Sleep disturbances are highly prevalent throughout the course of psychosis, with different stages of psychosis exhibiting both shared and distinct abnormalities in sleep quality, sleep architecture, and sleep spindles, according to study findings published in JAMA Psychiatry.
Recognizing that abnormal sleep is common among individuals with psychosis, researchers sought to identify sleep abnormalities across the various stages of psychosis (eg, clinical high risk for psychosis [CHR-P], early psychosis [EP], and chronic psychosis [CP]) in a systematic review and meta-analysis. They systematically investigated the occurrence and severity of sleep abnormalities in CHR-P, EP, and CP populations, in an effort to help differentiate sleep dysfunction associated with chronicity and long-term exposure to medication (ie, seen mainly in CP) from those involved in the manifestation of advanced psychosis (ie, occurring first in EP) and from sleep alterations associated with vulnerability to psychosis (ie, present since CHR-P).
For inclusion, studies needed to be published from inception of the meta-analysis through June 15, 2022, and to have been written in English. The prevalence of sleep disturbance was assessed in 3 different analyses:
- an analysis of pooled cases of sleep disturbance prevalence that combined all stages of psychosis;
- a stage-specific case analysis of sleep disturbance; and
- a moderator analysis that compared the clinical stages of psychosis with one another.
Additionally, a secondary analysis was conducted that evaluated insomnia in a subgroup of studies.
Sleep architecture and oscillatory alterations were assessed in 3 separate analyses:
- a pooled case-control comparison of each sleep variable that combined all stages of psychosis;
- a stage-specific case-control analysis of sleep abnormalities; and
- a moderator analysis that compared clinical stages of psychosis with one another.
Main outcomes and measures used in the study comprised the following:
- sleep disturbance prevalence;
- self-reported sleep quality (ie, total sleep time, sleep latency, sleep efficiency, nonrapid eye movement, rapid eye movement stages, number of arousals); and
- sleep electroencephalography oscillations (ie, spindle density, amplitude, and duration, as well as slow wave density).
Following a full-text review, a total of 59 articles were included in the meta-analysis, with 21 studies evaluating the prevalence of sleep disturbance in 5135 individuals and 39 studies measuring sleep alterations subjectively (eg, sleep quality) and/or objectively (eg, sleep architecture and sleep oscillatory measures) in 1575 patients and 977 control individuals.
Researchers found that sleep disturbance prevalence in pooled cases was 50% (95% CI, 40%-61%), which was similar in each stage of psychosis. Sleep quality was worse in pooled cases compared with control individuals (standardized mean difference [SMD], 1.00; 95% CI, 0.70-1.30).
Alterations in sleep architecture included the following:
- longer onset of sleep latency (pooled cases: SMD, 0.96; 95% CI, 0.62-1.30; EP: SMD, 0.72; 95% CI, 0.52-0.92; CP: SMD, 1.36; 95% CI, 0.66-2.05);
- higher wake after sleep onset (pooled cases: SMD, 0.50; 95% CI, 0.29-0.71; EP: SMD, 0.62; 95% CI, 0.34-0.89; CP: SMD, 0.51; 95% CI, 0.09-0.93);
- higher number of arousals (pooled cases: SMD, 0.45; 95% CI, 0.07-0.83; CP: SMD, 0.81; 95% CI, 0.30-1.32);
- higher stage 1 sleep (pooled cases: SMD, 0.23; 95% CI, 0.06-0.40; EP: SMD, 0.34; 95% CI, 0.15-0.53);
lower sleep efficiency (pooled cases: SMD, –0.75; 95% CI, –0.98 to –0.52; EP, –0.90; 95% CI, –1.20 to –0.60; CP: SMD, –0.73; 95% CI, –1.14 to –0.33); and
- lower rapid eye movement density (pooled cases: SMD, 0.37; 95% CI, 0.14-0.60; CP: SMD, 0.40; 95% CI, 0.19-0.77).
Spindle parameter deficits included the following:
- density (pooled cases: SMD, –1.06; 95% CI, –1.50 to –0.63; EP: SMD, –0.80; 95% CI, –1.22 to –0.39; CP: SMD, –1.39; 95% CI, –2.05 to –0.74);
- amplitude (pooled cases: SMD, –1.08; 95% CI, –1.33 to –0.82; EP: SMD, –0.86; 95% CI, –1.24 to –0.47; CP: SMD, –1.25; 95% CI, –1.58 to –0.91); and
- duration (pooled cases: SMD, –1.20; 95% CI, –1.69 to –0.73; EP: SMD, –0.71; 95% CI, –1.08 to –0.34; CP: SMD, –1.74; 95% CI, –2.10 to –1.38).
Individuals with CP experienced significantly more frequent arousals and reduced spindle duration compared with those with EP (P =.02 and P <.001, respectively).
Several limitations of the meta-analysis should be noted. Although the studies included were chosen based on comparable sleep evaluation tools, considerable variability in across-study methodology nonetheless remained. Further, 2 of the studies assessed were rated as “poor” and 26 were rated as “weak,” although the “quality” of 27 of the studies was rated as “good” and the “quality” of 5 was rated as “excellent.”
Researchers concluded that “Findings from these studies may help to establish sleep as a core clinical target and research domain from prodromal to early and chronic stages of psychosis.”
Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on Neurology Advisor
Bagautdinova J, Mayeli A, Wilson JD, et al. Sleep abnormalities in different clinical stages of psychosis: a systematic review and meta-analysis. JAMA Psychiatry. Published online January 18, 2023. doi:10.1001/jamapsychiatry.2022.4599