title: Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies.
abstract: OBJECTIVE
  Sleep dysregulation is highly prevalent in bipolar disorders (BDs), with previous actigraphic studies demonstrating sleep abnormalities during depressive, manic, and interepisode periods. We undertook a meta-analysis of published actigraphy studies to identify whether any abnormalities in the reported sleep profiles of remitted BD cases differ from controls.
  
  
  METHODS
  A systematic review identified independent studies that were eligible for inclusion in a random effects meta-analysis. Effect sizes for actigraphy parameters were expressed as standardized mean differences (SMD) with 95% confidence intervals (95% CI).
  
  
  RESULTS
  Nine of 248 identified studies met eligibility criteria. Compared with controls (N=210), remitted BD cases (N=202) showed significant differences in SMD for sleep latency (0.51 [0.28-0.73]), sleep duration (0.57 [0.30-0.84]), wake after sleep onset (WASO) (0.28 [0.06-0.50]) and sleep efficiency (-0.38 [-0.70-0.07]). Moderate heterogeneity was identified for sleep duration (I2=44%) and sleep efficiency (I2=44%). Post hoc meta-regression analyses demonstrated that larger SMD for sleep duration were identified for studies with a greater age difference between BD cases and controls (β=0.22; P=0.03) and non-significantly lower levels of residual depressive symptoms in BD cases (β=-0.13; P=0.07).
  
  
  CONCLUSIONS
  This meta-analysis of sleep in remitted bipolar disorder highlights disturbances in several sleep parameters. Future actigraphy studies should pay attention to age matching and levels of residual depressive symptoms.
authors.affiliation: Inserm, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris Cedex 10, France; Université Paris Descartes, UMR-S 1144, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Fondation FondaMental, Créteil, France.
authors.forename: P A
authors.initials: PA
authors.lastname: Geoffroy
authors.forename: J
authors.initials: J
authors.lastname: Scott
authors.forename: C
authors.initials: C
authors.lastname: Boudebesse
authors.forename: M
authors.initials: M
authors.lastname: Lajnef
authors.forename: C
authors.initials: C
authors.lastname: Henry
authors.forename: M
authors.initials: M
authors.lastname: Leboyer
authors.forename: F
authors.initials: F
authors.lastname: Bellivier
authors.forename: B
authors.initials: B
authors.lastname: Etain
mesh_terms: D056044:Actigraphy / Q000379:methods*; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000523:psychology*; D055815:Young Adult
keywords: actigraphy; bipolar disorders; circadian rhythms; euthymia; sleep