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Sleep Disorders in Early Psychosis: New Research
Brian Miller, MD, PhD, MPH
Sleep disturbance-including shorter sleep time and lowered sleep quality-is associated with increased psychotic experiences. So what's new?
Sleep disturbance-including shorter sleep time and lowered sleep quality-is associated with increased psychotic experiences [1] Few studies have investigated clinical sleep disorders (eg, insomnia, nightmares, sleep apnea) in psychosis. One study found that comorbid insomnia and nightmares was associated with a significant increased risk of suicide in schizophrenia [2]. So what's new?
• Reeve and colleagues[3] performed a detailed assessment of clinical sleep disorders-including presence, severity, and treatment-in patients with early psychosis
• A secondary objective was to investigate the association between sleep disorders, psychiatric symptoms, and wellbeing
• Participants completed a Consensus Sleep Diary for 7 days
• Participants also worse a wrist-based activity monitoring device for the same 7 days
• A subgroup of 29 subjects completed the self-report Sleep-50, which was used to validate DISP outcomes
• Fatigue was measured via the Multi-Dimensional Fatigue Symptom Inventory
• Differences in psychotic experiences, mood, and well-being between those with and without sleep disorders were assessed via independent samples t-tests
• Mean subject age was 24, and 65% of subjects were male
• 75% of subjects were referred from early intervention psychosis services
• The most common diagnoses were Psychosis NOS (42%) and schizophrenia (28%)
• 82% of subjects were prescribed antipsychotics and 40% antidepressants
• 80% of subjects had a positive screen or diagnosis for at least one sleep disorder, most commonly insomnia (50%) and nightmare disorder (48%)
• Comorbidity was high, with an average of 3.3 sleep disorders per subject, and 52% of all sleep disorders were rated as severe
• Over half of all sleep disorders had been discussed with a medical professional
• 30% of all sleep disorders (57% of those discussed with a professional) had received some form of (typically non-recommended) treatment
• Having at least one (versus none) sleep disorder was associated with more severe paranoia, hallucinations, and disorganization, as well as more depression, anxiety, and fatigue, and lower health-related quality of life
• There was no difference in antipsychotic dose between subjects with and without insomnia
• The authors concluded that 80% of their sample with early psychosis had comorbid sleep disorder, which was often severe and untreated
• Subjects with comorbid sleep disorders had more severe psychopathology and lower quality of life
• Study limitations include uncertain generalizability to other patients with non-affective psychosis and the absence of polysomnographic data
• Nevertheless, findings have important potential implications for clinicians
REFERENCES:
1. Reeve S, Sheaves B, Freeman D. The role of sleep dysfunction in the occurrence of delusions and hallucinations: a systematic review. Clin Psychol Rev. 2015; 42: 96–115.
2. Li SX, Lam SP, Zhang J, et al. Sleep disturbances and suicide risk in an 8-year longitudinal study of schizophreniaspectrum disorders. Sleep. 2016; 39: 1275–1282.
3. Reeve S, Sheaves B, Freeman D. Sleep disorders in early psychosis: incidence, severity, and association with clinical symptoms. Schizophr Bull. 2018. [Epub ahead of print].