were controlled.


RESULTS
In women, poor sleep quality at baseline predicted increased severity (B=0.28, p<0.001) and frequency of episodes (B=0.32, p<0.001) of depression, and poor sleep quality was a stronger predictor than baseline depression; poor sleep quality predicted increased severity (B=0.19, p<0.05) and variability (B=0.20, p<0.05) of mania, and frequency of mixed episodes (B=0.27, p<0.01). In men, baseline depression and neuroticism were stronger predictors of mood outcome compared to poor sleep quality.


LIMITATIONS
We measured perception of sleep quality, but not objective changes in sleep.


CONCLUSIONS
In a longitudinal study of BD, women reported poorer perceived sleep quality than men, and poor sleep quality predicted worse mood outcome in BD. Clinicians should be sensitive to addressing sleep complaints in women with BD early in treatment to improve outcome in BD.
['Saunders|Erika F H|EF|', 'Fernandez-Mendoza|Julio|J|', 'Kamali|Masoud|M|', 'Assari|Shervin|S|', 'McInnis|Melvin G|MG|']
D000328:Adult D000339:Affect D000368:Aged D001714:Bipolar Disorder D005260:Female D006801:Humans D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D012727:Sex Characteristics D012893:Sleep Wake Disorders
Sleep Mood Bipolar disorder Sex Depression Mania