Irregular sleep linked to worsening symptoms of schizophrenia

Erratic sleep patterns, dysregulated transitions between sleep and wake cycles, and excessive daytime sleep are linked to worsening symptoms of schizophrenia, new research suggests.

The results also showed that people with schizophrenia spectrum disorders (SSDs) who lived in residential facilities had rigid routines, which were correlated with a higher degree of negative symptoms.

Doctor Fabio Ferrarelli

Rigid routines were problematic for patients living in residential settings, said lead researcher Fabio Ferrarelli, MD, PhD. Medscape Medical News. Ferrarelli is an associate professor of psychiatry at the University of Pittsburgh School of Medicine.

“Engaging in different activities at different times in activities associated with motivation and social interaction – this helps to improve hard-to-treat negative symptoms,” he said.

THE results were published online on April 14 in Molecular psychiatry.

Need to increase activity levels

Although there is no shortage of research on sleep disturbances in people with schizophrenia, research looking specifically at rest-activity rhythm disturbances and their relationship to schizophrenia symptoms has been limited by small sample sizes or the absence of a control group, note the researchers.

To fill this research gap, investigators recruited 230 patients with DSS from participating residential facilities and communities across Italy. Participants included 108 healthy control participants, 54 community-dwelling patients with SSD who received outpatient services, and 68 patients with SSD who lived in residential facilities.

All participants wore an actigraph for 7 consecutive days so that investigators could monitor sleep-wake patterns.

Compared to healthy control participants, both SSD groups had more total sleep time and spent more time resting or being passive (P < .001). In contrast, healthy control participants were significantly more active.

This may be partly explained by the fact that most control participants were employed or attending school. Additionally, investigators note that many drugs used to treat SSD can be highly sedating, causing some patients to sleep up to 15 hours a day.

Among residential participants with SSD, there was a higher level of inter-daily stability and higher daily rest-activity-rest fragmentation than in healthy control participants or community-dwelling patients with SSD (P < .001). There was also a higher level of negative symptoms among the residential participants with SSD than among the community-dwelling group with SSD.

Taken together, Ferrarelli and his team interpreted the results to mean that inter-day stability might reflect premature aging or neurodegenerative processes in patients with more severe forms of schizophrenia.

Another explanation could be that the rigid routine of the residential facility made negative symptoms worse, Ferrarelli said. It’s important to add variety to the mix – getting people to engage in different activities at different times of the day would likely help residential SSD patients overcome the negative symptoms of the disorder.

Although the participants were recruited in Italy, Ferrarelli said he thought the results were generalizable.

Two-way relationship?

Commenting on the findings of Medscape Medical NewsMatcheri Keshavan, MD, professor of psychiatry at Harvard Medical School in Boston, Massachusetts, said the findings are consistent with “well-known clinical observations that SSD patients tend to spend more time in bed and have a more dysregulated sleep.

Dr. Matcheri Keshavan

“Negative symptoms are also common, especially in residential patients. However, determining causation is difficult, as we do not know whether excessive sleepiness and decreased physical activity cause negative symptoms, or vice versa. , or if it’s a two-way relationship,” Keshavan says.

He pointed out that physical exercise is known to increase the quality of sleep for people with mental illness and can also improves negative symptoms. “A useful approach in clinical practice is to increase activity levels, especially physical activities like walking and gardening.”

Keshavan said he would like to see future research focused on whether an intervention such as aerobic exercise will improve sleep quality as well as negative symptoms.

He also said that future research should ideally examine the characteristics of sleep alterations in schizophrenia.

“For example, while sleep duration is increased in schizophrenia, studies suggest that time spent in deep sleep is reduced; sleep spindles, which are important for consolidating memory during sleep, are also reduced. correcting these deficits can improve negative symptoms and cognitive deficits,” he added.

The study was funded by the Italian Ministry of Health and the National Institute of Mental Health. There were no conflicts of interest.

Mol Psychiatry. Published online April 14, 2023. Full Text

For more information about Medscape Psychiatry, join us on Facebook And Twitter.