title: The effect of poor sleep quality on mood outcome differs between men and women: A longitudinal study of bipolar disorder.
abstract: BACKGROUND
  Sleep disturbance is bi-directionally related to mood de-stabilization in bipolar disorder (BD), and sleep quality differs in men and women. We aimed to determine whether perception of poor sleep quality would have a different effect on mood outcome in men versus women.
  
  
  METHODS
  We assessed association between sleep quality (Pittsburgh Sleep Quality Index (PSQI)) at study intake and mood outcome over 2 years in subjects from the Prechter Longitudinal Study of Bipolar Disorder (N=216; 29.6% males). The main outcome measure was the severity, variability, and frequency of mood episodes measured by self-report over 2 years of follow-up. Multivariable linear regression models stratified by sex examined the relationship between PSQI with mood outcomes, while age, stressful life events, mood state and neuroticism at baseline were controlled.
  
  
  RESULTS
  In women, poor sleep quality at baseline predicted increased severity (B=0.28, p<0.001) and frequency of episodes (B=0.32, p<0.001) of depression, and poor sleep quality was a stronger predictor than baseline depression; poor sleep quality predicted increased severity (B=0.19, p<0.05) and variability (B=0.20, p<0.05) of mania, and frequency of mixed episodes (B=0.27, p<0.01). In men, baseline depression and neuroticism were stronger predictors of mood outcome compared to poor sleep quality.
  
  
  CONCLUSIONS
  We measured perception of sleep quality, but not objective changes in sleep.
  
  
  CONCLUSIONS
  In a longitudinal study of BD, women reported poorer perceived sleep quality than men, and poor sleep quality predicted worse mood outcome in BD. Clinicians should be sensitive to addressing sleep complaints in women with BD early in treatment to improve outcome in BD.
authors.affiliation: Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, Mail Code: HO73, Hershey, PA, USA; University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan Depression Center, Ann Arbor, MI, USA. Electronic address: esaunders@hmc.psu.edu.
authors.forename: Erika F H
authors.initials: EF
authors.lastname: Saunders
authors.affiliation: Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, Mail Code: HO73, Hershey, PA, USA; Sleep Research & Treatment Center, Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. Electronic address: jfernandezmendoza@hmc.psu.edu.
authors.forename: Julio
authors.initials: J
authors.lastname: Fernandez-Mendoza
authors.affiliation: University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan Depression Center, Ann Arbor, MI, USA. Electronic address: masoud@med.umich.edu.
authors.forename: Masoud
authors.initials: M
authors.lastname: Kamali
authors.affiliation: University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan School of Public Health, Ann Arbor, MI, USA. Electronic address: assari@umich.edu.
authors.forename: Shervin
authors.initials: S
authors.lastname: Assari
authors.affiliation: University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan Depression Center, Ann Arbor, MI, USA. Electronic address: mmcinnis@umich.edu.
authors.forename: Melvin G
authors.initials: MG
authors.lastname: McInnis
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D012893:Sleep Wake Disorders / Q000150:complications / Q000523:psychology*
keywords: Bipolar disorder; Depression; Mania; Mood; Sex; Sleep