title: State-related differences in heart rate variability in bipolar disorder.
abstract: Heart rate variability (HRV) is a validated measure of sympato-vagal balance in the autonomic nervous system. HRV appears decreased in patients with bipolar disorder (BD) compared with healthy individuals, but the extent of state-related alterations has been sparingly investigated. The present study examined differences in HRV between affective states in BD. A heart rate and movement sensor weighing 8 g collected average acceleration, heart rate and the two slowest and fastest heart beats (of the most recent 16 beats) every 30 s over a period of at least three consecutive weekdays and nights in a prospective longitudinal design from a total of 31 different affective states in 16 outpatients with BD. A proxy measure of HRV was calculated as the difference between the second-shortest and the second-longest inter-beat-interval collected during each of the epochs. Analyses were based on over 100.000 HRV data-points. In unadjusted analyses and in analyses adjusted for age, gender and heart rate, during a manic state HRV was increased by 18% compared with a depressed state (eB= 1.18, 95% CI: 1.16-1.20, p < 0.001) and increased by 17% compared with a euthymic state (eB= 1.17, 95% CI: 1.15-1.19, p < 0.001), whereas there was no difference between a depressive state and a euthymic state (eB= 0.98, 95% CI: 0.96-1.00, p = 0.12). Further inclusion of BMI as a covariate did not alter any of the associations. HRV appears to be altered in a state-dependent manner in bipolar disorder and could represent a candidate state marker. Further studies with larger sample sizes are warranted.
authors.affiliation: Psychiatric Center Copenhagen, Rigshospitalet, Denmark. Electronic address: maria@faurholt-jepsen.dk.
authors.forename: Maria
authors.initials: M
authors.lastname: Faurholt-Jepsen
authors.affiliation: MRC Epidemiology Unit, Cambridge, United Kingdom.
authors.forename: Søren
authors.initials: S
authors.lastname: Brage
authors.affiliation: Psychiatric Center Copenhagen, Rigshospitalet, Denmark.
authors.forename: Lars Vedel
authors.initials: LV
authors.lastname: Kessing
authors.affiliation: Psychiatric Center Copenhagen, Rigshospitalet, Denmark.
authors.forename: Klaus
authors.initials: K
authors.lastname: Munkholm
mesh_terms: D056044:Actigraphy; D000328:Adult; D000339:Affect / Q000502:physiology*; D000367:Age Factors; D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D018670:Monitoring, Ambulatory; D009043:Motor Activity / Q000502:physiology; D010045:Outpatients; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012737:Sex Factors
keywords: Affective state; Bipolar disorder; HRV; Heart rate variability; State-dependent marker