Sleep-related breathing disorders and cardiovascular risk profiles in adolescents with bipolar disorder: a correlation analysis stratified by overweight/obesity status

doi:10.3877/cma.j.issn.1674-0785.2025.11.007

Abstract

Abstract:

Objective

To examine the effects of overweight/obesity on sleep-related breathing disorders, cardiovascular risk characteristics, and their interrelationships in adolescents with bipolar disorder (BD).

Methods

A cross-sectional study was conducted on 44 BD patients aged 12–18 years from the People's Hospital of Xinjiang Uygur Autonomous Region between June 2024 to June 2025. According to the Chinese screening standard for overweight and obesity in school-age children and adolescents, the patients were divided into an overweight/obesity BD group (n=23) and a normal-weight BD group (n=21). Demographic data, clinical course, and objective sleep parameters were collected via overnight polysomnography (PSG). Cardiovascular indicators were measured simultaneously. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression and Pearson and Spearman correlation analyses were employed to examine the related factors.

Results

The overweight/obesity group had a longer disease duration, higher systolic blood pressure (SBP), lower sleep efficiency (SE), and significantly higher obstructive apnea-hypopnea index (OAHI) and subjective sleep quality scores compared to the normal-weight group (all P＜0.05). Logistic regression analysis indicated that SE (OR=0.867, 95%CI: 0.765~0.982), OAHI (OR=1.374, 95%CI: 1.017~1.858), SBP (OR=1.190, 95%CI: 1.066~1.328), and PSQI sleep quality score (OR=2.280, 95%CI: 1.041~4.994) were influencing factors for overweight/obesity status. Multivariate analysis further confirmed that SE (OR=0.826, 95%CI: 0.699~0.976, P=0.025) and SBP (OR=1.254, 95%CI: 1.075~1.461, P=0.004) were independent predictors of overweight/obesity status. Correlation analysis revealed that BMI was negatively correlated with SE (r=−0.334, P=0.027) and positively correlated with OAHI (ρ=0.436, P=0.003) and SBP (r =0.467, P＜0.01).

Conclusion

Overweight/obese adolescents with BD exhibit more severe sleep-related breathing disorders and cardiovascular risks. Sleep efficiency and SBP are independent predictors of overweight/obesity status. Comprehensive management of body weight, sleep, and blood pressure should be emphasized in clinical practice to improve patient prognosis.

Key words: Bipolar disorder, Adolescents, Overweight/obesity, Obstructive sleep apnea, Cardiovascular risk factors, Correlation analysis

Yuxin Xiao, Gaiyu Tong, Shaohong Zou. Sleep-related breathing disorders and cardiovascular risk profiles in adolescents with bipolar disorder: a correlation analysis stratified by overweight/obesity status[J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(11): 839-847.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2025.11.007

