Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Sleep Disturbances Common in Schizophrenia

Compr Psychiatry; 2019 May; Laskamoen, et al

Sleep disturbances, including insomnia, hypersomnia, and delayed sleep phase, are frequent in schizophrenia, and associated with more severe clinical symptomatology, a recent study found. This suggests that sleep disturbance is a clinically relevant transdiagnostic phenomenon. Participants with schizophrenia spectrum disorders (n=617) and healthy controls (HC, [n=173]) were included in the study. Sleep disturbances were identified based on items from the Inventory of Depressive Symptoms–Clinician rated scale. Clinical symptoms were assessed with the Positive and Negative Syndrome scale and level of functioning with the Global Assessment of Functioning scale. Researchers found:

  • The rate of any sleep disturbance was 78% in schizophrenia and 39% in HC.
  • Insomnia was the most frequently reported sleep disturbance.
  • The schizophrenia group reported significantly more of any sleep disturbances than HC.
  • Having a sleep disturbance was associated with more severe negative and depressive symptoms and with lower functioning across diagnostic groups.
  • Hypersomnia was the only sleep disturbance associated with previous treatment history.

Citation:

Laskamoen F, Simonsen C, Büchmann C, et al. Sleep disturbances in schizophrenia spectrum and bipolar disorders—A transdiagnostic perspective. Compr Psychiatry. 2019;91:6-12. doi:10.1016/j.comppsych.2019.02.006.

Commentary:

Sleep problems are a major concern in people with psychotic disorders such as schizophrenia and bipolar disorder and contribute substantially to disability and burden. In line with previous studies, this cross-sectional analysis found that sleep disorder was more common in those with psychotic disorder vs healthy controls and that sleep problems were associated with greater symptom severity and worse functioning. The fact that 4 out of 5 individuals with psychotic spectrum disorders self-report sleep problems is notable, and underscores both the consideration of sleep disorder as a core cross-cutting diagnostic feature of serious mental illness and the need for clinicians to evaluate problems in falling and staying asleep in their patients. —Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.