Sleep disturbance highly prevalent throughout course and different stages of psychosis: JAMA

A new study published in the Journal of American Medical Association suggests that sleep issues were discovered to be pervasive throughout psychosis, and various phases of psychosis revealed both common and unique problems in sleep architecture, quality, and spindles. 

Although aberrant sleep patterns are common in psychosis, they have not yet been identified in the distinct phases (i.e., clinical high risk for psychosis [CHR-P], early psychosis [EP], and chronic psychosis [CP]). The purpose of this study framed by Jolle Bagautdinova and colleagues was to pinpoint sleep anomalies across phases of psychosis.

Between the beginning and June 15, 2022, Web of Science and PubMed were searched. Included were studies that were written in English. Studies on the prevalence of sleep disorders and case-control studies reporting on sleep architecture, sleep quality, or oscillations in the CHR-P, EP, or CP were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting standard was used for this systematic review and meta-analysis.

The assessment of heterogeneity, research quality, and meta-regressions were done together with stage-specific and pooled random-effects meta-analyses (age, clinical stage, sex, medication status, and psychotic symptoms). Sleep architecture (sleep efficiency, total sleep time, sleep efficiency, nonrapid eye movement, sleep latency, rapid eye movement phases, and number of arousals), prevalence of sleep disturbances, self-reported sleep quality, and sleep electroencephalography oscillations (spindle amplitude, density, and duration, and slow wave density) were the main outcomes.

The key findings of this study were:

There were 59 studies total, with up to 6710 cases and 977 controls. 

In pooled instances, the prevalence of sleep disorders was 50%, and it remained consistent throughout each stage of psychosis. 

Compared to controls, sleep quality was poorer in pooled cases. 

Alterations in sleep architecture included increased sleep start delay, increased waking after sleep onset, increased arousals, increased stage 1 sleep, decreased sleep efficiency, and decreased rapid eye movement density. 

Deficits in spindle parameters included density. 

Individuals with CP showed shorter spindle durations compared to EP (z = 3.91, P .001) and more frequent arousals compared to CHR-P (z = 2.24, P =.02).

Reference: 

Bagautdinova, J., Mayeli, A., Wilson, J. D., Donati, F. L., Colacot, R. M., Meyer, N., Fusar-Poli, P., & Ferrarelli, F. (2023). Sleep Abnormalities in Different Clinical Stages of Psychosis. In JAMA Psychiatry. American Medical Association (AMA). https://doi.org/10.1001/jamapsychiatry.2022.4599