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Journal Articles L'Encéphale Year : 2017

[How to characterize and treat sleep complaints in bipolar disorders?]

Comment caractériser et traiter les plaintes de sommeil dans les troubles bipolaires ?

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Objectives Sleep complaints are very common in bipolar disorders (BD) both during acute phases (manic and depressive episodes) and remission (about 80 % of patients with remitted BD have poor sleep quality). Sleep complaints during remission are of particular importance since they are associated with more mood relapses and worse outcomes. In this context, this review discusses the characterization and treatment of sleep complaints in BD. Methods We examined the international scientific literature in June 2016 and performed a literature search with PubMed electronic database using the following headings: “bipolar disorder” and (“sleep” or “insomnia” or “hypersomnia” or “circadian” or “apnoea” or “apnea” or “restless legs”). Results Patients with BD suffer from sleep and circadian rhythm abnormalities during major depressive episodes (insomnia or hypersomnia, nightmares, nocturnal and/or early awakenings, non-restorative sleep) and manic episodes (insomnia, decreased need for sleep without fatigue), but also some of these abnormalities may persist during remission. These remission phases are characterized by a reduced quality and quantity of sleep, with a longer sleep duration, increased sleep latency, a lengthening of the wake time after sleep onset (WASO), a decrease of sleep efficiency, and greater variability in sleep/wake rhythms. Patients also present frequent sleep comorbidities: chronic insomnia, sleepiness, sleep phase delay syndrome, obstructive sleep apnea/hypopnea syndrome (OSAHS), and restless legs syndrome (RLS). These disorders are insufficiently diagnosed and treated whereas they are associated with mood relapses, treatment resistance, affect cognitive global functioning, reduce the quality of life, and contribute to weight gain or metabolic syndrome. Sleep and circadian rhythm abnormalities have been also associated with suicidal behaviors. Therefore, a clinical exploration with characterization of these abnormalities and disorders is essential. This exploration should be helped by questionnaires and documented on sleep diaries or even actimetric objective measures. Explorations such as ventilatory polygraphy, polysomnography or a more comprehensive assessment in a sleep laboratory may be required to complete the diagnostic assessment. Treatments obviously depend on the cause identified through assessment procedures. Treatment of chronic insomnia is primarily based on non-drug techniques (by restructuring behavior and sleep patterns), on psychotherapy (cognitive behavioral therapy for insomnia [CBT-I]; relaxation; interpersonal and social rhythm therapy [IPSRT]; etc.), and if necessary with hypnotics during less than four weeks. Specific treatments are needed in phase delay syndrome, OSAHS, or other more rare sleep disorders. Conclusions BD are defined by several sleep and circadian rhythm abnormalities during all phases of the disorder. These abnormalities and disorders, especially during remitted phases, should be characterized and diagnosed to reduce mood relapses, treatment resistance and improve BD outcomes.
Objectifs Cette revue propose une synthèse sur la caractérisation et le traitement des plaintes de sommeil dans les troubles bipolaires (TB). Méthodes Une recherche de la littérature scientifique a été effectuée en juin 2016 sur PubMed à l’aide d’une équation de recherche suivante : « bipolar disorder » and (« sleep » or « insomnia » or « hypersomnia » or « circadian » or « apnea » or « restless legs »). Résultats Les TB présentent des perturbations du sommeil et des rythmes circadiens durant les épisodes aigus mais également au cours des phases de rémission marquées par des anomalies de la qualité et de la quantité du sommeil, et une plus grande variabilité des rythmes veille/sommeil. Ces patients souffrent très fréquemment de troubles du sommeil comorbides : insomnie chronique, hypersomnolence, retard de phase, syndrome d’apnées-hypopnées obstructives du sommeil (SAHOS), et syndrome des jambes sans repos. Ces troubles favorisent les rechutes thymiques, altèrent le fonctionnement cognitif, diminuent la qualité de vie, favorisent une prise de poids et l’apparition d’un syndrome métabolique. Une exploration clinique avec caractérisation de ces troubles est donc indispensable, aidée par des questionnaires, et documentée sur des agendas du sommeil voire des mesures objectives actimétriques. Un bilan plus complet en laboratoire du sommeil peut être nécessaire. Les traitements associés dépendent de la cause. Le traitement de l’insomnie chronique s’appuie sur des techniques non médicamenteuses (restructuration des comportements et rythmes du sommeil), la psychothérapie, et si besoin sur les hypnotiques. Des traitements spécifiques seront proposés dans le syndrome de retard de phase, le SAHOS, ou les autres troubles du sommeil plus rares.
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inserm-03854490 , version 1 (15-11-2022)



P.A. Geoffroy, J.-A. Micoulaud Franchi, R. Lopez, I. Poirot, A. Brion, et al.. Comment caractériser et traiter les plaintes de sommeil dans les troubles bipolaires ?. L'Encéphale, 2017, 43 (4), pp.363-373. ⟨10.1016/j.encep.2016.06.007⟩. ⟨inserm-03854490⟩
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