title: High resolution examination of the role of sleep disturbance in predicting functioning and psychotic symptoms in schizophrenia: A novel experience sampling study.
abstract: 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 7 days in 22 patients with a diagnosis of schizophrenia. Momentary assessments of mood, psychotic symptoms, and functioning were gathered at 5 points each day following pseudorandom schedules. Multilevel modeling was performed to evaluate the links between variables. 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. Therefore, interventions targeting sleep may have the potential to directly and indirectly enhance functional and symptomatic recovery in those experiencing psychosis. (PsycINFO Database Record
authors.affiliation: School of Psychological Sciences.
authors.forename: Lee D
authors.initials: LD
authors.lastname: Mulligan
authors.affiliation: School of Psychological Sciences.
authors.forename: Gillian
authors.initials: G
authors.lastname: Haddock
authors.affiliation: Centre for Biostatistics, Institute of Population Health.
authors.forename: Richard
authors.identifier: 0000-0002-1218-675X
authors.initials: R
authors.lastname: Emsley
authors.affiliation: Cromwell House Community Mental Health Team, Greater Manchester West Mental Health National Health Service Foundation Trust.
authors.forename: Sandra T
authors.initials: ST
authors.lastname: Neil
authors.affiliation: Sleep and Circadian Neuroscience Institute, University of Oxford.
authors.forename: Simon D
authors.identifier: 0000-0002-9581-5311
authors.initials: SD
authors.lastname: Kyle
mesh_terms: D056044:Actigraphy; D000328:Adult; D000072860:Ecological Momentary Assessment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000150:complications* / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D012892:Sleep Deprivation; D012893:Sleep Wake Disorders / Q000150:complications*; D055815:Young Adult