Increased delta power and discrepancies in objective and subjective sleep measurements in borderline personality disorder.
BACKGROUND
Previous studies have shown depression-like sleep abnormalities in borderline personality disorder (BPD). However, findings in BPD are not unequivocal for REM dysregulation, as well as for a decrement of slow wave sleep and sleep continuity disturbances. Earlier findings in sleep EEG abnormalities in BPD may have been confounded by concomitant depressive symptoms.


METHODS
Twenty unmedicated female BPD patients without current comorbid major depression and 20 sex- and age-matched control subjects entered the study. Conventional polysomnographic parameters and for the first time sleep EEG spectral power analysis was performed on two sleep laboratory nights. Subjective sleep parameters were collected by sleep questionnaires in order to assess the relationship between objective and subjective sleep measurements.


RESULTS
BPD patients showed a tendency for shortened REM latency and significantly decreased NonREM sleep (stage 2). Spectral EEG analysis showed increased delta power in total NREM sleep as well as in REM sleep in BPD patients. Subjective ratings documented drastically impaired sleep quality in BPD patients for the two weeks before the study and during the two laboratory nights.


CONCLUSIONS
Not-depressed BPD patients only showed tendencies for depression-like REM sleep abnormalities. Surprisingly, BPD patients displayed higher levels of delta power in the sleep EEG in NREM sleep than healthy control subjects. There was a marked discrepancy between objective and subjective sleep measurements, which indicates an altered perception of sleep in BPD. The underlying psychological and neurobiological mechanisms of these alterations are still unclear and need to be clarified in future studies including interventions on a pharmacological and cognitive-behavioral level.
Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Haupt-strasse 5, 79104 Freiburg, Germany. alexandra_philipsen@psyallg.uni-freiburg.de
Alexandra
A
Philipsen
Bernd
B
Feige
Anam
A
Al-Shajlawi
Christian
C
Schmahl
Martin
M
Bohus
Harald
H
Richter
Ulrich
U
Voderholzer
Klaus
K
Lieb
Dieter
D
Riemann
D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000150:complications* / Q000523:psychology; D016022:Case-Control Studies; D003863:Depression / Q000523:psychology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008875:Middle Aged; D012893:Sleep Wake Disorders / Q000145:classification* / Q000209:etiology*