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Review
. 2016 Sep;142(9):969-990.
doi: 10.1037/bul0000053. Epub 2016 Jul 14.

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

Chiara Baglioni  1 , Svetoslava Nanovska  1 , Wolfram Regen  1 , Kai Spiegelhalder  1 , Bernd Feige  1 , Christoph Nissen  1 , Charles F Reynolds  2 , Dieter Riemann  1
Affiliations
Review

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

Chiara Baglioni et al. Psychol Bull. 2016 Sep.

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, attention-deficit-hyperactivity disorder (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" software. 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, that is, 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 1 condition; however, no 2 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 1 single variable. (PsycINFO Database Record

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Conflict of interest statement

Christoph Nissen received speaker honoraria from Servier. Charles F. Reynolds is part of the Editorial Review Board of the American Association of Geriatric Psychiatry; and he received in the past three years extramural support from: a) National Institute of Health (NIH), b) National Institute of Mental Health (NIMH), c) National Institute on Aging (NIA), d) National Center for Minority Health Disparities (NIMHD), e) National Heart Lung and Blood Institute (NHLBI), f) Center for Medicare and Medicaid Services (CMS), g) Patient Centered Outcomes Research Institute (PCORI), h) John A. Hartford Foundation, i) American Foundation for Suicide Prevention, j) Commonwealth of Pennsylvania, k) Clinical and Translational Science Institute (CTSI), l) National Palliative Care Research Center (NPCRC), m) American Association for Geriatric Psychiatry (for services as associate editor), n) UPMC Endowment in Geriatric Psychiatry (which supports the endowed professorship). Moreover, Charles F. Reynolds received: a) grant support Bristol Meyers Squibb Forrest Labs Lily Pfizer which provide pharmaceutical supplies for NIH sponsored work (the pharmaceutical companies plays no role in the design, analysis and in the reporting of data from Charles F. Reynolds in peer reviewed journals); b) speaker honorarium from Medscape/WEB MD; c) licensed intellectual property as co-inventor for the Psychometric analysis of the Pittsburgh Sleep Quality Index (PSQI): PRO10050447, PI: Dr. Daniel Buysse; d) support for manuscripts by the NIH through grant numbers P60MD000207, P30MH090333, UL1RR024153, UL1TR000005 and by the UPMC Endowment in Geriatric Psychiatry. Dieter Riemann received speaker honoraria from Abbvie. All other authors report no competing interests.

Figures

Figure 1
Figure 1
Search flow with respect to each disorder. *Six studies were considered for more than one disorder: 4 for both affective and anxiety disorders; 1 for affective and borderline personality disorder; and 1 for affective disorders and schizophrenia. Moreover for pervasive developmental disorders, studies focused either on autistic disorder or Asperger syndrome. Two studies included both a group with autistic disorder and a group with Asperger syndrome. In total, we could analyze 6 studies for autistic disorder and 3 for Asperger syndrome. In addition, searching for ‘antisocial personality disorder’, one study was found comparing subjects with conduct disorder with healthy controls, which was added to the list “externalizing disorders”. Finally, some of the included studies compared more than two groups, for example considering sex or age differences, which resulted in a total of 114 comparisons to analyze (from 91 studies). Please refer to Table S1 for detailed information for each included study.
Figure 2
Figure 2
Graphical summary of the main results for sleep domains. Effect sizes and significance values are reported in Tables 3,4 and 5. *No analyses for sleep depth in seasonal affective disorder (SAD) could be run due to lack of a sufficient number of studies.
See this image and copyright information in PMC

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List of references of the 91 studies included in this meta-analysis

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List of references of the 205 studies excluded in this meta-analysis

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