Meta-analysis Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies Geoffroy PA, Scott J, Boudebesse C, Lajnef M, Henry C, Leboyer M, Bellivier F, Etain B. Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies. Objective: Sleep dysregulation is highly prevalent in bipolar disorders (BDs), with previous actigraphic studies demonstrating sleep abnormalities during depressive, manic, and interepisode periods. We undertook a meta-analysis of published actigraphy studies to identify whether any abnormalities in the reported sleep profiles of remitted BD cases differ from controls. Method: A systematic review identified independent studies that were eligible for inclusion in a random effects meta-analysis. Effect sizes for actigraphy parameters were expressed as standardized mean differences (SMD) with 95% confidence intervals (95% CI). Results: Nine of 248 identified studies met eligibility criteria. Compared with controls (N = 210), remitted BD cases (N = 202) showed significant differences in SMD for sleep latency (0.51 [0.28–0.73]), sleep duration (0.57 [0.30–0.84]), wake after sleep onset (WASO) (0.28 [0.06– 0.50]) and sleep efficiency (À0.38 [À0.70–0.07]). Moderate heterogeneity was identified for sleep duration (I 2 = 44%) and sleep efficiency (I 2 = 44%). Post hoc meta-regression analyses demonstrated that larger SMD for sleep duration were identified for studies with a greater age difference between BD cases and controls (b = 0.22; P = 0.03) and non- significantly lower levels of residual depressive symptoms in BD cases (b = À0.13; P = 0.07). Conclusion: This meta-analysis of sleep in remitted bipolar disorder highlights disturbances in several sleep parameters. Future actigraphy studies should pay attention to age matching and levels of residual depressive symptoms. P. A. Geoffroy 1,2,3,4,5 , J. Scott 6,7 , C. Boudebesse 5,8,9 , M. Lajnef 9 , C. Henry 5,8,9,10 , M. Leboyer 5,8,9,10 , F. Bellivier 1,2,3,4,5 , B. Etain 5,8,9,10 1 Inserm, UMR-S 1144, Paris, France, 2 AP-HP, GH Saint- Louis - Lariboisi ere - Fernand Widal, P^ ole Neurosciences, Paris Cedex 10, 3 Universit e Paris Descartes, UMR-S 1144, Paris, 4 Universit e Paris Diderot, UMR-S 1144, Paris, 5 Fondation FondaMental, Cr eteil, France, 6 Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, 7 Centre for Affective Disorders, Institute of Psychiatry, London, UK, 8 AP-HP, H^ opital H. Mondor - A. Chenevier, DHU PePsy, P^ ole de Pstychiatrie, 9 INSERM, U955, Equipe Psychiatrie G en etique, and 10 Universit e Paris Est, Facult e de m edecine, Cr eteil, France Key words: bipolar disorders; actigraphy; euthymia; sleep; circadian rhythms Pierre Alexis Geoffroy, Service de Psychiatrie Adulte (Pr Bellivier), H^ opital Fernand Widal, 200, rue du Faubourg Saint-Denis, 75475 Paris Cedex 10, France. E-mail: pierre.a.geoffroy@gmail.com Accepted for publication October 21, 2014 Summations • This meta-analysis demonstrates that, compared with non-psychiatric controls, cases with bipolar disorders experience a range of sleep abnormalities during remission. • In clinical practice, systematic assessment of sleep quality in bipolar disorders is indicated even dur- ing remission, including monitoring of sleep latency, duration, efficiency and wake after sleep onset (WASO) using actigraphy when available or a subjective quality sleep measure such as the PSQI that incorporates these parameters in the generated subscores. • Methodological improvements for future actigraphy studies in bipolar disorder cases in remission should particularly include more careful matching for age and reliable assessment of any residual symptomatology. 89 Acta Psychiatr Scand 2015: 131: 89–99 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd All rights reserved DOI: 10.1111/acps.12367 ACTA PSYCHIATRICA SCANDINAVICA