New Data Reveal Sleep Disturbance Affects Patients at All Stages of Psychosis

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Based on data from the systematic review, investigators urge for the prioritization of sleep as a core clinical target and further investigation across the stages of psychosis.

Psychosis and issues related to sleep are known to coincide, but in this study, investigators decided to take a more specific approach to analyze how sleep abnormalities impact patients at different stages of psychosis. The aim was to determine how sleep disturbance presents in severity, and in occurrence, across this population.

Disturbances like insomnia, have been reported alongside psychological disorders since the beginning, and could indicate the likelihood of a subsequent relapse. Joëlle Bagautdinova, MSc, Department of Neuroscience, University of Pennsylvania, and investigators, assessed clinical high risk for psychosis (CHR-P), early psychosis (EP), and chronic psychosis (CP).

"Altered sleep often precedes a psychotic episode in early psychosis (EP), and disrupted sleep contributes to predicting transition to psychosis in youth at clinical high risk for psychosis (CHR-P). Thus, sleep abnormalities not only co-occur with psychotic symptoms but are also implicated in the development, manifestation, and recurrence of psychosis," the team wrote.

Categorizing Sleep Disturbances Across Psychosis Stages

The measures for the study's main outcome included sleep 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).

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed for reporting items in the systematic review and meta-analysis. Data from Web of Science and PubMed from inception through June 2022 were reviewed and screened for inclusion.

Investigators sought studies on the prevalence of sleep disturbance that reported sleep quality, sleep architecture, or sleep electroencephalography oscillations in each targeted stage of psychosis. Meta-analyses and pooled random-effects were performed within each stage, along with the assessment of heterogeneity, study quality, and meta-regressions (clinical stage, sex, age, medication status, and psychotic symptoms).

The Sleep Architecture of Psychosis

Overall, the analysis demonstrated a prevalence of sleep disturbances thoughout the course of physchosis, with both shared and distinct features in sleep quality, architecture, and spindles. Poor self-reported sleep quality among patients with psychosis was observed when investigators compared 1575 patients with 977 controls.

Approximately half of patients experienced sleep disturbance with similar comparison across the stages in the initial analysis that consisted of 5135 patients from 21 studies. Those with chronic psychosis exhibited more arousal than those with clinical high-risk psychosis, and reduced spindle duration than patients with early psychosis.

The variations in sleep architecture in the target populations in contrast with controls showed higher rates of, sleep onset latency, wake after sleep onset, number of arousals, stage 1 sleep; and lower rates of sleep efficiency and rapid eye movement density.

"In 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," investigators wrote. "These findings suggest that sleep should become a core clinical target and research domain from at-risk to early and chronic stages of psychosis."

The study "Sleep Abnormalities in Different Clinical Stages of Psychosis" was published in JAMA Psychiatry.