Elsevier

L'Encéphale

Volume 40, Supplement 3, December 2014, Pages S40-S45
L'Encéphale

Les anomalies du sommeil peuvent-elles participer au risque cardio-vasculaire des troubles bipolaires ?Do sleep abnormalities contribute to cardiovascular risk in bipolar disorders?

https://doi.org/10.1016/S0013-7006(14)70130-7Get rights and content

Résumé

Les patients souffrant de troubles bipolaires (TB) présentent cinq fois plus de risque de maladies cardiovasculaires que des sujets sans TB. Le syndrome métabolique est un facteur qui augmente significativement le risque de développer une maladie cardiovasculaire chez ces patients. Deux autres facteurs importants, mais néanmoins moins reconnus en pratique clinique, augmentent également le risque de maladie cardiovasculaire. Il s’agit des troubles de la réactivité émotionnelle et des pathologies du sommeil, avec en particulier le syndrome d’apnée obstructive du sommeil (SAOS). En effet, l’hyperréactivité émotionnelle semble favorisée par certains tempéraments dits « colériques », le TB et la privation de sommeil. Il est démontré que l’ensemble de ces variables interagissent et conduisent à une augmentation du risque cardiovasculaire. Par ailleurs, le SAOS est une pathologie du sommeil très fortement associée au TB, qui tend à fragmenter le sommeil et qui est également associée à un risque cardiovasculaire plus élevé. La synthèse de ces données souligne ainsi la place centrale des anomalies du sommeil et de la réactivité émotionnelle dans la vulnérabilité du TB aux maladies cardio-vasculaires. Ces données permettent également de rappeler l’importance d’identifier et de prendre en charge les anomalies du sommeil dans le TB, afin d’améliorer la morbidité et la mortalité de ce trouble.

Summary

Objectives

The aim of this review is to summarize the state of knowledge concerning the relationship between cardiovascular risk, sleep abnormalities, and emotional reactivity in patients with bipolar disorder (BD).

Method

A scientific literature search of international articles was performed during August and September 2014 using the PubMed electronic database. We used the following MeSH terms : “Bipolar Disorders”, “Cardiovascular risk”, “Emotional reactivity”, “Sleep apnea”, and “Sleep disorder”.

Results

Obstructive sleep apnea (OSA) is a sleep disorder strongly associated with BD, which tends to fragment sleep. OSA is associated with an increased cardiovascular risk.

Furthermore, emotional hyper-reactivity is favored by “hostility” temperaments, BD and sleep deprivation. The combination of these factors interacts and also results in an increased cardiovascular risk. Taken as a whole, both sleep disorders and emotional hyper-reactivity seem to increase the risk of cardiovascular diseases in BD.

Conclusion

These data emphasize the central role of sleep abnormalities and emotional reactivity in the vulnerability of BD to express cardiovascular diseases. From a clinical point of view, these data also emphasize the importance of identifying and care for sleep abnormalities in BD in order to improve BD outcome.

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