https://zhlcyszz.cma-cmc.com.cn/EN/Y2025/V19/I11/839

Figures/Tables 5

项目分组	BD体重正常组（n=21）	BD超重/肥胖组（n=23）	统计值	P值
人口学资料
年龄（岁， $x ¯$ ±s）	15.8±2.5	16.4±1.7	t=-0.977	0.334
性别[例（%）]			χ²=1.634	0.287
男性	3（14.3）	7（30.4）
女性	18（85.7）	16（69.6）
民族[例（%）]			χ²=1.392	0.503
汉族	4（19.0）	8（34.8）
维吾尔族	10（47.6）	9（39.1）
其他民族	7（33.3）	6（26.1）
受教育年限[年，M（Q₁，Q₃）]	10（8，12）	11（9，12）	U=197.500	0.292
临床特征
病程[月，M（Q₁，Q₃）]	12（6，24）	24（12，48）	U=139.000	0.015
BMI（ $x ¯$ ±s）	20.31±1.59	28.29±3.72	t=12.917	＜0.001
PSG
TST（ $x ¯$ ±s）	453.24±48.25	427.26±68.45	t=-1.442	0.157
SE [M（Q₁，Q₃）]	87.90（84.80，91.00）	83.90（78.80，87.90）	U=134.500	0.012
SL [M（Q₁，Q₃）]	18.50（7.00，36.00）	30.00（11.00，46.50）	U=187.500	0.204
WASO [M（Q₁，Q₃）]	35.50（29.50，50.00）	41.00（24.00，85.00）	U=199.500	0.324
N1期[M（Q₁，Q₃）]	5.00（3.00，6.40）	4.90（3.60，8.90）	U=213.000	0.503
N2期（ $x ¯$ ±s）	67.01±8.61	65.60±7.82	t=-0.569	0.572
N3期（ $x ¯$ ±s）	13.37±5.48	13.33±6.00	t=-0.024	0.981
REM期（ $x ¯$ ±s）	15.03±5.57	14.63±5.91	t=-0.229	0.820
RL [M（Q₁，Q₃）]	196.50（96.00，271.50）	148.50（93.50，236.00）	U=217.000	0.565
Min SpO₂ [M（Q₁，Q₃）]	90.00（89.00，91.00）	89.00（85.00，90.00）	U=191.500	0.233
呼吸暂停[M（Q₁，Q₃）]	2（0，8）	8（1，11）	U=170.000	0.091
低通气[M（Q₁，Q₃）]	0（0，11）	14（1，35）	U=149.500	0.027
OAHI [M（Q₁，Q₃）]	1.50（0.15，2.55）	3.40（0.30，9.90）	U=149.000	0.029
心血管指标
Mean HR（ $x ¯$ ±s）	74.0±10.0	75.0±11.0	t=0.144	0.887
Max HR [M（Q₁，Q₃）]	94（90，105）	104（96，110）	U=158.500	0.051
Min HR [M（Q₁，Q₃）]	58（50，64）	58（46，64）	U=214.500	0.525
SBP（ $x ¯$ ±s）	108.0±9.0	118.0±6.0	t=4.411	＜0.001
DBP [M（Q₁，Q₃）]	68（64，74）	74（70，77）	U=158.000	0.050
匹兹堡睡眠量表
睡眠质量[M（Q₁，Q₃）]	2（2，2）	3（2，3）	U=154.000	0.028
入睡时间[M（Q₁，Q₃）]	3（2，3）	3（2，3）	U=226.000	0.664
睡眠时间[M（Q₁，Q₃）]	1（0，2）	1（0，2）	U=218.000	0.567
主观睡眠效率[M（Q₁，Q₃）]	3（2，3）	3（1，3）	U=214.500	0.459
睡眠障碍[M（Q₁，Q₃）]	2（2，2）	2（2，3）	U=217.500	0.536
催眠药物[M（Q₁，Q₃）]	2（0，3）	2（0，3）	U=227.500	0.726
日间功能障碍[M（Q₁，Q₃）]	3（3，3）	3（3，3）	U=224.000	0.518
总分	14.0±3.0	15.0±4.0	t=0.724	0.473

