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Bipolar disorder is associated with a loss of heartbeat complexity during depressive and hypomanic states, with this autonomic nervous system dysregulation being most pronounced during sleep. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 14, 2017Open Access

Heartbeat Complexity Modulation in Bipolar Disorder during Daytime and Nighttime

MNM. NardelliUniversity of Pisa ALAntonio LanatàUniversity of Florence GBGilles BertschyInserm

Structured PICO

Does continuous ECG monitoring of heartbeat complexity differentiate pathological mood states in bipolar disorder from healthy controls?

Population

19 subjects (8 patients with bipolar disorder and 11 healthy control subjects). Bipolar patients: age 18-65, DSM-IV TR criteria, low risk of suicide, no cognitive impairment or substance abuse, in hypomanic or moderately depressive phase. Healthy controls: females, age 18-45, no psychiatric or physical disorders.

Intervention

Continuous ECG monitoring using a textile-based sensorized t-shirt (PSYCHE platform) during daytime (8 am to 8 pm) and nighttime (8 pm to 7:30 am)

Comparator

Healthy control subjects monitored with the same device

Outcome

Heartbeat complexity modulation assessed via multiscale entropy (MSE) analysis of R-R interval seriessurrogate

Heartbeat complexity analysis via multiscale entropy reveals significant autonomic dysregulation during depressive and hypomanic states in bipolar disorder, particularly during sleep.

Abstract

This study reports on the complexity modulation of heartbeat dynamics in patients affected by bipolar disorder. In particular, a multiscale entropy analysis was applied to the R-R interval series, that were derived from electrocardiographic (ECG) signals for a group of nineteen subjects comprised of eight patients and eleven healthy control subjects. They were monitored using a textile-based sensorized t-shirt during the day and overnight for a total of 47 diurnal and 27 nocturnal recordings. Patients showed three different mood states: depression, hypomania and euthymia. Results show a clear loss of complexity during depressive and hypomanic states as compared to euthymic and healthy control states. In addition, we observed that a more significant complexity modulation among healthy and pathological mood states occurs during the night. These findings suggest that bipolar disorder is associated with an enhanced sleep-related dysregulation of the Autonomic Nervous System (ANS) activity, and that heartbeat complex dynamics may serve as a viable marker of pathological conditions in mental health.

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