Sleep and mental disorders: A meta-analysis of polysomnographic research.

Abstract

Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, ADHD, and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the “Comprehensive Meta-Analysis” and “R” softwares. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges’g). Sources of variability, i.e., sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in one condition; however, no two conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in one single variable.

Perfectionism and Polysomnography-Determined Markers of Poor Sleep

“…For each combination of perfectionism-related variable (FMPS total and subscale scores; independent variable) and PSG parameter (see "Polysomnography" in Methods; dependent variable), a linear regression analysis was conducted with age, sex, BDI scores, and somatic sleep disorders (sleep apnea syndrome, restless legs syndrome / periodic leg movement disorder, organic insomnia, non-rapid eye movement parasomnia, circadian rhythm sleep disorder, narcolepsy, and idiopathic hypersomnia) as covariates. BDI scores were used as covariates in all analyses because depression levels have been linked to both poor sleep 36 and perfectionism levels. 2 To investigate the association between perfectionism and subjective sleep, the same analyses have been performed with PSQI scores as dependent variable.…”

“…This fits well with previous findings showing that acute psychological stress is primarily related to sleep continuity disturbances in patients with insomnia, 40 whereas sleep architecture changes are rather common in the context of chronic psychiatric conditions. 36 …”

Opposite Impact of REM Sleep on Neurobehavioral Functioning in Children with Common Psychiatric Disorders Compared to Typically Developing Children

“…Next, REM sleep has been proposed to generate an innate virtual model of the world, thus modulating predictive coding (Hobson and Friston, 2012; Hobson et al, 2014; Hopkins, 2016). In view of REM sleep deviations in almost all psychiatric conditions (Benca et al, 1997; Gottesmann and Gottesman, 2007; Baglioni et al, 2016), REM sleep also has been regarded as a mechanism mediating brain adaptation in normal and pathological conditions (Benca et al, 1992; Horne, 2013, 2015; Goldstein and Walker, 2014; Hobson et al, 2014; Hopkins, 2016; Mota et al, 2016). …”

Sleep, Nightmares and Schizophrenia

“…Precisely because it is very much appreciated, one can never dismiss the operation of a placebo effect in reports of well-being. No specific effect on psychotic symptoms such as delusions and hallucinations has been demonstrated as of yet, but this line of research is worth pursuing because sleep pathology and psychosis pathology share some commonalities such as paranoid themes and a lack of appreciation that what is being seen and heard is not real [88][89][90][91]. In general, sleep disorders cut across many psychiatric diagnoses whose symptoms overlap with each other to significant degrees [92], which is why it makes sense for clinicians to address sleep issues in all mental illness, including schizophrenia.…”