A systematic review and meta-analysis of sleep and circadian rhythms disturbances in individuals at high-risk of developing or with early onset of bipolar disorders

Jan Scott*, Bruno Etain, David Miklowitz, Jacob J. Crouse, Joanne Carpenter, Steven Marwaha, Daniel Smith, Kathleen Merikangas, Ian Hickie

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Sleep and circadian rhythms disturbances (SCRD) in young people at high risk or with early onset of bipolar disorders (BD) are poorly understood. We systematically searched for studies of self, observer or objective estimates of SCRD in asymptomatic or symptomatic offspring of parents with BD (OSBD), individuals with presentations meeting recognised BD-at-risk criteria (BAR) and youth with recent onset of full-threshold BD (FT-BD). Of 76 studies eligible for systematic review, 35 (46%) were included in random effects meta-analyses. Pooled analyses of self-ratings related to circadian rhythms demonstrated greater preference for eveningness and more dysregulation of social rhythms in BAR and FT-BD groups; analyses of actigraphy provided some support for these findings. Meta-analysis of prospective studies showed that pre-existing SCRD were associated with a 40% increased risk of onset of BD, but heterogeneity in assessments was a significant concern. Overall, we identified longer total sleep time (Hedges g: 0.34; 95% confidence intervals:.1, .57), especially in OSBD and FT-BD and meta-regression analysis indicated the effect sizes was moderated by the proportion of any sample manifesting psychopathology or receiving psychotropic medications. This evolving field of research would benefit from greater attention to circadian rhythm as well as sleep quality measures.

Original languageEnglish
Article number104585
Number of pages11
JournalNeuroscience and biobehavioral reviews
Early online date17 Feb 2022
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information:
Prof. Merikangas was supported in part by Grant Z-01-MH002804 from the National Institute of Mental Health (NIMH) Intramural Research Program. She leads an international consortium called mMARCH (investigating rest-activity rhythms in mental disorders). The views and opinions expressed in this report are those of the author and should not be construed to represent the views of any of the sponsoring organisations, agencies, or US Government.

Drs. Crouse is supported in part by a Breakthrough Mental Health Research Foundation Fellowship and Dr Carpenter is supported in part by the Caroline Quinn Research Grant.

Publisher Copyright:
© 2022


  • Bipolar disorders
  • Children
  • Circadian rhythms
  • First episode
  • High risk
  • Meta-regression
  • Sleep quality
  • Youth

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Cognitive Neuroscience
  • Behavioral Neuroscience


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