Sleep disturbance in schizophrenia (original) (raw)

Schizophrenia and comorbid sleep disorders

Neuroimmunology and Neuroinflammation, 2016

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Schizophrenia and sleep disorders: links, risks, and management challenges

Nature and Science of Sleep, 2017

Schizophrenia is a major psychiatric disorder that has a massive, long-lasting negative impact on the patients as well as society. While positive symptoms (i.e., delusions and hallucinations), negative symptoms (i.e., anhedonia, social withdrawal), and cognitive impairments are traditionally considered the most prominent features of this disorder, the role of sleep and sleep disturbances has gained increasing prominence in clinical practice. Indeed, the vast majority of patients with schizophrenia report sleep abnormalities, which tend to precede illness onset and can predict an acute exacerbation of psychotic symptoms. Furthermore, schizophrenia patients often have a comorbid sleep disorder, including insomnia, obstructive sleep apnea, restless leg syndrome, or periodic limb movement disorder. Despite accumulating data, the links between sleep disorders and schizophrenia have not been thoroughly examined, in part because they are difficult to disentangle, as numerous factors contribute to their comorbidity, including medication status. Additionally, sleep disorders are often not the primary focus of clinicians treating this population, despite studies suggesting that comorbid sleep disorders carry their own unique risks, including worsening of psychotic symptoms and poorer quality of life. There is also limited information about effective management strategies for schizophrenia patients affected by significant sleep disturbances and/or sleep disorders. To begin addressing these issues, the present review will systematically examine the literature on sleep disorders and schizophrenia, focusing on studies related to 1) links between distinct sleep disorders and schizophrenia; 2) risks unique to patients with a comorbid sleep disorder; and 3) and management challenges and strategies.

Sleep disturbances in schizophrenia: what we know, what still needs to be done

Current Opinion in Psychology, 2019

Sleep disturbances are commonly observed in schizophrenia (SCZ) and are associated with worse psychotic symptoms and poorer clinical outcomes. Early polysomnography studies have focused on characterizing differences in sleep architecture between patients with SCZ and healthy controls. More recently, research has focused on sleep-specific EEG oscillations, such as sleep spindles and slow waves, which reflect the integrity of underlying thalamo-cortical networks. Furthermore, highdensity (hd)-EEG (64 channels), which affords enhanced spatial resolution, has been employed to better localize abnormalities in sleep characteristics and related thalamocortical circuits in patients with SCZ and related disorders. In this article, we will review the most relevant sleep abnormalities reported in SCZ, with an emphasis on recent findings, and propose directions for future research.

Sleep in schizophrenia: a preliminary study using the Pittsburgh Sleep Quality Index

… of Sleep-Wakefulness …, 2002

Schizophrenia is related to changes in the architecture of sleep evaluated with polysomnography. Our purpose is to evaluate the sleep quality of schizophrenic people, comparing a schizophrenic group with a control group, and to investigate the effect of these factors. Material and methods: We evaluated 44 patients, 32 men and 12 women, comparing them with 44 healthy people. Both groups were questioned using the Spanish version of the Pittsburgh Sleep Quality Index (PSQI). Results: Sleep quality in schizophrenics is damaged; they spend more time in bed than controls of the same age do and they sleep longer. These factors could represent an attempt to compensate for the deficit in slow wave sleep. Conclusion: Sleep quality in schizophrenic people is damaged. Thus, sleep quality profile could be a risk marker for this illness.

Sleep in schizophrenia: time for closer attention

The British Journal of Psychiatry, 2012

Summary Recent sleep research has highlighted two specific anomalies in schizophrenia that have a proven impact on cognition. One is an abnormality of circadian rhythm, reported in this journal in two separate studies over the past year, and the other is the finding in electroencephalograms of reduced sleep spindles.

Sleep Abnormalities in Schizophrenia: State of the Art and Next Steps

American Journal of Psychiatry, 2021

Sleep disturbances are commonly observed in schizophrenia (SCZ), including chronic, early course, and first episode individuals. This has generated considerable interest, both in the clinical and research endeavors, in characterizing the relationship between disturbed sleep and SCZ. Sleep features can be objectively assessed with EEG recordings. Traditionally, EEG studies have focused on sleep architecture, which includes non-rapid eye movement (NREM) and REM sleep stages. More recently, numerous studies have investigated alterations in sleep-specific rhythms, including EEG oscillations like sleep spindles and slow waves of individuals with SCZ relative to control groups. In this article, I will first review the state-of-the-art evidence of disturbed sleep in SCZ, starting from the relationship between sleep disturbances and the clinical symptoms of these patients. I will then present studies demonstrating abnormalities in sleep architecture and sleep oscillatory rhythms in SCZ and related psychotic disorders with an emphasis on recent work demonstrating sleep spindles and slow wave deficits in early course and first-episode individuals. Next, I will show how these sleep abnormalities relate to the cognitive impairments in patients diagnosed with SCZ and point to dysfunctions in underlying thalamo-cortical circuits, Ca+ channel activity, and GABA/glutamate neurotransmission. Finally, I will discuss some of the next steps needed to further establish the role of altered sleep in SCZ, including the need to investigate sleep abnormalities across the psychotic spectrum and establishing their relationship with circadian disturbances, which in turn will contribute to the development of novel, sleep informed treatment interventions.

