Letters to the editor 3. Geoffroy PA, Boudebesse C, Bellivier F et al. Sleep in remitted bipolar disorder: a naturalistic case-control study using actigraphy. J Affect Disord 2014;158:1–7. 4. Kaplan KA, Talbot LS, Gruber J, Harvey AG. Evaluating sleep in bipolar disorder: comparison between actigraphy, polysomnography, and sleep diary. Bipolar Disord 2012;14:870–879.
5. Boudebesse C, Geoffroy PA, Bellivier F et al. Correlations between objective and subjective sleep and circadian markers in remitted patients with bipolar disorder. Chronobiol Int 2014;31:698–704.
Reply Sleep in Patients with Remitted Bipolar Disorders: Analyses stratified on actigraphy devices, age and gender
DOI: 10.1111/acps.12400 In reply to Dr. Kawada, we conducted subanalyses using random-effect modelling for pooled effect sizes according to actigraphy devices, age and gender (1). First, when we strictly focused on studies that used an ActiwatchÒ from Cambridge Neurotechnology, only 3 of 9 studies can be used. This subanalysis showed that BD cases presented with longer sleep latency (SMD = 0.61 [0.26, 0.96]; Z = 3.38; P = 0.0007), lower sleep efficiency (SMD = 0.44 [ 0.79, 0.09]; Z = 2.48; P = 0.01) and trends towards longer sleep duration (SMD = 0.33[ 0.02, 0.68]; Z = 1.87; P = 0.06) and more wake after sleep onset (WASO) (SMD = 0.30 [ 0.05, 0.64]; Z = 1.69; P = 0.09). This analysis should be interpreted with caution given the reduction of the statistical power. The second concern was about age matching: we conducted subanalysis by excluding three studies with mean age of cases and controls under 40-year-olds (2–4). We confirmed that BD cases presented with longer sleep latency (SMD = 0.48 [0.16, 0.80]; Z = 2.94; P = 0.003), longer sleep duration (SMD = 0.45 [0.19, 0.70]; Z = 3.47; P = 0.0005) and lower sleep efficiency (SMD = 0.55 [ 0.96, 0.14; Z = 2.61; P = 0.009). No significant difference was observed for WASO (SMD = 0.24 [ 0.07, 0.56]; Z = 1.53; P = 0.13). The third concern was about incomplete age matching. We selected only studies with less than 10% of frequency difference for gender between cases and controls, excluding so three studies (2, 4, 5). We showed that BD cases presented with longer sleep latency (SMD = 0.51 [0.17, 0.86]; Z = 2.89; P = 0.004), lower sleep efficiency (SMD = 0.47 [ 0.95, 0.01]; Z = 1.94; P = 0.05), longer sleep duration (SMD = 0.59 [0.23, 0.94]; Z = 3.26; P = 0.001) and more wake after sleep onset (WASO) (SMD = 0.32 [ 0.01, 0.64]; Z = 1.93; P = 0.05). To conclude, after performing subanalyses in more homogeneous subgroups depending on actigraph devices, age and gender, we found similar results as compared to the initial report despite loosing statistical power with these stratifications. As recommended, future studies should pay attention to carefully report such methodological aspects to improve comparability between studies. A better identification of sleep abnormalities during remission might improve functioning and prevent the evolution of prodromes of mood relapses.
400
P. A. Geoffroy1,2,3,4,5, J. Scott6,7, C. Boudebesse5,9,10, M. Lajnef10, C. Henry5,8,9,10, M. Leboyer5,8,9,10, F. Bellivier1,2,3,4,5 and B. Etain5,8,9,10 1 Inserm, UMR-S 1144, Paris, France, 2AP-HP, GH SaintLouis - Lariboisi ere - Fernand Widal, P^ ole Neurosciences, Paris, e Paris Descartes, UMR-S 1144, Paris, France, 3Universit e Paris Diderot, UMR-S 1144, Paris, France, France , 4Universit 5 Fondation FondaMental, Cr eteil, France, 6Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK, 7Centre for Affective Disorders, Institute of opital H. Mondor - A. Psychiatry, London, UK, 8AP-HP, H^ Chenevier, DHU PePsy, P^ ole de Pstychiatrie, Cr eteil, France, 9 INSERM, U955, Equipe Psychiatrie G en etique, Cr eteil, e de m edecine, Universit e Paris Est, Cr eteil, France and 10Facult France E-mail: pierre.a.geoff[email protected]
References 1. Geoffroy PA, Scott J, Boudebesse C et al. Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies. Acta Psychiatr Scand 2014;131:89–99. 2. Harvey AG, Schmidt DA, Scarna A, Semler CN, Goodwin GM. Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. Am J Psychiatry 2005;162:50–57. 3. Ritter PS, Marx C, Lewtschenko N et al. The characteristics of sleep in patients with manifest bipolar disorder, subjects at high risk of developing the disease and healthy controls. J Neural Transm 2012;119:1173–1184. 4. Gershon A, Thompson WK, Eidelman P, McGlinchey EL, Kaplan KA, Harvey AG. Restless pillow, ruffled mind: sleep and affect coupling in interepisode bipolar disorder. J Abnorm Psychol 2012;121:863–873. 5. Geoffroy PA, Boudebesse C, Bellivier F et al. Sleep in remitted bipolar disorder: a naturalistic case-control study using actigraphy. J Affect Disord 2014;158:1–7.
Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
5. Boudebesse C, Geoffroy PA, Bellivier F et al. Correlations between objective and subjective sleep and circadian markers in remitted patients with bipolar disorder. Chronobiol Int 2014;31:698–704.
Reply Sleep in Patients with Remitted Bipolar Disorders: Analyses stratified on actigraphy devices, age and gender
DOI: 10.1111/acps.12400 In reply to Dr. Kawada, we conducted subanalyses using random-effect modelling for pooled effect sizes according to actigraphy devices, age and gender (1). First, when we strictly focused on studies that used an ActiwatchÒ from Cambridge Neurotechnology, only 3 of 9 studies can be used. This subanalysis showed that BD cases presented with longer sleep latency (SMD = 0.61 [0.26, 0.96]; Z = 3.38; P = 0.0007), lower sleep efficiency (SMD = 0.44 [ 0.79, 0.09]; Z = 2.48; P = 0.01) and trends towards longer sleep duration (SMD = 0.33[ 0.02, 0.68]; Z = 1.87; P = 0.06) and more wake after sleep onset (WASO) (SMD = 0.30 [ 0.05, 0.64]; Z = 1.69; P = 0.09). This analysis should be interpreted with caution given the reduction of the statistical power. The second concern was about age matching: we conducted subanalysis by excluding three studies with mean age of cases and controls under 40-year-olds (2–4). We confirmed that BD cases presented with longer sleep latency (SMD = 0.48 [0.16, 0.80]; Z = 2.94; P = 0.003), longer sleep duration (SMD = 0.45 [0.19, 0.70]; Z = 3.47; P = 0.0005) and lower sleep efficiency (SMD = 0.55 [ 0.96, 0.14; Z = 2.61; P = 0.009). No significant difference was observed for WASO (SMD = 0.24 [ 0.07, 0.56]; Z = 1.53; P = 0.13). The third concern was about incomplete age matching. We selected only studies with less than 10% of frequency difference for gender between cases and controls, excluding so three studies (2, 4, 5). We showed that BD cases presented with longer sleep latency (SMD = 0.51 [0.17, 0.86]; Z = 2.89; P = 0.004), lower sleep efficiency (SMD = 0.47 [ 0.95, 0.01]; Z = 1.94; P = 0.05), longer sleep duration (SMD = 0.59 [0.23, 0.94]; Z = 3.26; P = 0.001) and more wake after sleep onset (WASO) (SMD = 0.32 [ 0.01, 0.64]; Z = 1.93; P = 0.05). To conclude, after performing subanalyses in more homogeneous subgroups depending on actigraph devices, age and gender, we found similar results as compared to the initial report despite loosing statistical power with these stratifications. As recommended, future studies should pay attention to carefully report such methodological aspects to improve comparability between studies. A better identification of sleep abnormalities during remission might improve functioning and prevent the evolution of prodromes of mood relapses.
400
P. A. Geoffroy1,2,3,4,5, J. Scott6,7, C. Boudebesse5,9,10, M. Lajnef10, C. Henry5,8,9,10, M. Leboyer5,8,9,10, F. Bellivier1,2,3,4,5 and B. Etain5,8,9,10 1 Inserm, UMR-S 1144, Paris, France, 2AP-HP, GH SaintLouis - Lariboisi ere - Fernand Widal, P^ ole Neurosciences, Paris, e Paris Descartes, UMR-S 1144, Paris, France, 3Universit e Paris Diderot, UMR-S 1144, Paris, France, France , 4Universit 5 Fondation FondaMental, Cr eteil, France, 6Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK, 7Centre for Affective Disorders, Institute of opital H. Mondor - A. Psychiatry, London, UK, 8AP-HP, H^ Chenevier, DHU PePsy, P^ ole de Pstychiatrie, Cr eteil, France, 9 INSERM, U955, Equipe Psychiatrie G en etique, Cr eteil, e de m edecine, Universit e Paris Est, Cr eteil, France and 10Facult France E-mail: pierre.a.geoff[email protected]
References 1. Geoffroy PA, Scott J, Boudebesse C et al. Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies. Acta Psychiatr Scand 2014;131:89–99. 2. Harvey AG, Schmidt DA, Scarna A, Semler CN, Goodwin GM. Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. Am J Psychiatry 2005;162:50–57. 3. Ritter PS, Marx C, Lewtschenko N et al. The characteristics of sleep in patients with manifest bipolar disorder, subjects at high risk of developing the disease and healthy controls. J Neural Transm 2012;119:1173–1184. 4. Gershon A, Thompson WK, Eidelman P, McGlinchey EL, Kaplan KA, Harvey AG. Restless pillow, ruffled mind: sleep and affect coupling in interepisode bipolar disorder. J Abnorm Psychol 2012;121:863–873. 5. Geoffroy PA, Boudebesse C, Bellivier F et al. Sleep in remitted bipolar disorder: a naturalistic case-control study using actigraphy. J Affect Disord 2014;158:1–7.
Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
