Towards A Deeper Understand of Sleep Disorders and Psychosis
Sleep disorders are a common experience for individuals with psychosis, and understanding how they manifest may help clinicians develop tailored treatment.
Neurology Learning Network spoke with Ahmad Mayeli, PhD, department of psychiatry, University of Pittsburg, about his study “Sleep Abnormalities in Different Clinical Stages of Psychosis,” recently published in JAMA Psychiatry.
In Part 1 of this Q&A, Dr Mayeli explains more about the need to investigate the connection between sleep and psychosis, study designs, and the most significant findings.
Evi Arthur, Associate Digital Editor, Neurology Learning Network (NLN): What led you and your colleagues to investigate the connection between sleep and psychosis?
Ahmad Mayeli, PhD: Sleep disturbances have long been recognized as a common feature of psychotic disorders in psychiatric literature. Individuals with psychotic symptoms frequently experience disrupted sleep patterns, which can manifest as difficulties falling asleep and staying asleep. These disturbances may exacerbate the severity of psychotic symptoms and contribute to a poorer prognosis. Given the crucial role of sleep in psychosis, we aimed to identify sleep abnormalities across various stages of the disorder through a systematic review and meta-analysis. Our analysis encompassed a wide range of sleep measures, from self-reported measures to more advanced measures such as sleep slow waves and spindles, providing a comprehensive understanding of sleep disturbances in different stages of psychosis based on existing literature.
Arthur, NLN: Please briefly describe the study method and participants.
Dr Mayeli: In this meta-analysis, we searched Web of Science and PubMed between inception and June 2022 for observational studies reporting the prevalence of sleep disturbances and case-control studies reporting sleep architecture, sleep oscillatory, or sleep quality measures for clinical high risk for psychosis (CHR-P), early psychosis (EP), or chronic psychosis (CP) both separately and combined.
Overall, 59 studies were included in the meta-analysis. Twenty-one of these studies assessed sleep disturbance prevalence in 5135 patients, while 39 studies measured sleep alterations subjectively (such as sleep quality) and/or objectively (such as sleep architecture and sleep oscillatory measures) in 1575 patients and 977 controls.
Arthur, NLN: Please briefly describe the most significant finding(s).
Dr Mayeli: We found that approximately half of the patients experienced sleep disturbances, with similar rates of prevalence observed across different stages of psychosis. While the self-report sleep disturbance were consistent among different stages, those with chronic psychosis exhibited more arousal than those with clinical high-risk psychosis, and reduced spindle duration than patients with early psychosis.
Our study revealed that sleep disturbances were prevalent across all stages of psychosis, as measured by both subjective and objective methods. We found that different stages of psychosis exhibited both shared and distinct abnormalities in sleep quality, architecture, and spindles. These findings suggest that sleep abnormalities are a common feature of psychosis and may have a significant impact on the course and severity of the disorder.
Arthur, NLN: Which outcomes were different than you expected?
Dr Mayeli: In conducting our research, we encountered several outcomes that differed from our initial expectations. Firstly, we noted a lack of studies focusing on the clinical high risk for psychosis, which would have been valuable in understanding the early stages of the disorder. Additionally, we found that many studies did not utilize validated tools for diagnosis or standard questionnaires for assessing sleep, which may have led to inconsistencies in the findings. Finally, we discovered a relative dearth of studies investigating sleep spindles and slow waves, which are important markers of sleep abnormalities in psychosis. These outcomes highlight the need for further research in these areas to better understand the complex relationship between sleep disturbances and psychosis.
Ahmad Mayeli, PhD, is a postdoctoral research associate at the University of Pittsburgh, Department of Psychiatry, with a specialization in neuroimaging, signal processing, and data analysis. He holds a PhD in Electrical and Computer Engineering from the University of Oklahoma, which focused on developing new approaches to simultaneous EEG-fMRI acquisition, finding objective biomarker for mood and anxiety disorders, and studying fMRI neurofeedback in healthy and depressive individuals. Currently, he is working as a postdoctoral research associate in Dr Fabio Ferrarelli's lab, where he is researching sleep characteristics and circadian rhythm in individuals at clinical high risk for psychosis individuals and patients with schizophrenia and investigating the neurobiology of psychosis.
