{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T07:54:20Z","timestamp":1768895660759,"version":"3.49.0"},"posted":{"date-parts":[[2025,12,30]]},"group-title":"Psychiatry and Clinical Psychology","reference-count":51,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,12,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Adolescents with a parental history of bipolar disorder (BD; High-Risk) are more likely to develop BD than those without such history (Low-Risk). Actigraphy studies in adults indicate that instability in sleep and rest-activity rhythms (RAR) may be associated with progression to BD. However, it remains unclear whether High-and Low-Risk adolescents are differentially affected by sleep\/RAR instability and their impact on emerging mood symptoms.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We recruited 50 adolescents unaffected by BD (mean age[SD]=15.97[1.31], 58% female) stratified into High-Risk (N=22) and Low-Risk (N=28) groups. All participants completed two weeks of Baseline actigraphy; a subset of 11 High-Risk participants then completed a two-week sleep Stabilization Manipulation at home. Depression and mania rating scales were collected at Baseline and post-Manipulation. Covariates included age, sex at birth, total tracking days, and ratio of weekday to weekend tracking days; false-discovery rate correction was applied.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At Baseline, sleep\/RAR instability did not differ between High and Low-Risk groups (P-values&gt;0.05). Among High-Risk participants only, greater sleep duration variability was linked to higher levels of depressive (\u03b2[95%CI]=0.012[0.006,0.018]) and mania (\u03b2[95%CI]=0.011[0.003,0.019]) symptoms, and lower Circadian Function Index (CFI; composite measure of circadian activity robustness) was linked to greater mania symptoms (\u03b2[95%CI]=-8.236[-12.525,-3.940]). The Stabilization protocol reduced variability in sleep duration (P&lt;0.001), midsleep (P=0.005), and CFI (P=0.044) in High-Risk adolescents, and reduced subthreshold mania symptoms, but this did not survive multiple comparison correction.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These findings highlight that sleep\/RAR instability may have a stronger impact on mood in High-Risk adolescents but simple behavioral interventions stabilizing sleep and rhythms could buffer against BD risk.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2025.12.29.25342858","type":"posted-content","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T06:10:26Z","timestamp":1767161426000},"source":"Crossref","is-referenced-by-count":1,"title":["Unstable sleep and rest-activity rhythms in adolescents at-risk for bipolar disorder: links to mood symptoms and the effect of sleep stabilization"],"prefix":"10.64898","author":[{"given":"Jo\u00e3o Paulo","family":"Lima Santos","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy G.","family":"Hartman","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simey","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary L.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriane M.","family":"Soehner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026010206501136000_2025.12.29.25342858v1.1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-017-0780-z"},{"key":"2026010206501136000_2025.12.29.25342858v1.2","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1977.01770220111013"},{"key":"2026010206501136000_2025.12.29.25342858v1.3","unstructured":"Angold, A., Costello, E.J., Messer, S.C., Pickles, A., Winder, F., Silver, D., 1995. 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