Sleep quality and emotional reactivity cluster in bipolar disorders and impact on functioning

Eur Psychiatry. 2017 Sep;45:190-197. doi: 10.1016/j.eurpsy.2017.06.013. Epub 2017 Jul 16.


Objective: Bipolar disorders (BD) are characterized by sleep disturbances and emotional dysregulation both during acute episodes and remission periods. We hypothesized that sleep quality (SQ) and emotional reactivity (ER) defined clusters of patients with no or abnormal SQ and ER and we studied the association with functioning.

Method: We performed a bi-dimensional cluster analysis using SQ and ER measures in a sample of 533 outpatients patients with BD (in remission or with subsyndromal mood symptoms). Clusters were compared for mood symptoms, sleep profile and functioning.

Results: We identified three clusters of patients: C1 (normal ER and SQ, 54%), C2 (hypo-ER and low SQ, 22%) and C3 (hyper-ER and low SQ, 24%). C1 was characterized by minimal mood symptoms, better sleep profile and higher functioning than other clusters. Although highly different for ER, C2 and C3 had similar levels of subsyndromal mood symptoms as assessed using classical mood scales. When exploring sleep domains, C2 showed poor sleep efficiency and a trend for longer sleep latency as compared to C3. Interestingly, alterations in functioning were similar in C2 and C3, with no difference in any of the sub-domains.

Conclusion: Abnormalities in ER and SQ delineated three clusters of patients with BD and significantly impacted on functioning.

Keywords: Bipolar disorder; Cluster analysis; Emotional reactivity; Functioning; Sleep.

MeSH terms

  • Adult
  • Affect*
  • Arousal
  • Bipolar Disorder / complications*
  • Bipolar Disorder / psychology
  • Cluster Analysis
  • Female
  • France
  • Humans
  • Impulsive Behavior
  • Male
  • Middle Aged
  • Sleep Initiation and Maintenance Disorders / complications
  • Sleep Wake Disorders / complications*
  • Sleep Wake Disorders / psychology
  • Stress, Psychological / complications*
  • Stress, Psychological / psychology