High-resolution examination of the relationship between sleep disturbance, functioning and psychotic symptoms in schizophrenia: a novel experience sampling study.

Journal article

Sleep disturbance is common in schizophrenia but its role in predicting functioning and psychotic symptoms has yet to be rigorously examined. The purpose of this study was to conduct a prospective, high-resolution examination of the relationship between nightly sleep and next-day functioning and psychotic symptoms in people with a diagnosis of schizophrenia. Experience sampling methodology was integrated with actigraphy and sleep diaries across seven days in twenty-two patients with a diagnosis of schizophrenia. Momentary assessments of mood, psychotic symptoms and functioning were gathered at five points each day following pseudo-random schedules. Multilevel modelling was performed to evaluate the links between variables. Both objective and subjective sleep disturbance predicted reduced next-day functioning, which remained significant after controlling for psychotic symptom severity. Increased sleep fragmentation and reduced subjective and objective sleep efficiency predicted greater next-day auditory hallucinations, whereas increased objective sleep fragmentation and reduced subjective sleep quality predicted greater paranoia and delusions of control. Negative affect on awakening mediated a proportion of these relationships (range: 17.9% - 57.3%). For the first time, we show that sleep disturbance is a predictor of next-day impaired functioning and psychotic symptom severity in people with a diagnosis of schizophrenia. Interventions targeting sleep may therefore have the potential to enhance functional and symptomatic recovery in those experiencing psychosis, both directly and indirectly.

Authors: Mulligan, L; Haddock, G; Emsley, R; Neil, S; Kyle, S

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Psychological Association
• Journal: Journal of Abnormal Psychology
• Publication date: 2016-08-01
• Acceptance date: 2016-05-13
• DOI: 10.1037/abn0000180
• EISSN: 1939-1846
• ISSN: 0021-843X
• Keywords: schizophrenia; sleep; insomnia; psychosis; functioning