Sleep and Cognition in Schizophrenia

2017

Background and Objective: Schizophrenia (SCZ) affects both genders with similar rates. It usually appears in the second to the third decades of one’s life. Schizophrenia is marked by a wide spectrum of symptoms, which functionally impair patients. The symptoms are categorized as positive, negative, or cognitive deficits. Among them, cognitive disturbance is highly valued. However, the relationship between sleep and cognition in patients with schizophrenia has been less widely considered. In this study, we aimed to review the relationship between sleep and cognition in patients with schizophrenia. Materials and Methods: We considered selected key words (e.g. Cognition, Schizophrenia, and Sleep), and searched the online databases at the first step with defined time window of 2010 to the present; while at the second step, the incomplete knowledge was completed from 1990 to 2010. Among them, articles related to our research objectives were selected for further review. Results: Cognitive...

Sleep in Untreated Patients With Schizophrenia: A Meta-Analysis

Schizophrenia Bulletin, 2004

The present meta-analysis investigated the characteristics of sleep in patients with schizophrenia without neuroleptic treatment at the time of sleep recording. The 20 selected studies included 652 participants (321 patients with schizophrenia and 331 healthy subjects). Effect sizes were evaluated using d values for the following sleep variables: sleep latency (SL), total sleep time (TST), sleep efficiency index (SEI), total awake time (TAT), stage 2 percentage (S2%), stage 4 percentage, slow-wave-sleep percentage, rapid-eye-movement (REM) percentage, and REM latency. The initial meta-analysis revealed that patients with schizophrenia have the following sleep disorders: increased SL, decreased TST, and decreased SEI. A moderator analysis revealed that these sleep disorders were worse for the neuroleptic-withdrawal group relative to the never-treated group. However, only never-treated patients showed significantly increased TAT and diminished S2%. These results confirm that patients with schizophrenia have sleep disorders that are not necessarily a consequence of neuroleptic treatments, suggesting that sleep disorders are an intrinsic feature of schizophrenia. However, it must be noted that some sleep disorders may be amplified by residual effects of neuroleptic withdrawal, while others appear to be dampened by neuroleptic treatment.

Sleep in schizophrenia patients and the effects of antipsychotic drugs

Sleep Medicine Reviews, 2004

Insomnia is a common feature in schizophrenia. However, it seldom is the predominant complaint. Nevertheless, severe insomnia is often seen during exacerbations of schizophrenia, and may actually precede the appearance of other symptoms of relapse. The sleep disturbances of either never-medicated or previously treated schizophrenia patients are characterized by a sleep-onset and maintenance insomnia. In addition, stage 4 sleep, slow wave sleep (stages 3 and 4), non-REM (NREM) sleep in minutes and REM latency are decreased. The atypical antipsychotics olanzapine, risperidone, and clozapine significantly increase total sleep time and stage 2 sleep. Moreover, olanzapine and risperidone enhance slow wave sleep. On the other hand, the typical antipsychotics haloperidol, thiothixene, and flupentixol significantly reduce stage 2 sleep latency and increase sleep efficiency.Future research should address: (1) the sleep patterns in subtypes of schizophrenia patients; (2) the role of neurotransmitters other than dopamine in the disruption of sleep in schizophrenia; (3) the functional alterations in CNS areas related to the pathophysiology of schizophrenia during NREM sleep and REM sleep (brain imaging studies); (4) the short-term, intermediate-term, and long-term effects of atypical antisychotics on sleep variables.

Further observations on electrophysiological sleep patterns in schizophrenia

Comprehensive Psychiatry, 1965

RESULTS of a study of electroeneephalographic (EEG~) and rapid eye-movement (REM) aeti~dty recorded during sleep of schizophrenic and control subjects, a This previous report described results obtained for total sleep, REM activity, and associated low-voltage fast (Stage 1) EEG, or "'dream time.'" Here, we will present data for sleep latency, dream latency, and eye-movement density during dream periods obtained from the same group of subjects.