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Meta-Analysis
. 2023 Mar 1;80(3):202-210.
doi: 10.1001/jamapsychiatry.2022.4599.

Sleep Abnormalities in Different Clinical Stages of Psychosis: A Systematic Review and Meta-analysis

Joëlle Bagautdinova  1 , Ahmad Mayeli  2 , James D Wilson  2 , Francesco L Donati  2   3 , Rebekah M Colacot  4 , Nicholas Meyer  5 , Paolo Fusar-Poli  6   7 , Fabio Ferrarelli  2
Affiliations
Meta-Analysis

Sleep Abnormalities in Different Clinical Stages of Psychosis: A Systematic Review and Meta-analysis

Joëlle Bagautdinova et al. JAMA Psychiatry. .

Abstract

Importance: Abnormal 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.

Objective: To identify sleep abnormalities across psychosis stages.

Data sources: Web of Science and PubMed were searched between inception and June 15, 2022. Studies written in English were included.

Study selection: Sleep 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 synthesis: This 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 measures: 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).

Results: Fifty-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 relevance: 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. These findings suggest that sleep should become a core clinical target and research domain from at-risk to early and chronic stages of psychosis.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Fusar-Poli reported personal fees from Lundbeck, Angelini, Menarini, Sunovion, Proxymm Science, and Boehringer Ingelheim outside the submitted work. Dr Ferrarelli reported grants from the National Institute of Mental Health during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. PRISMA Workflow of Study Selection
aOf note, 1 study was included in both the prevalence and sleep architecture analyses.
Figure 2.
Figure 2.. Forest Plots of Prevalence of Sleep Disturbance and Prevalence of Insomnia
Logit transformation was applied for analysis and the final pooled logit was back transformed to proportions for ease of interpretation of the forest plots. CHR-P indicates clinical high risk for psychosis; CP, chronic psychosis; EP, early psychosis.
Figure 3.
Figure 3.. Summary of Standardized Mean Differences (SMDs) in Sleep Quality as Measured by Total Pittsburgh Sleep Quality Index
CHR-P indicates clinical high risk for psychosis; CP, chronic psychosis; EP, early psychosis.
Figure 4.
Figure 4.. Summary of Standardized Mean Differences (SMDs) for Sleep Architecture Parameters
CHR-P indicates clinical high risk for psychosis; CP, chronic psychosis; EP, early psychosis; REM, rapid eye movement. aSignificant (P < .05) effect sizes between 2 subgroups are indicated.
Figure 5.
Figure 5.. Summary of Standardized Mean Differences (SMDs) for Sleep Spindle Parameters and Slow-Wave Density
CP indicates chronic psychosis; EP, early psychosis. aSignificant (P < .05) effect sizes between 2 subgroups are indicated.
See this image and copyright information in PMC

References

    1. Kraeplin E. Dementia Praecox and Paraphenia. Robert E. Krieger Publishing Co; 1919.
    1. Hou CL, Li Y, Cai MY, et al. . Prevalence of insomnia and clinical and quality of life correlates in Chinese patients with schizophrenia treated in primary care. Perspect Psychiatr Care. 2017;53(2):80-86. doi:10.1111/ppc.12139 - DOI - PubMed
    1. Meyer N, Joyce DW, Karr C, et al. . The temporal dynamics of sleep disturbance and psychopathology in psychosis: a digital sampling study. Psychol Med. 2021;52(13):1-10. doi:10.1017/S0033291720004857 - DOI - PMC - PubMed
    1. Yung AR, McGorry PD. The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull. 1996;22(2):353-370. doi:10.1093/schbul/22.2.353 - DOI - PubMed
    1. Ruhrmann S, Schultze-Lutter F, Salokangas RKR, et al. . Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Arch Gen Psychiatry. 2010;67(3):241-251. doi:10.1001/archgenpsychiatry.2009.206 - DOI - PubMed

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