title: Clinical significance of mobile health assessed sleep duration and variability in bipolar disorder.
abstract: Sleep disturbances are prevalent, persistent, and impairing features of bipolar disorder. However, the near-term and cumulative impact of the severity and variability of sleep disturbances on symptoms and functioning remains unclear. We examined self-reported daily sleep duration and variability in relation to mood symptoms, medication adherence, cognitive functioning, and concurrent daily affect.
  
  
  
  Forty-one outpatients diagnosed with bipolar disorder were asked to provide daily reports of sleep duration and affect collected via ecological momentary assessment with smartphones over eleven weeks. Measures of depressive and manic symptoms, medication adherence, and cognitive function were collected at baseline and concurrent assessment of affect were collected daily. Analyses examined whether sleep duration or variability were associated with baseline measures and changes in same-day or next-day affect.
  
  
  
  Greater sleep duration variability (but not average sleep duration) was associated with greater depressive and manic symptom severity, and lower medication adherence at baseline, and with lower and more variable ratings of positive affect and higher ratings of negative affect. Sleep durations shorter than 7-8 h were associated with lower same-day ratings of positive and higher same-day ratings of negative affect, however this did not extend to next-day affect.
  
  
  
  Greater cumulative day-to-day sleep duration variability, but not average sleep duration, was related to more severe mood symptoms, lower self-reported medication adherence and higher levels of negative affect. Bouts of short- or long-duration sleep had transient impact on affect. Day-to-day sleep variability may be important to incorporate into clinical assessment of sleep disturbances in bipolar disorder.
authors.affiliation: Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. Electronic address: cnkaufmann@ucsd.edu.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Kaufmann
authors.affiliation: Child and Adolescent Psychiatry, Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Palo Alto, CA, 94305, USA.
authors.forename: Anda
authors.initials: A
authors.lastname: Gershon
authors.affiliation: Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
authors.forename: Lisa T
authors.initials: LT
authors.lastname: Eyler
authors.affiliation: Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
authors.forename: Colin A
authors.initials: CA
authors.lastname: Depp
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000209:etiology*; D000068997:Smartphone; D013997:Time Factors
keywords: Affective states; Bipolar disorder; Sleep