Table 1.
| Sleep disorder (N articles) | Articles | Population | Findings |
|---|---|---|---|
| Insomnia (N=14) | Kajimura et al74 | SZa (N=6) | M: Zopiclone treatment resulted in lower BPRS negative and lower total scores compared to treatment with benzodiazepines. |
| Shamir et al75 | SZa (N=19) | L: SZ patients had reduced endogenous melatonin; M: melatonin improved sleep efficiency in low-efficiency more than in high-efficiency sleepers. | |
| Chemerinski et al24 | SZ/SAD/SDa (N=122) | L: Antipsychotic discontinuation lead to worsening sleep quality; R: total insomnia score prior to antipsychotic withdrawal predicted the severity of psychotic symptoms at the end of the medication-free period. | |
| Luthringer et al68 | SZb (N=36) SZa (N=40) |
M: Paliperidone extended-release benefitted schizophrenia patients with insomnia by improving their sleep continuity and sleep architecture. Moreover, it did not cause daytime drowsiness, it was well tolerated, and ameliorated symptoms of schizophrenia. | |
| Suresh et al76 | SZa (N=24); SADa (N=4) | M: Melatonin treatment ameliorated the quality, depth, and duration of sleep. It also improved mood and daytime functioning. | |
| Freeman et al25 | DDa (N=2) | L: Out of all psychiatric patients (PP), 54% experienced severe clinical insomnia and moderate clinical insomnia; R: severity of insomnia symptoms predicted intensity of persecutory ideation. | |
| Xiang et al57 | SZa (N=255) | L: Prevalence of insomnia in SZ was 36%. Older age, fewer psychiatric hospitalizations, symptoms of depression, and use of hypnotics were all associated with worse insomnia symptoms; R: insomnia and other sleep disturbances predicted a poorer physical quality of life in SZ. | |
| Tek et al73 | SZ/SADa (N=39) | M: In the SZ group treated with eszopiclone, there was an improvement in the Insomnia Severity Index and in a working memory test. Psychiatric symptoms remained stable. | |
| Hou et al58 | SZc (N=623) | L: 28.9% of SZ patients had one type of insomnia; R: patients with insomnia had worse symptoms and poorer mental quality of life. | |
| Waters et al63 | SZ/SADa (N=14) | M: For insomnia management, 71% of all PP identified behavioral therapies as acceptable, 57.2% for melatonin, and only 22.5% for medication-based treatment. However, pharmacotherapy was considered useful for short-term and acute sleep problems by the majority of patients. | |
| Chiu et al65 | SZd (N=36); SADd (N=6) | L: Behavioral factors are common in both psychiatric and healthy groups suffering from insomnia (e.g., nighttime rumination); | |
| Freeman et al67 | SZa (N= 38); SADa (N=10) | M: psychological therapy (i.e., sleep education, cognitive and behavioral strategies) can be effectively used to correct wrong sleep habits. | |
| Li et al62 | SZc (N=308); SADc (N=26); DDc (N=16) | M: Cognitive behavioral therapy had the longest efficacy on insomniac PP. Beneficial effects were still present at 24-week follow-ups. L: SSD prevalence of insomnia =19%, SSD prevalence of nightmare =9%; R: severity of insomnia predicted number of suicide attempts. |
|
| Chiu et al66 | SSDc (N= 14) | L: Prevalence of insomnia =100%, circadian dysfunctions =78.6%, delayed sleep phase =21.4%, night terrors =21%, sleepwalking =14.3%, sleep disordered breathing =42.9%; R: sleep difficulties had a strong negative effect on daytime functions and caused disability in these patients. | |
| Restless leg syndrome (RLS) and periodic limb movement (PLM) disorder (N=4) | Walters et al30 | NIAc (N=9); RLS (N=11) | L: The RLS group had more sleep disturbances and longer sleep latency, whereas both groups had more awakenings and less sleep efficiency. RLS patients had also worse symptoms at night and resting. |
| Ancoli-Israel et al28 Staedt et al27 |
SZc (N=44); SADc (N=8) SZa (N=10) |
L: Only 14% of the patients had at least five limb movements per hour of sleep. L: PLMs were detected in every patient. This finding suggests a connection between long-term neuroleptic treatment and PLMD. |
|
| Kang et al29 | SZa (N=182) | L: 39% of SZ had RLS and 87% met one criteria; R: BPRS and Athens Insomnia Scale (AIS) were higher in the RLS group. | |
| Obstructive sleep apnea (OSA) (N=6) | Ancoli-Israel et al28 | SZc (N=44); SADc (N=8) | L: 48% of patients with SZ had at least 10 respiratory events per hour of sleep, which were associated with daytime sleepiness. |
| Alam et al32 | PPc (N=100; SZ=56; SAD=18) | L: 69% of the patient population was at high risk for OSA; among them, 62% had a SZ diagnosis; 85% of the patients were taking clozapine (N=42) and 69% of those on risperidone (N=42) had a positive STOP-BANG screening for OSA. | |
| Winkelman33 | PPc (N=364; SZa =46) | L: OSA was more prevalent in SZ, regardless of age, gender, BMI, and chronic neuroleptic use. However, SZ had a higher BMI compared to other patients. | |
| Waters et al55 | PPc (N=74; SZa=52) | L: 25% of patients with SZ were at high risk for OSA. High-risk SZ patients were on more than one antipsychotic medication and on higher doses compared to the other patients at low risk for OSA. | |
| Annamalai et al35 | SZ/SADc (N=175) | L: 14.6% of all patients had a OSA diagnosis, 57.7% were at high risk. SZ with a OSA had higher BMI; M: treatment compliance with CPAP was 53.8%. | |
| Stubbs et al31 | SSDc (N=138,700) | L: In SZ patients the prevalence of OSA was 15.4%, and was associated with older age and higher BMI. | |
