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Sleep quality during euthymia in bipolar disorder: the role of clinical features, personality traits, and stressful life events

Erika FH Saunders123*, Danielle M Novick234, Julio Fernandez-Mendoza15, Masoud Kamali23, Kelly A Ryan23, Scott A Langenecker236, Alan J Gelenberg1 and Melvin G McInnis23

Author Affiliations

1 Department of Psychiatry, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850, USA

2 University of Michigan Department of Psychiatry, Ann Arbor, MI 48109-2700, USA

3 University of Michigan Depression Center, Ann Arbor, MI 48109-2700, USA

4 Mood Disorders Clinic, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA

5 Sleep Research and Treatment Center, Department of Psychiatry, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033-0850, USA

6 University of Illinois at Chicago, Chicago, IL 60612, USA

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International Journal of Bipolar Disorders 2013, 1:16  doi:10.1186/2194-7511-1-16

Published: 13 September 2013



Poor sleep quality is known to precede the onset of mood episodes and to be associated with poor treatment outcomes in bipolar disorder (BD). We sought to identify modifiable factors that correlate with poor sleep quality in BD independent of residual mood symptoms.


A retrospective analysis was conducted to assess the association between the Pittsburgh Sleep Quality Index and clinical variables of interest in euthymic patients with DSM-IV BD (n = 119) and healthy controls (HC; n = 136) participating in the Prechter Longitudinal Study of Bipolar Disorder. Multivariable linear regression models were constructed to investigate the relationship between sleep quality and demographic and clinical variables in BD and HC participants. A unified model determined independent predictors of sleep quality.

Results and discussion

Euthymic participants with BD and HC differed in all domains. The best fitting unified multivariable model of poor sleep quality in euthymic participants with BD included rapid cycling (β = .20, p = .03), neuroticism (β = .28, p = 2 × 10−3), and stressful life events (β = .20, p = .02). Poor sleep quality often persists during euthymia and can be a target for treatment. Clinicians should remain vigilant for treating subjective sleep complaints independent of residual mood symptoms in those sensitive to poor sleep quality, including individuals with high neuroticism, rapid cycling, and recent stressful life events. Modifiable factors associated with sleep quality should be targeted directly with psychosocial or somatic treatment. Sleep quality may be a useful outcome measure in BD treatment studies.

Bipolar disorder; Sleep; Neuroticism; Rapid cycling; Stress