Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: A Systematic Review and Meta-analysis

Abstract

Background Sleep and circadian rhythm disturbances in schizophrenia are common, but incompletely characterized. We aimed to describe and compare the magnitude and heterogeneity of sleep-circadian alterations in remitted schizophrenia and compare them with those in interepisode bipolar disorder. Methods EMBASE, Medline, and PsycINFO were searched for case–control studies reporting actigraphic parameters in remitted schizophrenia or bipolar disorder. Standardized and absolute mean differences between patients and controls were quantified using Hedges’ g, and patient–control differences in variability were quantified using the mean-scaled coefficient of variation ratio (CVR). A wald-type test compared effect sizes between disorders. Results Thirty studies reporting on 967 patients and 803 controls were included. Compared with controls, both schizophrenia and bipolar groups had significantly longer total sleep time (mean difference [minutes] [95% confidence interval {CI}] = 99.9 [66.8, 133.1] and 31.1 [19.3, 42.9], respectively), time in bed (mean difference = 77.8 [13.7, 142.0] and 50.3 [20.3, 80.3]), but also greater sleep latency (16.5 [6.1, 27.0] and 2.6 [0.5, 4.6]) and reduced motor activity (standardized mean difference [95% CI] = −0.86 [−1.22, −0.51] and −0.75 [−1.20, −0.29]). Effect sizes were significantly greater in schizophrenia compared with the bipolar disorder group for total sleep time, sleep latency, and wake after sleep onset. CVR was significantly elevated in both diagnoses for total sleep time, time in bed, and relative amplitude. Conclusions In both disorders, longer overall sleep duration, but also disturbed initiation, continuity, and reduced motor activity were found. Common, modifiable factors may be associated with these sleep-circadian phenotypes and advocate for further development of transdiagnostic interventions that target them.

Sleep and Memory Consolidation Dysfunction in Psychiatric Disorders: Evidence for the Involvement of Extracellular Matrix Molecules

“…Recent studies point to sleep and circadian rhythm disturbances as key aspects of schizophrenia (SZ) (Ferrarelli et al, 2007;Manoach et al, 2014Manoach et al, , 2016Ferrarelli, 2015Ferrarelli, , 2020Ferrarelli and Tononi, 2017;D'Agostino et al, 2018;Baran et al, 2019;Manoach and Stickgold, 2019;Merikanto et al, 2019;Seney et al, 2019;Delorme T.C. et al, 2020;Gerstenberg et al, 2020;Markovic et al, 2020;Meyer et al, 2020). Furthermore, altered diurnal molecular expression rhythms have been recently reported in the prefrontal cortex of subjects with SZ using RNAseq profiling of postmortem brain samples, suggesting broad molecular circadian rhythm disturbances in this disease (Seney et al, 2019).…”

Are Circadian Disturbances a Core Pathophysiological Component of Schizophrenia?

“…A meta-analysis of sleep parameters accessed by actigraphy reported various sleep disturbances in patients with treated and remitted schizophrenia compared with healthy controls. These included greater total sleep time, longer time in bed, greater sleep latency, greater wake after sleep onset, and reduced motor activity (Meyer et al, 2020).…”

Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies

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