项目分组	BD体重正常组（n=21）	BD超重/肥胖组（n=23）	统计值	P值
人口学资料
年龄（岁， $x ¯$ ±s）	15.8±2.5	16.4±1.7	t=-0.977	0.334
性别[例（%）]			χ²=1.634	0.287
男性	3（14.3）	7（30.4）
女性	18（85.7）	16（69.6）
民族[例（%）]			χ²=1.392	0.503
汉族	4（19.0）	8（34.8）
维吾尔族	10（47.6）	9（39.1）
其他民族	7（33.3）	6（26.1）
受教育年限[年，M（Q₁，Q₃）]	10（8，12）	11（9，12）	U=197.500	0.292
临床特征
病程[月，M（Q₁，Q₃）]	12（6，24）	24（12，48）	U=139.000	0.015
BMI（ $x ¯$ ±s）	20.31±1.59	28.29±3.72	t=12.917	＜0.001
PSG
TST（ $x ¯$ ±s）	453.24±48.25	427.26±68.45	t=-1.442	0.157
SE [M（Q₁，Q₃）]	87.90（84.80，91.00）	83.90（78.80，87.90）	U=134.500	0.012
SL [M（Q₁，Q₃）]	18.50（7.00，36.00）	30.00（11.00，46.50）	U=187.500	0.204
WASO [M（Q₁，Q₃）]	35.50（29.50，50.00）	41.00（24.00，85.00）	U=199.500	0.324
N1期[M（Q₁，Q₃）]	5.00（3.00，6.40）	4.90（3.60，8.90）	U=213.000	0.503
N2期（ $x ¯$ ±s）	67.01±8.61	65.60±7.82	t=-0.569	0.572
N3期（ $x ¯$ ±s）	13.37±5.48	13.33±6.00	t=-0.024	0.981
REM期（ $x ¯$ ±s）	15.03±5.57	14.63±5.91	t=-0.229	0.820
RL [M（Q₁，Q₃）]	196.50（96.00，271.50）	148.50（93.50，236.00）	U=217.000	0.565
Min SpO₂ [M（Q₁，Q₃）]	90.00（89.00，91.00）	89.00（85.00，90.00）	U=191.500	0.233
呼吸暂停[M（Q₁，Q₃）]	2（0，8）	8（1，11）	U=170.000	0.091
低通气[M（Q₁，Q₃）]	0（0，11）	14（1，35）	U=149.500	0.027
OAHI [M（Q₁，Q₃）]	1.50（0.15，2.55）	3.40（0.30，9.90）	U=149.000	0.029
心血管指标
Mean HR（ $x ¯$ ±s）	74.0±10.0	75.0±11.0	t=0.144	0.887
Max HR [M（Q₁，Q₃）]	94（90，105）	104（96，110）	U=158.500	0.051
Min HR [M（Q₁，Q₃）]	58（50，64）	58（46，64）	U=214.500	0.525
SBP（ $x ¯$ ±s）	108.0±9.0	118.0±6.0	t=4.411	＜0.001
DBP [M（Q₁，Q₃）]	68（64，74）	74（70，77）	U=158.000	0.050
匹兹堡睡眠量表
睡眠质量[M（Q₁，Q₃）]	2（2，2）	3（2，3）	U=154.000	0.028
入睡时间[M（Q₁，Q₃）]	3（2，3）	3（2，3）	U=226.000	0.664
睡眠时间[M（Q₁，Q₃）]	1（0，2）	1（0，2）	U=218.000	0.567
主观睡眠效率[M（Q₁，Q₃）]	3（2，3）	3（1，3）	U=214.500	0.459
睡眠障碍[M（Q₁，Q₃）]	2（2，2）	2（2，3）	U=217.500	0.536
催眠药物[M（Q₁，Q₃）]	2（0，3）	2（0，3）	U=227.500	0.726
日间功能障碍[M（Q₁，Q₃）]	3（3，3）	3（3，3）	U=224.000	0.518
总分	14.0±3.0	15.0±4.0	t=0.724	0.473

项目	BD体重正常组（n=21）	BD超重/肥胖组（n=23）	χ²值	P值
诊断OSA
无OSA	9（42.9）	7（30.4）	0.732	0.392
有OSA	12（57.1）	16（69.6）

变量	β	标准误	Wald χ²	P值	OR（95%CI）
单因素Logistic回归分析
病程（月）	0.025	0.015	2.709	0.100	1.025（0.995~1.056）
SE（%）	-0.143	0.064	5.024	0.025	0.867（0.765~0.982）
OAHI（次/h）	0.318	0.154	4.276	0.039	1.374（1.017~1.858）
SBP（mmHg）	0.174	0.056	9.593	0.002	1.190（1.066~1.328）
睡眠质量评分	0.824	0.400	4.246	0.039	2.280（1.041~4.994）
多因素Logistic回归分析
SE	-0.191	0.085	5.019	0.025	0.826（0.699~0.976）
SBP	0.226	0.078	8.351	0.004	1.254（1.075~1.461）
睡眠质量评分	1.163	0.644	3.261	0.071	3.200（0.906~11.306）

