Sleep Abnormalities in Different Clinical Stages of Psychosis

Abstract

ImportanceAbnormal sleep is frequent in psychosis; however, sleep abnormalities in different stages (ie, clinical high risk for psychosis [CHR-P], early psychosis [EP], and chronic psychosis [CP]) have not been characterized.ObjectiveTo identify sleep abnormalities across psychosis stages.Data SourcesWeb of Science and PubMed were searched between inception and June 15, 2022. Studies written in English were included.Study SelectionSleep disturbance prevalence studies and case-control studies reporting sleep quality, sleep architecture, or sleep electroencephalography oscillations in CHR-P, EP, or CP.Data Extraction and SynthesisThis systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Stage-specific and pooled random-effects meta-analyses were conducted, along with the assessment of heterogeneity, study quality, and meta-regressions (clinical stage, sex, age, medication status, and psychotic symptoms).Main Outcomes and MeasuresSleep disturbance prevalence, self-reported sleep quality, sleep architecture (total sleep time, sleep latency, sleep efficiency, nonrapid eye movement, rapid eye movement stages, and number of arousals), and sleep electroencephalography oscillations (spindle density, amplitude, and duration, and slow wave density).ResultsFifty-nine studies with up to 6710 patients (n = 5135 for prevalence) and 977 controls were included. Sleep disturbance prevalence in pooled cases was 50% (95% CI, 40%-61%) and it was similar in each psychosis stage. Sleep quality was worse in pooled cases vs controls (standardized mean difference [SMD], 1.00 [95% CI, 0.70-1.30]). Sleep architecture alterations included higher sleep onset latency (SMD [95% CI]: pooled cases, 0.96 [0.62-1.30]; EP, 0.72 [0.52-0.92]; CP, 1.36 [0.66-2.05]), higher wake after sleep onset (SMD [95% CI]: pooled cases, 0.5 [0.29-0.71]; EP, 0.62 [0.34-0.89]; CP, 0.51 [0.09-0.93]), higher number of arousals (SMD [95% CI]: pooled cases, 0.45 [0.07-0.83]; CP, 0.81 [0.30-1.32]), higher stage 1 sleep (SMD [95% CI]: pooled cases, 0.23 [0.06-0.40]; EP, 0.34 [0.15-0.53]), lower sleep efficiency (SMD [95% CI]: pooled cases, −0.75 [−0.98 to −0.52]; EP, −0.90 [−1.20 to −0.60]; CP, −0.73 [−1.14 to −0.33]), and lower rapid eye movement density (SMD [95% CI]: pooled cases, 0.37 [0.14-0.60]; CP, 0.4 [0.19-0.77]). Spindle parameter deficits included density (SMD [95% CI]: pooled cases, −1.06 [−1.50 to −0.63]; EP, −0.80 [−1.22 to −0.39]; CP, −1.39 [−2.05 to −0.74]; amplitude: pooled cases, −1.08 [−1.33 to −0.82]; EP, −0.86 [−1.24 to −0.47]; CP, −1.25 [−1.58 to −0.91]; and duration: pooled cases: −1.2 [−1.69 to −0.73]; EP, −0.71 [−1.08 to −0.34]; CP, −1.74 [−2.10 to −1.38]). Individuals with CP had more frequent arousals vs CHR-P (z = 2.24, P = .02) and reduced spindle duration vs EP (z = −3.91, P < .001).Conclusions and RelevanceIn this systematic review and meta-analysis, sleep disturbances were found to be prevalent throughout the course of psychosis, and different psychosis stages showed both shared and distinct abnormalities in sleep quality, architecture, and spindles. These findings suggest that sleep should become a core clinical target and research domain from at-risk to early and chronic stages of psychosis.

Clinical Evaluation of Sleep Disorders in Parkinson’s Disease

“…In this advanced phase of the disease, normally, many drugs affecting cognition, depression, anxiety, behavior symptoms, and mobility are prescribed with a tailored therapy that could be specific for each patient. This topic was recently emphasized in the context of psychosis, where authors underlined different sleep disorders throughout the course of the disease and different psychosis stages showed distinct abnormalities in sleep quality, architecture, and spindles [ 128 ]. These findings altogether suggest that sleep disorders could become a core treatment in different neurodegenerative diseases, such as psychosis, Parkinson’s disease, and dementia [ 129 , 130 ].…”

Sleep disturbance in schizophrenia spectrum disorders: more than just a symptom?

“…the Pittsburgh Sleep Quality Index, PSQI) enable the evaluation of the prevalence of sleep complaints in SSD as well as to quantify subjective sleep quality in patients with SSD compared with non-clinical populations. Of note, while sleep disturbance prevalence is 20-25% in the general population, several studies showed higher prevalence (≥50%) in patients with SSD, as recently reported by a meta-analysis (Bagautdinova et al, 2023). Besides subjective sleep assessments that are inexpensive and easy to implement in large clinical cohorts, several objective measures collected with actigraphy, electroencephalography, and polysomnography allow for the quantification of altered sleep characteristics in patients with SSD compared to healthy controls.…”

“…Cognitive dysfunction is a core feature of SSD and represents one of the best predictors of poor functional outcomes in patients with SSD. In recent work, we reported that decreased prefrontal spindle density was associated with worse working memory performance in patients with schizophrenia relative to the control group (Buchmann et al ., 2014). Furthermore, several sleep studies have shown that, in chronic patients with schizophrenia, reduced spindle density was associated with impaired memory consolidation, involving both procedural and declarative memory (Manoach and Stickgold, 2019).…”

Sleep spindles as neurophysiological biomarkers of schizophrenia

“…In a recent meta‐analysis, our research group established that sleep disturbance prevalence was 50% across stages of psychosis, compared with less than 25% in the general population, thus representing a relevant but currently undertreated clinical target in patients with SCZ (Mayeli et al, 2023). In that meta‐analysis, sleep spindles, a sleep‐specific oscillatory activity occurring during NREM, were found to be defective across stages of psychosis, thus suggesting that a reduction in sleep spindles is present and persists throughout the course of the disorder (Bagautdinova et al, 2023). Furthermore, altered spindle parameters in SCZ have been associated with a range of clinical outcomes, including increased severity of positive and negative symptoms, cognitive impairment and poorer functional outcomes (Ferrarelli, 2021).…”