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Sleep spindles have been linked to cognitive ability in healthy populations and psychotic disorders. While there is preliminary evidence for altered spindle activity in BD, research directly examining the association between sleep spindle parameters and cognitive performance in this population is lacking. Therefore, our primary objective was to examine the association between fast spindle density and episodic memory performance in euthymic individuals with BD. As exploratory analyses, we looked at associations between fast and slow spindle density and subjective sleep quality with other cognitive domains. We also conducted a sensitivity analysis, separating all analyses by lithium intake. Thirty-four euthymic participants with BD underwent comprehensive cognitive assessments and were assessed for three consecutive nights using mobile sleep-EEG headbands. Sleep spindles were detected using validated, adapted algorithms and characterised by fast and slow spindle density. Fast spindle density was not associated with episodic memory performance (\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u2009\u22120.004,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.491, 95% CI [\u22120.353, 0.499]) but did show a significant positive association with working memory (\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u20090.423,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.014, 95% CI (bootstrapped) [\u22120.167, 0.722]). When removing participants taking lithium, several positive associations emerged between fast spindle density and cognitive performance. These findings suggest domain-specific relationships between sleep spindle activity and cognition in BD, with fast spindles potentially being associated with working memory. Preliminary evidence for lithium-related modulation highlights the importance of considering pharmacological factors. However, the analyses were underpowered, and large-scale studies are needed to deepen our understanding of sleep spindle-cognition relationships in BD.\n                  <\/jats:p>","DOI":"10.1038\/s41398-026-04273-2","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:34:07Z","timestamp":1784050447000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The association between sleep spindles and cognitive performance in euthymic bipolar disorder"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9835-0900","authenticated-orcid":false,"given":"Anna","family":"Tr\u00f6ger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1986-3263","authenticated-orcid":false,"given":"Jules","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimosthenis","family":"Tsapekos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1150-8080","authenticated-orcid":false,"given":"Stephan","family":"Bialonski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3774-5418","authenticated-orcid":false,"given":"Niklas","family":"Grieger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3029-9149","authenticated-orcid":false,"given":"Michail","family":"Kalfas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Frending","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Hartland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Kuivaniemi-Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan H.","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4286-5830","authenticated-orcid":false,"given":"Philipp","family":"Ritter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2984-1124","authenticated-orcid":false,"given":"Rebecca","family":"Strawbridge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"4273_CR1","doi-asserted-by":"publisher","first-page":"1841","DOI":"10.1016\/S0140-6736(20)31544-0","volume":"396","author":"RS McIntyre","year":"2020","unstructured":"McIntyre RS, Berk M, Brietzke E, Goldstein BI, L\u00f3pez-Jaramillo C, Kessing LV, et al. 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A.H.Y. reports paid lectures and advisory board membership for the following companies, in regard to drugs used in affective and related disorders: AstraZeneca, Eli Lilly, Lundbeck, Sunovion, Servier, LivaNova, Allegan, Bionomics, Sumitomo, Dainippon Pharma and Janssen; consultancy to Johnson & Johnson and LivaNova; principal investigator on the Restore-Life VNS registry study funded by LivaNova, and on ESKETINTRD3004 funded by Janssen. RS has received honoraria for educational lectures from Janssen.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The study was reviewed and approved by the London \u2013 Bromley research ethics committee (REC) in Spring 2022 (22\/LO\/0210) and was conducted in accordance with the declaration of Helsinki. All participants gave informed consent prior to participation.","order":2,"name":"Ethics","label":"Ethics declaration","group":{"name":"EthicsHeading","label":"Ethics"}}],"article-number":"434"}}