| Circadian rhythm disorders (N=5) | Martin et al39 | SZc (N=28) | L: Medicated patients with SZ slept more hours both night and during the day (i.e., more naps). R/L: SZ patients who performed better in neurophysiological tests slept more during the night and were more alert during the daytime. |
| Poulin et al37 | SZ/SADc (N=150) | L: SZ patients had longer sleep latency, time in bed, total sleep time, and more naps during the day than healthy controls. | |
| Afonso et al50 | SZc (N=23) | L: More than 50% of SZ patients presented irregular sleep–wake patterns. SZ had more disrupted sleep and a lower quality of life compared to healthy controls. | |
| Wulff et al36 | SZc (N=20) | L: 17 SZ patients had abnormal wake–sleep patterns, including longer sleep periods (5), irregular/broken sleep/wake cycles (5), delayed sleep cycles (6), and delayed and non-24-hour sleep–wake cycles (4). The last two groups had a delayed melatonin peak and non-24-hour melatonin cycle, respectively. | |
| Afonso et al38 | SZc (N=34) | L: SZ patients slept more at night, but had lower sleep efficiency, longer sleep latency, more awakenings during the night, and poorer quality of sleep. Advanced sleep-phase syndrome (N=3) and irregular sleep-wake patterns (N=3) were also found in a small subset of patients. | |
| Night eating syndrome (NES) (N=2) | Palmese et al42 | SZ/SADc (N=175) | L: 44% of SZ patients had clinical insomnia. SZs with severe insomnia had higher depression scores, lower quality of life score, and higher BMI. SZs with severe insomnia had higher scores in the Night Eating Questionnaire (NEQ). |
| Palmese et al41 | SZ/SAD2 (N=100) | L: The prevalence of NES among SZs was 12%, with additional 10% who had a subthreshold condition. R: SZ patients with both full and subthreshold NES were more depressed and had worse insomnia. |
|
| Narcolepsy (NT) (N=2) | Huang et al46 | SZa (N=13); NC (N=37) NCSZa (10) |
L: NCSZ patients had higher BMI than NC patients at narcolepsy onset. NCSZ patients had more severe psychotic symptoms and more frequent depressive symptoms than SZ. Long-term response to treatment was poorer. NCSZ group had higher recurrence of DQB1(∗)-03:01/06:02 genes (70%). |
| Plazzi et al44 | NT (N=28); SZa (N= 21) | L: NT type 1 hallucinations are more frequently multimodal and hypnagogic/hypnopompic. Positive and negative symptoms were higher in SZ patients. | |
| Sleep disturbances that do not meet criteria for sleep disorders (N=10) | Göder et al53 | SZa (N=17) | R: Reduced SWS and sleep efficiency in SZ patients predicted an impaired performance in visuospatial memory tasks. |
| Müller et al69 | SZa (N= 10) | M: After a 4-weeks treatment with olanzapine, PANSS scores, sleep efficiency, SWS sleep, and REM sleep were all improved. | |
| Yamashita et al71 | SZa (N=86) | M: Olanzapine, quetiapine, and risperidone showed more efficacy in treating sleep disturbances than other atypical antipsychotics. Higher improvement was observed in elderly patients with schizophrenia, as well as in patients with longer sleep latency and worse daytime dysfunction. | |
| Hofstetter et al59 | SZ a(N=23); SAD a (N= 6) | R: Association between lower sleep quality and lower quality of life. SZ patients with sleep disturbances had less positive reappraisal in stressful situations. | |
| Waters et al60 | SSDd (N=67) | L: 60% reported fatigue, 67% sleep disturbances, and 28.4% both; R: poorer functional health for SZ patients with higher levels of fatigue. | |
| Brissos et al61 | SZd (N=811) | L: SZ patients with sleep problems had more symptoms; R: association between SZ quality of sleep and patients’ and caregivers’ satisfaction with their life. | |
| Kluge et al70 | SZc (N=26); SADc (N=3); SDc (N=1) | M: Treatment with both olanzapine and clozapine improved sleep continuity, whereas olanzapine alone resulted in longer REM sleep and SWS duration. Neither of these medications caused RLS-related symptoms. | |
| Afonso et al51 | SZc (N= 811) | R: SZ patients with sleep disturbances had more symptoms. SZ patients less compliant with pharmacological treatment had higher rates of sleep disturbances. | |
| Mulligan et al52 | SZd (N= 22) | R: Association between sleep fragmentation and reduction in subjective and objective sleep efficiency with auditory hallucinations the following day. Association between objective sleep fragmentation and a reduction in subjective sleep quality with paranoia and delusions. |
|
| Faulkner and Bee64 | SZd(N=8); SADd (N=6); DDd(N=1) | R: Association between sleep disturbances and a reduction in the participation in valued activities; M: concerns related to side effects of pharmacotherapy. Antipsychotics were preferred to hypnotics. Importance of discussing pharmacological and other treatments with the patients. |
Notes:
a
Treated,
b
untreated,
c
combination,
d
partial or data absent.
Abbreviations: BMI, body mass index; BPRS, Brief Psychiatric Rating Scale; CPAP, continuous positive airway pressure; DD, delusional disorder; NC, narcoleptic-cataplectic; NCSZ, narcoleptic-cataplectic schizophrenia; NIA, neuroleptic-induced akathisia; PANSS, Positive and Negative Syndrome Scale; PLMD, periodic limb movement disorder; REM, rapid eye movement; SAD, schizoaffective disorder; SD, schizophreniform disorder; SSD, schizophrenia spectrum disorder; SWS, slow-wave sleep; SZ, schizophrenia; L, links; R, risks; M, management.