Sleep in untreated patients with schizophrenia: a meta-analysis.

The present meta-analysis investigated the characteristics of sleep in patients with schizophrenia without neuroleptic treatment at the time of sleep recording. The 20 selected studies included 652 participants (321 patients with schizophrenia and 331 healthy subjects). Effect sizes were evaluated using d values for the following sleep variables: sleep latency (SL), total sleep time (TST), sleep efficiency index (SEI), total awake time (TAT), stage 2 percentage (S2%), stage 4 percentage, slow-wave-sleep percentage, rapid-eye-movement (REM) percentage, and REM latency. The initial meta-analysis revealed that patients with schizophrenia have the following sleep disorders: increased SL, decreased TST, and decreased SEI. A moderator analysis revealed that these sleep disorders were worse for the neuroleptic-withdrawal group relative to the never-treated group. However, only never-treated patients showed significantly increased TAT and diminished S2%. These results confirm that patients with schizophrenia have sleep disorders that are not necessarily a consequence of neuroleptic treatments, suggesting that sleep disorders are an intrinsic feature of schizophrenia. However, it must be noted that some sleep disorders may be amplified by residual effects of neuroleptic withdrawal, while others appear to be dampened by neuroleptic treatment.

[1]  R. Godbout,et al.  Sleep architecture and its clinical correlates in first episode and neuroleptic-naive patients with schizophrenia , 2003, Schizophrenia Research.

[2]  A. Rush,et al.  Slow-wave activity during non-REM sleep in men with schizophrenia and major depressive disorders , 2000, Psychiatry Research.

[3]  S. Dursun,et al.  Effects of typical antipsychotic drugs and risperidone on the quality of sleep in patients with schizophrenia: a pilot study. , 1999, Journal of psychiatry & neuroscience : JPN.

[4]  E. Mignot,et al.  Cerebrospinal fluid prostaglandins and corticotropin releasing factor in schizophrenics and controls: relationship to sleep architecture , 1998, Psychiatry Research.

[5]  D. Kupfer,et al.  Delta sleep deficits in schizophrenia: evidence from automated analyses of sleep data. , 1998, Archives of general psychiatry.

[6]  J. Röschke,et al.  An analysis of the brain's transfer properties in schizophrenia: Amplitude frequency characteristics and evoked potentials during sleep , 1998, Biological Psychiatry.

[7]  F. Holsboer,et al.  Sleep in Schizophrenia: A Polysomnographic Study on Drug-Naive Patients , 1997, Neuropsychopharmacology.

[8]  J. Panksepp.  Advances in Biological Psychiatry , 1996 .

[9]  T. Pollmächer,et al.  The electroencephalographic sleep pattern in schizophrenic patients treated with clozapine or classical antipsychotic drugs. , 1996, Journal of psychiatric research.

[10]  Edith V. Sullivan,et al.  Slow wave sleep and computed tomographic measures of brain morphology in schizophrenia , 1996, Psychiatry Research.

[11]  M. Keshavan,et al.  A longitudinal study of EEG sleep in schizophrenia , 1996, Psychiatry Research.

[12]  R. Tandon,et al.  Biological predictors of 1-year outcome in schizophrenia in males and females , 1995, Schizophrenia Research.

[13]  J. Sweeney,et al.  Slow-wave sleep and symptomatology in schizophrenia and related psychotic disorders. , 1995, Journal of psychiatric research.

[14]  D. Riemann,et al.  Sleep in adolescents with primary major depression and schizophrenia: a pilot study. , 1995, Journal of child psychology and psychiatry, and allied disciplines.

[15]  M. Bohus,et al.  Cholinergic REM induction test: muscarinic supersensitivity underlies polysomnographic findings in both depression and schizophrenia. , 1994, Journal of Psychiatric Research.

[16]  P. Keck,et al.  Polysomnographic characteristics of schizophrenia in comparison with mania and depression , 1993, Biological Psychiatry.

[17]  V. Zarcone,et al.  Rapid eye movement sleep eye movements in schizophrenia and depression. , 1993, Archives of general psychiatry.

[18]  R. Thisted,et al.  Sleep and Psychiatric Disorders: A Meta-analysis , 1992 .

[19]  T. Neylan,et al.  Sleep in schizophrenic patients on and off haloperidol therapy. Clinically stable vs relapsed patients. , 1992, Archives of general psychiatry.

[20]  D. Riemann,et al.  Effect of RS 86 on REM latency in schizophrenia , 1991, Psychiatry Research.

[21]  P. Linkowski,et al.  Circadian and sleep-related endocrine rhythms in schizophrenia. , 1991, Archives of general psychiatry.

[22]  V. Zarcone,et al.  Evidence for the role of serotonin in the regulation of slow wave sleep in schizophrenia. , 1991, Sleep.

[23]  John E. Hunter,et al.  Methods of Meta-Analysis , 1989 .

[24]  T. Neylan,et al.  Decreased slow-wave sleep and enlarged lateral ventricles in schizophrenia. , 1988, Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology.

[25]  P. Linkowski,et al.  Sleep EEG variables in young schizophrenic and depressive patients , 1988, Biological Psychiatry.

[26]  D. Kupfer,et al.  Electroencephalographic sleep in young, never-medicated schizophrenics. A comparison with delusional and nondelusional depressives and with healthy controls. , 1987, Archives of general psychiatry.

[27]  V. Zarcone,et al.  Abnormal rapid eye movement latencies in schizophrenia. , 1987, Archives of general psychiatry.

[28]  J. Gaillard,et al.  Temporal Organization of Sleep in Schizophrenics and Patients with Obsessive-Compulsive Disorder , 1984 .

[29]  I. Karacan,et al.  Sleep Disorders: Diagnosis and Treatment , 1999 .

[30]  A. Jus,et al.  Sleep EEG studies in untreated, long-term schizophrenic patients. , 1973, Archives of general psychiatry.

[31]  D. Kupfer,et al.  Sleep disturbance in acute schizophrenic patients. , 1970, The American journal of psychiatry.

[32]  E. Wolpert.  A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. , 1969 .

[33]  A. Rechtschaffen.  A manual of standardized terminology, techniques and scoring system for sleep of human subjects , 1968 .