变量	年龄	TST	BMI	N2期	N3期	REM期	Mean HR	SBP
年龄
TST	0.006
BMI	.202	-0.323^*
N2期	0.175	0.215	-0.152
N3期	-0.474^**	0.013	0.054	-0.576^**
REM期	-0.066	-0.066	-0.105	-0.656^**	-0.027
Mean HR	-0.289	0.329^*	.009	-0.021	0.305^*	-0.141
SBP	-0.055	-0.107	0.467^**	-0.168	0.110	-0.070	0.121
总分	0.204	-0.041	0.132	0.028	0.033	-0.252	-0.070	0.029

变量	BMI	病程	N1期	低通气	OAHI	呼吸暂停	Min SpO₂	睡眠障碍
BMI
病程	0.366^*
SE	-0.334^*	-0.453^**
低通气	0.435^**		0.632^**
OAHI	0.436^**	0.340^*	0.542^**	0.907^**
呼吸暂停					0.615^**
Min SpO₂				-0.557^**
Max HR	0.310^*					0.354^*
睡眠障碍				0.308^*			-0.409^**
总分								0.495^**

References 32

1	Nierenberg AA, Agustini B, Köhler-Forsberg O, et al. Diagnosis and treatment of bipolar disorder: A review [J]. JAMA, 2023, 330(14): 1370-1380.
2	Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative [J]. Arch Gen Psychiatry, 2011, 68(3): 241-51.
3	Lai J, Li S, Wei C, et al. Mapping the global, regional and national burden of bipolar disorder from 1990 to 2019: trend analysis on the Global Burden of Disease Study 2019 [J]. Br J Psychiatry, 2024, 224(2): 36-46.
4	McGrath JJ, Al-Hamzawi A, Alonso J, WHO World Mental Health Survey Collaborators, et al. Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries [J]. Lancet Psychiatry, 2023, 10(9): 668-681.
5	Luciano M, Di Vincenzo M, Mancuso E, et al. Does the brain matter? Cortical alterations in pediatric bipolar disorder: A critical review of structural and functional magnetic resonance studies [J]. Curr Neuropharmacol, 2023, 21(6): 1302-1318.
6	NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults [J]. Lancet, 2024, 403(10431): 1027-1050.
7	中国居民营养与慢性病状况报告(2020年) [J]. 营养学报, 2020, 42(6): 521.
8	Kambey PA, Kodzo LD, Serojane F, et al. The bi-directional association between bipolar disorder and obesity: Evidence from Meta and bioinformatics analysis [J]. Int J Obes (Lond), 2023, 47(6): 443-452.
9	Yi W, Wu H, Li R, et al. Prevalence and associated factors of obesity and overweight in Chinese patients with bipolar disorder [J]. Front Psychiatry, 2022, 13: 984829.
10	Girela-Serrano BM, Guerrero-Jiménez M, Spiers ADV, et al. Obesity and overweight among children and adolescents with bipolar disorder from the general population: A review of the scientific literature and a meta-analysis [J]. Early Interv Psychiatry, 2022, 16(2): 113-125.
11	Morton E, Murray G. Assessment and treatment of sleep problems in bipolar disorder-A guide for psychologists and clinically focused review [J/OL]. Clin Psychol Psychother, 2020, 27(3): 364-377.
12	向婷. 青少年双相抑郁障碍患者的多导睡眠监测研究 [D]. 广州: 暨南大学, 2020.
13	Kawada T. Sleep and body mass index in patients with bipolar disorder [J]. Eur Psychiatry, 2014, 29(8): 528.
14	Chen TY, Hsieh TY, Wang YH, et al. Association between obstructive sleep apnea and migraine: A United States population‐based cohort study [J/OL]. Headache, 2025, 65(4): 608-618.
15	Liu P, Yang X, Li GC. Transcriptomic and polysomnographic insights into core signaling pathways in obstructive sleep apnea [J/OL]. Mediators Inflamm, 2025, 2025(1): 4579543.
