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Original research
Daily self-reported and automatically generated smartphone-based sleep measurements in patients with newly diagnosed bipolar disorder, unaffected first-degree relatives and healthy control individuals
  1. Sharleny Stanislaus1,2,
  2. Maj Vinberg1,
  3. Sigurd Melbye1,2,
  4. Mads Frost3,
  5. Jonas Busk4,
  6. Jakob Eyvind Bardram4,
  7. Maria Faurholt-Jepsen1,
  8. Lars Vedel Kessing1,2
  1. 1 Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
  2. 2 Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  3. 3 Monsenso Aps, Copenhagen, Denmark
  4. 4 Copenhagen Center for Health Technology (CACHET), Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
  1. Correspondence to Dr Sharleny Stanislaus, Rigshospitalet, Psychiatric Center Copenhagen, Copenhagen 2100, Denmark; sharleny.stanislaus.01{at}


Objectives (1) To investigate daily smartphone-based self-reported and automatically generated sleep measurements, respectively, against validated rating scales; (2) to investigate if daily smartphone-based self-reported sleep measurements reflected automatically generated sleep measurements and (3) to investigate the differences in smartphone-based sleep measurements between patients with bipolar disorder (BD), unaffected first-degree relatives (UR) and healthy control individuals (HC).

Methods We included 203 patients with BD, 54 UR and 109 HC in this study. To investigate whether smartphone-based sleep calculated from self-reported bedtime, wake-up time and screen on/off time reflected validated rating scales, we used the Pittsburgh Sleep Quality Index (PSQI) and sleep items on the Hamilton Depression Rating Scale 17-item (HAMD-17) and the Young Mania Rating Scale (YMRS).

Findings (1) Self-reported smartphone-based sleep was associated with the PSQI and sleep items of the HAMD and the YMRS. (2) Automatically generated smartphone-based sleep measurements were associated with daily self-reports of hours slept between 12:00 midnight and 06:00. (3) According to smartphone-based sleep, patients with BD slept less between 12:00 midnight and 06:00, with more interruption and daily variability compared with HC. However, differences in automatically generated smartphone-based sleep were not statistically significant.

Conclusion Smartphone-based data may represent measurements of sleep patterns that discriminate between patients with BD and HC and potentially between UR and HC.

Clinical implication Detecting sleep disturbances and daily variability in sleep duration using smartphones may be helpful for both patients and clinicians for monitoring illness activity.

Trial registration number (NCT02888262).

  • adult psychiatry
  • depression & mood disorders

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  • Contributors LVK and MF-J conceived the study. LVK obtained the required funding for the study and wrote the study protocol. LVK, MF-J, MV, JEB and MF were involved in optimising the study protocol. SS, SM and MV have been responsible for the recruitment of participants and have carried out the assessment and data collection. MF, JB and SS have been responsible for data processing. Data analysis was done by SS and MF-J and supervised by LVK. Interpretation of the data has been done by SS under the supervision of LVK and MF-J. All authors have read, contributed to and approved the final version of the manuscript. MF-J and LVK share last authorship.

  • Funding The study was funded by grants from the Mental Health Services, Capital Region of Denmark, The Danish Council for Independent Research, Medical Sciences (DFF-4183-00570), Weimans Fund, Markedmodningsfonden (the Market Development Fund) (2015-310), Gangstedfonden (A29594), Helsefonden (16-B-0063), Innovation Fund Denmark (5164-00001B), Copenhagen Center for Health Technology (CACHET), EU H2020 ITN (EU Project 722561), Augustinusfonden (16-0083), Lundbeck Foundation (R215-2015-4121).

  • Competing interests LVK and MV has been a consultant for Lundbeck within recent 3 years. JEB and MF are co-founders and shareholders of Monsenso ApS.

  • Patient consent for publication Not required.

  • Ethics approval The Bipolar Illness Onset (BIO) study has been approved by the ethics committee in the Capital Region, Copenhagen, Denmark (Ref. No. H-7-2014-007) and the Danish Data Protection Agency, Capital Region of Copenhagen (Protocol No. RHP-2015-023). The study was conducted in accordance with the Declaration of Helsinki and all participants provided written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The study is ongoing. Therefore, the research data are not shared.