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Sleep and rest-activity-rhythm abnormalities are commonly reported in schizophrenia spectrum disorder patients. However, an in-depth characterization of sleep and rest-activity-rhythm alterations in schizophrenia spectrum disorder, including patients in different treatment settings, and the relationship between these alterations and schizophrenia spectrum disorder clinical features, is lacking. Characterization of sleep and rest-activity-rhythm disturbances and their relationships with clinical symptoms may help to establish the implication of these disturbances in the pathophysiology of schizophrenia spectrum disorder, which could improve prognosis and treatment.

In a study recently published in Molecular Psychiatry, investigators including Ahmad Mayeli, PhD (postdoctoral scholar); Stephen Smagula, PhD (Associate Professor of Psychiatry and Assistant Professor of Epidemiology); and Fabio Ferrarelli, MD, PhD (Associate Professor of Psychiatry), examined whether sleep and rest-activity-rhythm parameters differed in residential and outpatient patients with schizophrenia spectrum disorder, relative to an unaffected comparison group and to each other. They also assessed whether negative symptoms differed between residential and outpatient groups and whether the severity of negative symptoms was linked with sleep-wake pattern disruptions.

Adults with schizophrenia spectrum disorder in treatment at residential facilities or as outpatients, and adults without a history of mental illness wore an ActiGraph for seven consecutive days to monitor habitual sleep and rest-activity-rhythm patterns. The investigators found that altogether, residential patients and outpatients with schizophrenia spectrum disorder had both shared and unique abnormalities in sleep and rest-activity-rhythm measures compared with the unaffected comparison group, and relative to one another, which also contributed to the patients’ negative symptom severity. 

“The consistency of altered sleep-wake patterns between the two patient cohorts suggest their implication in the pathophysiology of schizophrenia,” said Dr. Ferrarelli, senior author of the study. “But interestingly, we found that residential patients had much more stable daily routines. We tend to think of stable routines as a good thing, but when these routines become too rigid, they can present a problem. In our study, this rigidity in daily rhythms was strongly correlated to the severity of negative mental health symptoms in residential patients with schizophrenia. Keeping your sleep schedule consistent while mixing up your daily tasks and splitting them across different days of the week is a good way to add variety to your schedule and improve your health in the long term.”

Shared and distinct abnormalities in sleep-wake patterns and their relationship with the negative symptoms of Schizophrenia Spectrum Disorder patients
Mayeli A, LaGoy AD, Smagula SF, Wilson JD, Zarbo C, Rocchetti M, Starace F, Zamparini M, Casiraghi L, Calza S, Rota M, D’Agostino A, de Girolamo G, DiAPAson Consortium, Ferrarelli F.
Molecular Psychiatry (2023). https://doi.org/10.1038/s41380-023-02050-x