TOPLINE

Variability in several sleep outcomes, such as sleep efficiency and time in bed, was greater in individuals at clinical high risk for psychosis and those with schizophrenia spectrum disorders (SSDs) than healthy controls, a new meta-analysis showed. However, only those with SSDs had greater variability in total sleep time, which was the primary outcome.

METHODOLOGY

• A systematic review and meta-analysis included 1358 participants from 18 case-control studies, with 202 individuals at clinical high risk for psychosis (mean age, 20.7 years; 51.4% women), 574 with SSDs (mean age, 37.7 years; 63.2% women), and 582 healthy control individuals (mean age, 31.5 years; 47.6% women).
• Sleep variability was assessed using wrist actigraphy.
• The primary outcome measure was the natural logarithm of the variability ratio (lnVR) for total sleep time.
• Secondary outcome measures were the natural logarithm of the coefficient of variation ratio (lnCVR) for total sleep time and the lnVR and lnCVR for time in bed, sleep latency, wake after sleep onset, sleep efficiency, and number of awakenings.

TAKEAWAY

• Participants with SSDs had greater variability in total sleep time (lnVR, 0.46 minutes [mins]; P < .001), time in bed (lnVR, 0.38 mins; P < .001), wake after sleep onset (lnVR, 0.52 mins; P = .006), and sleep efficiency (lnVR, 0.27%; P = .02) than the control group.
• The group at risk for psychosis had greater variability in time in bed (lnVR, 0.29 mins; P = .02), wake after sleep onset (lnVR, 0.45 mins; P = .02), and sleep efficiency (lnVR, 0.35%; P = .02) than the control group.
• There were no significant between-group differences in sleep latency variability.
• Antipsychotic use, sex, and age did not significantly moderate total sleep time variability in the SSDs group. Although antipsychotic use was linked to greater total sleep time variability in the group at risk for psychosis (P = .008), only five studies were included in the analysis.

IN PRACTICE

“These findings support further investigations of sleep as a candidate biomarker to inform stratified care in psychosis using individual participant data and prospective studies,” the investigators wrote.

SOURCE

The study was led by Rosario Aronica, MD, Oxford Health NHS Foundation Trust, Oxford, England. It was published online on July 22 in JAMA Network Open.

LIMITATIONS

The study was limited by its case-control design, between-study heterogeneity, missing data on race and ethnicity, residual confounding, and constrained statistical power.

DISCLOSURES

The study was funded by the Wellcome Trust. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.