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Sleep and Parasympathetic Activity During Rest and Stress in Healthy Adolescents and Adolescents With Bipolar Disorder

Casement, Melynda D. PhD; Goldstein, Tina R. PhD; Merranko, John MS; Gratzmiller, Sarah M. BA; Franzen, Peter L. PhD

doi: 10.1097/PSY.0000000000000737

Objective Sleep disruption contributes to the pathophysiology of mental disorders, particularly bipolar illness, but the biobehavioral mechanisms of this relationship are insufficiently understood. This study evaluated sleep duration, timing, and variability as prospective predictors of parasympathetic nervous system activity during rest and social stress in adolescents with bipolar disorder, reflecting sleep-related interference in stress regulatory systems that may confer vulnerability to mood episodes.

Method Participants were adolescents with bipolar disorder (n = 22) and healthy adolescents (n = 27). Sleep duration and timing were measured by actigraphy for 1 week before a laboratory social stress task, during which high-frequency heart rate variability (HF-HRV) was indexed using electrocardiography. Multilevel models were used to evaluate group, sleep characteristics, and their interactions as predictors of initial HF-HRV and change in HF-HRV during rest and stress.

Results Associations between group and changes in HF-HRV during stress were moderated by sleep duration mean (z = 2.24, p = .025) and variability (z = −2.78, p = .006). There were also main effects of mean sleep duration on initial HF-HRV during rest (z = −5.37, p < .001) and stress (z = −2.69, p = .007). Follow-up analyses indicated that, in bipolar adolescents during stress, shorter and longer sleep durations were associated with lower initial HF-HRV (z = −5.44, p < .001), and greater variability in sleep duration was associated with less change in HF-HRV (z = −2.18, p = .029).

Conclusions Sleep durations that are relatively short or long, which are characteristic of mood episodes, are associated with parasympathetic vulnerability to social stress in adolescents with bipolar disorder. Obtaining regular sleep of moderate duration may favorably affect responses to stress in bipolar youth.

From the Department of Psychology (Casement), University of Oregon, Eugene, Oregon; and Department of Psychiatry, University of Pittsburgh (Goldstein, Merranko, Gratzmiller, Franzen), Pittsburgh, Pennsylvania.

Supplemental Content

Address correspondence to Melynda D. Casement, PhD, University of Oregon, 1451 Onyx St, Eugene, OR 97403. E-mail:; Peter L. Franzen, PhD, Western Psychiatric Institute and Clinic, 3118 O’Hara St, Pittsburgh, PA 15213. E-mail:

Received for publication August 7, 2018; revision received April 1, 2019.

Online date: August 1, 2019

Copyright © 2019 by American Psychosomatic Society
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