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Abnormal sleep is frequent in psychosis. Sleep disturbances, such as insomnia, are commonly reported by individuals with chronic psychosis, and are associated with subsequent relapse. In early psychosis, altered sleep often precedes a psychotic episode, and in youth at clinical high risk, disrupted sleep contributes to predicting transition to psychosis. However, sleep abnormalities in different stages (i.e., clinical high risk for psychosis, early psychosis, and chronic psychosis) have not been characterized.

In a systematic review and meta-analysis recently published in JAMA Psychiatry, scientists including corresponding authors Ahmed Mayeli, PhD (postdoctoral scholar), and Fabio Ferrarelli, MD, PhD (Associate Professor of Psychiatry), and Francesco Donati, MD (visiting scholar, San Paolo Hospital, Milan, Italy), from Pitt Psychiatry, investigated the occurrence and severity of sleep abnormalities in studies reporting sleep quality, sleep architecture, or sleep electroencephalography oscillations across clinical stages of psychosis. The review and meta-analysis included 5,135 patients from 21 studies and identified both uniformly present and stage-specific sleep disruptions.

The team reported that sleep disturbance prevalence is consistently high throughout psychosis stages, with similar prevalence in different psychosis stages, including at-risk individuals. In addition, they found that sleep quality is poor throughout stages of psychosis, and that shared and distinct sleep architecture alterations are present in early psychosis and chronic psychosis, but not in clinical high risk for psychosis. Finally, sleep spindles, but not slow waves, are severely altered in early psychosis and chronic psychosis (spindle measures could not be assessed in clinical high risk for psychosis).

“In the clinical setting, patients with schizophrenia and psychosis commonly report sleep disturbances. In this meta-analysis, for the first time, we quantified sleep disturbances by looking at both subjective (i.e., sleep questionnaires) and objective (i.e., sleep architecture, EEG sleep, slow waves, and spindles) measures,” said Dr. Ferrarelli, the paper’s senior author. “Sleep disturbances were found to be prevalent throughout the course of psychosis, from at-risk to chronic stages, and different stages showed both shared and distinct abnormalities in sleep quality, architecture, and spindles. Together, these findings suggest that sleep should become a core clinical target and research domain from at-risk to early and chronic stages of psychosis and schizophrenia.”    

Sleep Abnormalities in Different Clinical Stages of Psychosis: A Systematic Review and Meta-analysis
Bagautdinova J, Mayeli A, Wilson JD, Donati FL, Colacot RM, Meyer N, Fusar-Poli P, Ferrarelli F.
JAMA Psychiatry. 2023;80(3):202–210. doi:10.1001/jamapsychiatry.2022.4599