{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:45:10Z","timestamp":1787013910075,"version":"build-2736575974"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,8,23]],"date-time":"2017-08-23T00:00:00Z","timestamp":1503446400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008321","name":"Pennsylvania State University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008321","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2018,2]]},"abstract":"\n Objective<\/jats:title>\n \n Chronic, low\u2010level inflammation is associated with symptomatic bipolar disorder (\n BD<\/jats:styled-content>\n ) and with chronic insomnia. Disrupted sleep is a feature of episodes of both mania and depression. We examined the effect of neopterin, a marker of cellular immune activation, and kynurenine (\n KYN<\/jats:styled-content>\n ), an inflammatory byproduct of the serotonin pathway, on the association between total sleep time and depression severity in\n BD<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n \n Twenty\u2010one symptomatic\n BD<\/jats:styled-content>\n participants and 28 healthy controls (\n HC<\/jats:styled-content>\n ) were recruited and followed during usual clinical care. At baseline and after symptomatic recovery, total sleep time was objectively measured with actigraphy for 1\u00a0week and blood plasma was collected to measure the serotonin precursor tryptophan (\n TRP<\/jats:styled-content>\n ),\n KYN<\/jats:styled-content>\n ,\n the KYN<\/jats:styled-content>\n \/\n TRP<\/jats:styled-content>\n ratio, and neopterin levels. Statistical analyses were conducted using chi\u2010square, independent\n t<\/jats:italic>\n tests and hierarchical linear multiple regression models.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Total sleep time was correlated positively with depressive severity and negatively with manic severity.\n TRP<\/jats:styled-content>\n was significantly reduced in\n BD<\/jats:styled-content>\n participants compared to\n HC<\/jats:styled-content>\n .\n KYN<\/jats:styled-content>\n ,\n TRP<\/jats:styled-content>\n , and the\n KYN<\/jats:styled-content>\n \/\n TRP<\/jats:styled-content>\n ratio were associated with depressive severity when total sleep time and body mass index (\n BMI)<\/jats:styled-content>\n were included in the model. The\n KYN<\/jats:styled-content>\n \/\n TRP<\/jats:styled-content>\n ratio trended towards a negative association with mania symptoms, controlling for\n BMI<\/jats:styled-content>\n and total sleep time, in acutely symptomatic\n BD<\/jats:styled-content>\n participants. Neopterin was not associated with sleep or mood severity. After usual clinical care,\n BD<\/jats:styled-content>\n participants showed significantly decreased clinical symptoms but no significant differences in sleep phenotype or biomarkers.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Inflammation, sleep, and mood are closely intertwined. Future research into the effect of inflammation on sleep in\n BD<\/jats:styled-content>\n may lead to clinical markers of outcome.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bdi.12529","type":"journal-article","created":{"date-parts":[[2017,8,23]],"date-time":"2017-08-23T08:22:58Z","timestamp":1503476578000},"page":"27-34","source":"Crossref","is-referenced-by-count":46,"title":["Total sleep time and kynurenine metabolism associated with mood symptom severity in bipolar disorder"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1007-2094","authenticated-orcid":false,"given":"Dahlia","family":"Mukherjee","sequence":"first","affiliation":[{"name":"Department of Psychiatry Penn State Milton S Hershey Medical Center Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesh Bassapa","family":"Krishnamurthy","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Penn State Milton S Hershey Medical Center Hershey PA USA"},{"name":"Sleep Research and Treatment Center Penn State Milton S Hershey Medical Center Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin E.","family":"Millett","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Penn State Milton S Hershey Medical Center Hershey PA USA"},{"name":"Department of Neural and Behavioral Sciences Penn State University Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aubrey","family":"Reider","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Penn State Milton S Hershey Medical Center Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adem","family":"Can","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Groer","sequence":"additional","affiliation":[{"name":"University of South Florida School of Nursing Tampa FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Innsbruck Medical University Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodor T","family":"Postolache","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine Baltimore MD USA"},{"name":"Rocky Mountain MIRECC (Mental Illness Research Education and Clinical Center) Denver CO USA"},{"name":"The Military and Veteran Microbiome Consortium for Research and Education (MVM\u2010Core) Denver CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika F. 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