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Complicated grief and impaired sleep in patients with bipolar disorder


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Naomi M. Simon, MD, MSc, Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA 02114, USA.
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Objectives:  To examine the relationship of sleep disturbance with complicated grief (CG) in patients with bipolar disorder (BD).

Methods:  Adults with DSM-IV BD were asked if they ever experienced significant loss and, if so, completed the Inventory of Complicated Grief. Subjective sleep disturbance was assessed with the Pittsburgh Sleep Quality Index (PSQI). The association of CG with sleep disturbance was assessed in univariate t-tests, and in multivariate analyses controlling for the presence of anxiety disorder comorbidity and current bipolar recovery status.

Results:  Individuals with CG had significantly higher mean PSQI scores (10.9 versus 7.9, p = 0.003) than those without CG. Further, within the group of BD participants who had experienced a significant loss, those with CG had significantly poorer sleep (p = 0.01). CG remained significantly associated with greater sleep impairment after adjustment for comorbid anxiety disorder and bipolar mood state. This additive impairment in sleep with CG comorbidity was evident for four of the PSQI component scales: sleep quality, sleep duration, sleep efficiency and sleep disturbance.

Conclusions:  Our data indicate a significant association of CG with poor sleep in individuals with BD. Disturbed sleep may be a mechanism by which CG increases the burden of illness in BD.