16	Fürtjes AE, Coleman JRI, Tyrrell J, et al. Associations and limited shared genetic aetiology between bipolar disorder and cardiometabolic traits in the UK Biobank [J/OL]. Psychol Med, 2022, 52(16): 4039-4048.
17	Kartiosuo N, Raitakari OT, Juonala M, et al. Cardiovascular risk factors in childhood and adulthood and cardiovascular disease in middle age [J/OL]. JAMA Netw Open, 2024, 7(6): e2418148.
18	Kennedy KG, Grigorian A, Mitchell RHB, et al. Association of blood pressure with brain structure in youth with and without bipolar disorder[J/OL]. J Affect Disord, 2022, 15, 299: 666-674.
19	倪鑫. 中国儿童阻塞性睡眠呼吸暂停诊断与治疗指南(2020) [J]. 中国循证医学杂志, 2020, 20(8): 883-900.
20	Barton J, Mio M, Timmins V, et al. Factors associated with sleep disturbance among youth with bipolar disorder [J/OL]. J Can Acad Child Adolesc Psychiatry, 2022, 31(4): 165-175.
21	Manchia M. The relevance of body mass index in bipolar disorder [J/OL]. Am J Psychiatry, 2024, 181(1): 4-6.
22	Zaffanello M, Pietrobelli A, Piacentini G, et al. Mapping the fat: How childhood obesity and body composition shape obstructive sleep apnoea [J/OL]. Children, 2025, 12(7): 912.
23	Lo Bue A, Salvaggio A, Insalaco G. Obstructive sleep apnea in developmental age. A narrative review [J/OL]. Eur J Pediatr, 2020, 179(3): 357-365.
24	Zhu F, Cui C, Gu K. Prevalence and predictors of obstructive sleep apnea in patients with bipolar disorder: A systematic review and meta-analysis [J/OL]. Pak J Med Sci, 2024, 41(1): 302-311.
25	Caliendo C, Femiano R, Umano GR, et al. Effect of obesity on the respiratory parameters in children with obstructive sleep apnea syndrome [J/OL]. Children, 2023, 10(12): 1874.
26	Munkhjargal O, Oka Y, Tanno S, et al. Discrepancy between subjective and objective sleepiness in adolescents [J/OL]. Sleep Med, 2022, 96: 1-7.
27	Kashaninasab F, Khoozan M, Ghalebandi MF, et al. Comparison of subjective and objective sleep quality in patients with obstructive sleep apnea syndrome [J/OL]. Brain Behav, 2025, 15(8): e70759.
28	Wheaton AG, Claussen AH. Short sleep duration among infants, children, and adolescents aged 4 months-17 years-united states, 2016-2018 [J/OL]. MMWR Morb Mortal Wkly Rep, 2021, 70(38): 1315-1321.
29	Oakes DJ, Pearce HA, Roberts C, et al. Associations between comorbid anxiety and sleep disturbance inpeople with bipolar disorder: Findings from actigraphy and subjective sleep measures [J/OL]. J Affect Disord, 2022, 309: 165-171.
30	Dobbin ML, Bernard A, Pyle L, et al. Comparison of WatchPAT to polysomnography measurement of apnea-hypopnea index and obstructive sleep apnea severity in adolescents with overweight and obesity [J/OL]. J Clin Sleep Med, 2025, 21(4): 695-702.
31	Tran AH, Walsh A, Urbina EM. Hypertension, obesity, and target organ injury in children: An emerging health care crisis [J/OL]. Curr Hypertens Rep, 2025, 27(1): 12.
32	Chhabria SM, LeBron J, Ronis SD, et al. Diagnosis and management of hypertension in adolescents with obesity [J/OL]. Curr Cardiovasc Risk Rep, 2024, 18(8-9): 115-124.

