Gu Eon Kang1, Michelle A Patriquin2, Hung Nguyen1, Hyuntaek Oh3, Katrina A Rufino4, Eric A Storch5, Bella Schanzer5, Sanjay J Mathew2, Ramiro Salas2, Bijan Najafi6. 1. Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States. 2. The Menninger Clinic, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States. 3. The Menninger Clinic, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States. 4. The Menninger Clinic, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States; Department of Social Sciences, University of Houston Downtown, Houston, TX, United States. 5. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States. 6. Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States. Electronic address: bijan.najafi@bcm.edu.
Abstract
BACKGROUND: Emerging literature suggests that the arousal and regulatory systems as measured by sleep-wakefulness, heart rate (HR) and heart rate variability (HRV) may be powerful objective warning signs of suicidality. However, there is no systematic literature review examining the association between objective measurements of these variables with suicide and suicidal behavior. METHODS: A web-based, systematic literature search using PubMed and EMBASE was conducted for articles that measured sleep-wakefulness and HR/HRV quantitatively in association with suicide. Search results were limited to human subjects and articles published in peer-reviewed journals in English. There were no restrictions for age, sex, settings and durations of measurements, types of mental illnesses, or comorbidity. RESULTS: Twenty-three studies were included in the current systematic review. Across the studies, consistent patterns of disturbed sleep-wakefulness such as greater sleep onset latency and lower sleep efficiency were related to suicide. In addition, higher HR and lower variance of R-R intervals was an indicator of risk of suicide. LIMITATIONS: Studies that used different equipment for sleep studies (i.e., polysomnography, electroencephalogram, actigraphy) were combined, and potential differences in their findings due to the different equipment were not considered. CONCLUSIONS: Findings provide initial evidence for consistent patterns of sleep-wakefulness and HR/HRV possibly associated with suicidality; however, more studies are needed in order to identify the precise objective variables (e.g., sleep onset latency, high-frequency HRV), as well as time-varying patterns in these variables, that are related to acute suicide risk.
BACKGROUND: Emerging literature suggests that the arousal and regulatory systems as measured by sleep-wakefulness, heart rate (HR) and heart rate variability (HRV) may be powerful objective warning signs of suicidality. However, there is no systematic literature review examining the association between objective measurements of these variables with suicide and suicidal behavior. METHODS: A web-based, systematic literature search using PubMed and EMBASE was conducted for articles that measured sleep-wakefulness and HR/HRV quantitatively in association with suicide. Search results were limited to human subjects and articles published in peer-reviewed journals in English. There were no restrictions for age, sex, settings and durations of measurements, types of mental illnesses, or comorbidity. RESULTS: Twenty-three studies were included in the current systematic review. Across the studies, consistent patterns of disturbed sleep-wakefulness such as greater sleep onset latency and lower sleep efficiency were related to suicide. In addition, higher HR and lower variance of R-R intervals was an indicator of risk of suicide. LIMITATIONS: Studies that used different equipment for sleep studies (i.e., polysomnography, electroencephalogram, actigraphy) were combined, and potential differences in their findings due to the different equipment were not considered. CONCLUSIONS: Findings provide initial evidence for consistent patterns of sleep-wakefulness and HR/HRV possibly associated with suicidality; however, more studies are needed in order to identify the precise objective variables (e.g., sleep onset latency, high-frequency HRV), as well as time-varying patterns in these variables, that are related to acute suicide risk.
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