title: Associations between circadian activity rhythms and functional brain abnormalities among euthymic bipolar patients: a preliminary study.
abstract: BACKGROUND
  Working memory and underlying functional brain deficits have been observed in euthymic bipolar disorder (BD) patients, though there is heterogeneity in the degree of deficits. Sleep/circadian rhythm abnormalities are thought to be a core component of BD and may explain some of the heterogeneity in functional abnormalities. This preliminary study examined associations between sleep/circadian rhythm abnormalities and functional magnetic resonance imaging (fMRI) brain response on a working memory task among BD patients.
  
  
  METHODS
  Fourteen euthymic medicated BD patients wore an actigraph for 7 days before undergoing fMRI with a working memory task. Two matched healthy comparison (HC) groups were used (14 in each sample). One group completed the actigraphy portion and the other completed the fMRI portion of the study. Circadian activity rhythm and sleep variables were calculated and compared between BD and HC participants. Variables that significantly differed were used to examine the association between activity rhythms/sleep abnormalities and fMRI working memory brain response in anatomically defined regions.
  
  
  RESULTS
  Sleep efficiency and the rhythm robustness, mesor, and amplitude-to-width ratio were significantly abnormal in BD patients. Individual variability in all the sleep/circadian variables was significantly associated with the degree of abnormality of brain response in the dorsolateral prefrontal cortex and supramarginal gyri.
  
  
  CONCLUSIONS
  Small sample size and multiple comparison groups limit the interpretability of these findings.
  
  
  CONCLUSIONS
  BD patients have abnormal activity rhythms and sleep efficiency, which are associated with abnormal working memory brain response. These preliminary findings support the notion that the sleep/circadian system is important in the functional brain deficits among BD patients.
authors.affiliation: VA San Diego Healthcare System, VISN-22 Mental Illness Research, Education, and Clinical Center, San Diego, CA 92161, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA 92161, USA. Electronic address: bmckenna@ucsd.edu.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: McKenna
authors.affiliation: University of California, San Diego, Department of Psychiatry, La Jolla, CA 92161, USA; VA San Diego Healthcare System, Psychology Service, San Diego, CA 92161,USA; VA San Diego Healthcare System, Center for Excellence in Stress and Mental Health, San Diego, CA 92161, USA.
authors.forename: Sean P A
authors.initials: SP
authors.lastname: Drummond
authors.affiliation: VA San Diego Healthcare System, VISN-22 Mental Illness Research, Education, and Clinical Center, San Diego, CA 92161, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA 92161, USA.
authors.forename: Lisa T
authors.initials: LT
authors.lastname: Eyler
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000503:physiopathology* / Q000523:psychology; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D016022:Case-Control Studies; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology; D012890:Sleep
keywords: Bipolar disorder; Circadian rhythms; Euthymic; Functional magnetic resonance imaging; Sleep; Working memory