ArticleJournal of affective disorders2026
Unstable sleep and rest-activity rhythms in adolescents at-risk for bipolar disorder: Links to mood symptoms and the effect of sleep stabilization.
Article in Journal of affective disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAdolescents with a parental history of bipolar disorder (BD; High-Risk) are more likely to develop BD than those without such history (Low-Risk). Actigraphy studies in adults indicate that instability in sleep and rest-activity rhythms (RAR) may be associated with progression to BD. However, it remains unclear whether High- and Low-Risk adolescents are differentially affected by sleep and RAR instability and their impact on emerging mood symptoms.
methodsWe recruited 50 adolescents unaffected by BD (mean age[SD] = 15.97[1.31], 58% female) stratified into High-Risk (N = 22) and Low-Risk (N = 28) groups. All participants completed two weeks of Baseline actigraphy; a subset of 11 High-Risk participants then completed a two-week sleep stabilization Manipulation at home targeting regular sleep timing and duration. Depression and mania rating scales were collected at Baseline and post-Manipulation. We examined between-group differences in sleep duration variability, midsleep variability, and Circadian Function Index (CFI; measure of circadian activity robustness), tested group moderation of associations with mood symptoms, and examined effects of the sleep stabilization protocol.
resultsWe found no between-group-differences (P-values>0.05). Among High-Risk participants only, greater sleep duration variability was linked to higher levels of depressive (β[95%CI] = 0.012[0.006,0.018]) and mania (β[95%CI] = 0.011[0.003,0.019]) symptoms, and lower CFI was linked to greater mania symptoms (β[95%CI] = -8.236[-12.525,-3.940]). The sleep stabilization protocol reduced sleep duration (P < 0.001) and midsleep (P = 0.005) variability and improved CFI (P = 0.044), with trend-level reductions in subthreshold mania symptoms.
conclusionsThese findings highlight that sleep and RAR instability may have a stronger impact on mood in High-Risk adolescents but simple behavioral interventions stabilizing sleep and rhythms could buffer against BD risk.
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