24 Jul Sleep and Mental Health – Part 1
This is the first of a three part series of articles on Sleep and Mental Health.
Sleep apnea, psychopathology, and mental health care
Kaufmann CN, Susukida R, Depp CA.(2017) Sleep apnea, psychopathology, and mental health care. Sleep Health. Aug;3(4):244-249.
This study examined the association between sleep apnea and psychopathology and mental health service utilisation in US. They used data on 264,653 individuals who participated in the 2008-2014 waves of the National Survey on Drug Use and Health (NSDUH), of which 5498 (3.3%) reported having sleep apnea. Participants were categorized as having depression, suicidal ideation, anxiety, and serious psychological distress. Analyses consisted of using logistic regression models with sleep apnea as the main predictor and mental health conditions as the outcomes of interest. Results: Compared with those without sleep apnea, those reporting past-year sleep apnea had 3.11 times increased odds of having depression, 2.75 times increased odds of suicidal ideation, 3.68 times increased odds of anxiety, and 2.88 times increased odds of severe psychological distress, after controlling for confounders. Conclusion: Individuals with sleep apnea have increased risk for psychopathology, including suicidal ideation. Thus, efforts to address the mental health care requirements of those with sleep apnea are needed.
Sleep in schizophrenia: A systematic review and meta-analysis of polysomnographic findings in case-control studies.
Chan MS, Chung KF, Yung KP, Yeung WF. (2017). Sleep in schizophrenia: A systematic review and meta-analysis of polysomnographic findings in case-control studies. Sleep Med Rev.32:69-84.
This review and meta-analysis analysed multiple investigations regarding to polysomnographic abnormalities present in schizophrenia. This showed that patients with schizophrenia have significantly shorter total sleep time, longer sleep onset latency, more wake time after sleep onset, lower sleep efficiency, and decreased slow wave sleep, duration and latency of rapid eye movement sleep compared to healthy controls. One important note was that Illness duration, medication status, and duration of medication withdrawal are several of the clinical factors that contribute to the heterogeneity between studies. Patients with antipsychotic withdrawal for longer than eight weeks were shown to have less sleep architectural abnormalities, compared to shorter duration of withdrawal, but the abnormalities in sleep continuity were similar. Slow wave sleep deficit was found in patients with schizophrenia for more than three years, while sleep onset latency was increased in medication-naïve, medication-withdrawn, and medicated patients. Depending on the severity of illness, sleep disturbance occurs in 30-80% of patients with schizophrenia, and is associated with positive and negative symptoms, cognitive deficits, poorer outcome, and impaired quality of life. The early hypothesis that psychotic symptoms are due to an intrusion of REM sleep into alertness led to a number of investigations on REM sleep disturbance in schizophrenia; however, according to recent reviews, the findings were mixed. A few studies found that REM sleep latency (REML) was shortened in patients with schizophrenia; while some researchers argued that this finding might be due to heterogeneity in the study sample and the effect of medications.
Insomnia and paranoia
Freeman, D., Pugh, K., Vorontsova, N., & Southgate, L. (2009). Insomnia and paranoia. Schizophrenia Research, 108(1-3), 280–284.
Insomnia may contribute to the formation and maintenance of persecutory ideation. This study was to examine the association of insomnia symptoms and paranoia in the general population and the extent of insomnia in individuals with persecutory delusions attending psychiatric services. Assessments of insomnia, persecutory ideation, anxiety, and depression were completed by 300 individuals from the general population and 30 individuals with persecutory delusions and a diagnosis of non-affective psychosis. Results: Insomnia symptoms were clearly associated with higher levels of persecutory ideation. It was confirmed by the high prevalence of insomnia in the individuals with clinical paranoia. Insomnia is most likely an overlooked problem in psychiatric services for individuals with persecutory delusions. Consistent with the theoretical understanding of paranoia, the association was partly explained by the presence of anxiety and depression. Moderate or severe insomnia was present in more than 50% of the delusions group. Insomnia is common in individuals with high levels of paranoia.