Sleep disturbances and the At Risk Mental State: A systematic review and meta-analysis

Latoya Clarke; Katharine Chisholm; Francesco P Cappuccio; Nicole K Y Tang; Michelle A Miller; Farah Elahi; Andrew D Thompson

doi:10.1016/j.schres.2020.06.027

Sleep disturbances and the At Risk Mental State: A systematic review and meta-analysis

Schizophr Res. 2021 Jan:227:81-91. doi: 10.1016/j.schres.2020.06.027. Epub 2020 Jul 6.

Authors

Latoya Clarke¹, Katharine Chisholm², Francesco P Cappuccio³, Nicole K Y Tang⁴, Michelle A Miller³, Farah Elahi³, Andrew D Thompson³

Affiliations

¹ Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK. Electronic address: l.clarke.5@warwick.ac.uk.
² School of Life & Health Sciences, Aston University, Birmingham, UK.
³ Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK.
⁴ Department of Psychology, University of Warwick, Coventry, UK.

PMID: 32646803
DOI: 10.1016/j.schres.2020.06.027

Abstract

Aims: To synthesise and investigate how sleep disturbances relate to psychotic symptoms, functioning and Quality of Life (QoL) in At Risk Mental State (ARMS) youth.

Method: A comprehensive search of six databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and CENTRAL) was conducted. Eligible studies provided data on sleep disturbances or disorders in ARMS patients.

Results: Sixteen studies met the inclusion criteria (n = 1962 ARMS patients) including 7 cross-sectional studies, 2 RCT's and 7 cohort studies. Narrative synthesis revealed that self-reported sleep (e.g., general disturbances, fragmented night time sleep and nightmares) was poorer among ARMS patients compared to healthy controls. In the limited studies (n = 4) including objective measurements of sleep disturbances, ARMS patients experienced higher levels of movement during sleep, more daytime naps and increased sleep latency compared to controls. Furthermore, sleep disturbances were associated with attenuated psychotic symptoms and functional outcomes cross-sectionally and longitudinally. Only one study investigated the relationship between sleep and QoL. The exploratory meta-analysis revealed a significant difference in self-reported sleep disturbances measured by the PSQI (mean difference in score: 3.30 (95% CI 1.87, 4.74), p < 0.00001) and SIPS (mean difference in score: 1.58 (95% CI 0.80, 2.35), p < 0.00001) of ARMS patients compared to control groups.

Conclusions: ARMS individuals report impaired sleep quality and reduced sleep quantity compared to healthy controls. However, further research is needed to explore the longitudinal relationship between sleep disruptions and QoL in early psychosis. Significant variations in how sleep is measured across studies highlight a need to assess disturbances to sleep using robust and consistent approaches in this patient group.

Keywords: At Risk Mental State; Psychosis; Sleep; Ultra high risk; Youth mental health.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adolescent
Cross-Sectional Studies
Humans
Psychotic Disorders* / complications
Psychotic Disorders* / epidemiology
Quality of Life
Sleep
Sleep Wake Disorders* / epidemiology
Sleep Wake Disorders* / etiology