[1]	Yunda Huang, Qi Zhou, Donghui He, Minfang Huang. Advance in comparative analysis of upper airway flow field in obstructive sleep apnea patients before and after treatment based on computational fluid dynamics [J]. Chinese Journal of Stomatological Research(Electronic Edition), 2025, 19(02): 139-144.
[2]	Duo Li, Zhaozhao Hao, Yanwei Chen, Yandong Nan. Correlation analysis of serum PTX3 expression and bone metastasis in non-small cell lung cancer [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(04): 558-562.
[3]	Xiaoyi Chen, Xuexia Yin, Jing Liu, Guosong Wu. Risk factors and predictive analysis of obstructive sleep apnea-hypopnea syndrome complicated with pulmonary hypertension [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(01): 41-45.
[4]	Ningning Zhang, Jingyu Mu, Xiaoling Ma, Xiaolong Li, Yan Wang, Yong Zhao. Research status of fundus characteristics in children and adolescents with high myopia [J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(04): 252-256.
[5]	Yan Chen, Jue Chen. Psychosomatic disorders in children and adolescents: a practical guide under the ICD-11 CCDR framework [J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(11): 818-822.
[6]	Su Hong, Li Kuang. Mood disorders in children and adolescents: a practical guide under the ICD-11 CDDR framework [J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(11): 814-817.
[7]	Taipeng Sun, Yonggui Yuan. Current status and future prospects of mental health services for children and adolescents [J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(11): 805-808.
[8]	Jianxing Gao, Jingjing Ma, Jie Xia, Xiaoyan Ke, Hui Fang. Clinical characteristics of first-episode depression and factors associated with non-suicidal self-injury in children and adolescents [J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(09): 633-641.
[9]	Ying Wang, Yanyan Yang, Wenxiao Niu, Mengfan Li, Jinbiao Zhang. Relationship between nonpositional obstructive sleep apnea and cognitive impairment [J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(02): 108-116.
[10]	HeYan Gong, Jun Dai, Huiming Yang, Shuo Li, Min Xu, Hongmao Song, De Huai. Value of VEGF and IL-6 in diagnosis and surgical treatment of patients with obstructive sleep apneahypopnea syndrome [J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(11): 1000-1006.
[11]	Ke Zhang, Zhanqi Yang, Wei Yan, Erming Zhang, Pingchao Xiang. Effect of continuous positive airway pressure on occurrence of cardiovascular and cerebrovascular events in patients with obstructive sleep apnea syndrome [J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(05): 433-440.
[12]	Jie Chen, Yi Bai, Jinbo Liu, Huan Liu, Na Zhao, Hongwei Zhao, Hongyu Wang. Correlation between neutrophil/high-density lipoprotein ratio and lower extremity arterial disease in middle-aged and elderly people [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 402-408.
[13]	Zhenzhen Wang, Shuliang Pan, Mengting Jia, Li Zhang, Shichang Yang. Analysis of glycometabolic characteristics and influencing factors in patients with bipolar disorder comorbid with type 2 diabetes mellitus [J]. Chinese Journal of Diagnostics(Electronic Edition), 2025, 13(02): 111-116.
[14]	Lian Yang, Zheng Luo, Jiao Gong. Effect of obstructive sleep apnea hypopnea syndrome on the progression of diabetic retinopathy in elderly patients [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(03): 33-36.
[15]	Yan Zang, Hongxia Hua, Kang Zhao, Hui Liang, Ningli Yang. The application of peer education combined with family rehabilitation guidance among adolescent patients after bariatric and metabolic surgery [J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2024, 10(01): 40-44.

Please choose a citation manager

Content to export