Effect of early trauma on the sleep quality of euthymic bipolar patients

J Affect Disord. 2016 Dec;206:261-267. doi: 10.1016/j.jad.2016.07.045. Epub 2016 Jul 27.


Objective: Poor quality of sleep is frequent in euthymic bipolar patients and conveys worse clinical outcomes. We investigated the features of euthymic bipolar patients associated with poor sleep quality, with a focus on the effect of childhood trauma.

Method: 493 euthymic patients with DSM-IV-defined bipolar disorders were recruited in FondaMental Advanced Centers of Expertize for Bipolar Disorders (FACE-BD) between 2009 and 2014. Clinical variables were recorded. Subjective sleep quality and history of childhood trauma were respectively measured by the Pittsburgh Sleep Quality Index (PSQI) and the Childhood Trauma Questionnaire (CTQ).

Results: Poor sleepers were older, less professionally active, had significantly higher anxiety levels, took more anxiolytic drugs and did endorse more suicide attempts and suicidal ideas than good sleepers after adjusting for anxiety levels and age. Emotional abuse was associated with poor sleep quality after adjustment for BMI, age, professional activity, and bipolar disorders (BD) type (OR=1.83; 95% CI [1.30; 3.10]; p=0.02). However, this association was lost after adjustment for anxiety levels, anxiolytic treatment and suicide ideation/attempts.

Limitations: The main limitation was the type of sleep assessment, which only measured the subjective part of sleep complaints.

Conclusion: A history of emotional abuse might underlie sleep problems in many bipolar patients but anxiety seems to act as a confounding factor in this relationship. New studies are needed to elucidate the role of childhood maltreatment on poor sleep among bipolar patients.

Keywords: Anxiety; Bipolar disorders; Childhood trauma; Sleep quality.

MeSH terms

  • Adult
  • Anxiety Disorders / complications
  • Bipolar Disorder / complications*
  • Bipolar Disorder / psychology*
  • Cyclothymic Disorder / complications
  • Female
  • Humans
  • Male
  • Middle Aged
  • Sleep
  • Sleep Initiation and Maintenance Disorders / psychology
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / psychology*
  • Suicidal Ideation
  • Suicide, Attempted / psychology*
  • Surveys and Questionnaires