The following is a summary of “Sleep Abnormalities in Different Clinical Stages of Psychosis: A Systematic Review and Meta-analysis,” published in the January 2023 issue of Psychiatry by Bagautdinova, et al.
For a study, researchers sought to identify sleep abnormalities in different stages of psychosis including a clinical high risk for psychosis (CHR-P), early psychosis (EP), and chronic psychosis (CP).
They conducted a systematic review and meta-analysis of sleep disturbance prevalence studies and case-control studies that reported sleep quality, sleep architecture, or sleep electroencephalography oscillations in these three stages of psychosis. The search for relevant studies was conducted on Web of Science and PubMed between inception and June 15, 2022, and only studies written in English were included. The review included 59 studies with up to 6,710 patients and 977 controls. The study found that sleep disturbances were prevalent throughout the course of psychosis and that sleep quality was worse in pooled cases than in controls. Sleep architecture alterations included higher sleep onset latency, higher wake after sleep onset, a higher number of arousals, higher stage 1 sleep, lower sleep efficiency, and lower rapid eye movement density. Spindle parameter deficits included density, amplitude, and duration. These abnormalities were present in all three stages of psychosis, although there were some differences in the specific parameters affected.
There were 59 studies, with up to 6,710 cases (n = 5,135 for prevalence) and 977 controls. The prevalence of sleep disorders was similar at each stage of psychosis and was 50% (95% CI, 40%–61%) in the pooled cases. 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).
Sleep disturbances were discovered to be common throughout the course of psychosis in this systematic review and meta-analysis, and various stages of psychosis displayed both common and unique abnormalities in sleep architecture, quality, and spindles. From the at-risk to the early and chronic stages of psychosis, the findings implied that sleep should become a primary treatment goal and research domain.
Reference: jamanetwork.com/journals/jamapsychiatry/article-abstract/2800172