Sleep quality in bipolar disorder: A comparative study of treatment with lithium and valproic acid

Table 1 Demographic and clinical characteristics of bipolar disorder patients treated with lithium or valproic acid, mean ± SD or n (%)

	All patients (n = 130)		t value	χ2	P value
	Lithium (n = 78)	Valproic acid (n = 52)
Age	46.46 ± 11.13	44.26 ± 10.10	1.140		0.256
Education level (years)	10.50 ± 4.49	11.21 ± 4.25	-0.904		0.368
Body mass index	29.27 ± 4.81	29.52 ± 5.16	-0.280		0.780
Duration of illness (years)	20.57 ± 8.94	19.40 ± 10.12	0.695		0.489
Total number of episodes	6.46 ± 3.82	8.80 ± 6.73	-2.526		0.013
Number of depressive episodes	3.00 ± 3.06	4.28 ± 4.36	-1.978		0.050
Age at the first episode	28.02 ± 20.30	25.28 ± 8.56	0.918		0.360
Sex				0.923	0.337
Male	32 (41.0)	17 (32.7)
Female	46 (59.0)	35 (67.3)
Marital status (not married)	26 (33.3)	24 (46.2)		2.167	0.141
Employment				0.475	0.491
No/irregular	51 (65.4)	37 (71.2)
Regular	27 (34.6)	15 (28.8)
Smoking				1.154	0.283
Yes	42 (53.8)	23 (44.2)
No	36 (46.2)	29 (55.8)
History of ECT (yes)	29 (37.2)	11 (21.2)		3.765	0.052
History of suicide attempt (yes)	22 (28.2)	13 (25.0)		0.163	0.686
History of self-mutilation (yes)	2 (2.6)	2 (3.8)		0.172	0.678
Family history of bipolar disease (yes)	27 (34.6)	20 (38.5)		0.200	0.655
Psychotic features during episodes (present)	60 (76.9)	38 (73.1)		0.249	0.618
Diagnosis				0.836	0.361
Bipolar I disorder	61 (78.2)	37 (71.2)
Bipolar II disorder	17 (21.8)	15 (28.8)

Student's t-test and χ² test were used, P < 0.05 was considered as statistically significant (bold values). ECT: Electroconvulsive therapy.

Table 2 Differences in sleep quality between lithium or valproic acid treated bipolar disorder patients, mean ± SD

All Patients (n = 113)	Lithium (n = 78)	Valproic acid (n = 52)	F	P value
Pittsburgh sleep quality index total	6.91 ± 3.54	8.13 ± 4.38	2.553	0.114
Subjective sleep quality	0.84 ± 0.56	1.07 ± 0.76	1.921	0.169
Sleep latency	1.57 ± 1.21	1.65 ± 1.18	0.240	0.625
Sleep duration	0.33 ± 0.67	0.53 ± 0.89	3.073	0.082
Habitual sleep efficiency	0.47 ± 0.65	0.78 ± 0.87	7.035	0.009
Sleep disturbances	1.26 ± 0.57	1.61 ± 0.84	8.084	0.005
Use of sleep medication	1.66 ± 1.48	1.53 ± 1.48	0.379	0.539
Daytime drowsiness	0.74 ± 1.02	0.92 ± 1.15	0.903	0.344

ANCOVA analyses were adjusted for covariates, with age and sex, body mass index included for most variables. P < 0.05 statistically significant (bold values).

Table 3 Characteristics of medication use in bipolar disorder patients, n (%)

Adjunctive antipsychotic medication	Lithium (n = 78)	Valproic acid (n = 52)	χ2	P value
None	30 (41.0)	18 (34.6)	9.721	0.205
Quetiapine	15 (19.2)	11 (21.2)
Olanzapine	16 (20.5)	4 (7.7)
Aripiprazole	11 (14.1)	7 (13.5)
Paliperidone	0 (0)	5 (9.6)
Risperidone	2 (2.6)	5 (9.6)
Clozapine	0 (0)	1 (1.9)
Amisulpride	1 (1.3)	0 (0)
Haloperidol	1 (1.3)	1 (1.9)

χ² test were used.

Table 4 Correlations between sleep quality and clinical variables in bipolar disorder patients

	Correlations	Duration of illness	Total number of episodes	Number of depressive episodes	Body Mass Index	Education levels	Age
Pittsburgh sleep quality index total	Pearson correlation	0.137	0.024	0.100	0.2911	-0.112	0.2751
	Sig. (2-tailed)	0.119	0.784	0.259	0.001	0.205	0.002

¹Correlation is significant at the 001 Level (2-tailed).