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Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: a Systematic Review and Meta-Analysis.

Meyer, Nicholas, Faulkner, Sophie M., McCutcheon, Robert A., Pillinger, Toby, Dijk, Derk-Jan and MacCabe, James H. (2020) Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: a Systematic Review and Meta-Analysis. Schizophrenia Bulletin.

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Background: Sleep and circadian rhythm disturbances in schizophrenia are common, but incompletely characterised. We aimed to describe and compare the magnitude and heterogeneity of sleep-circadian alterations in remitted schizophrenia, and compare them with those in inter-episode bipolar disorder. Methods: EMBASE, Medline, and PsycINFO were searched for case-control studies reporting actigraphic parameters in remitted schizophrenia or bipolar disorder. Standardised and absolute mean differences between patients and controls were quantified using Hedges-g, and patient-control differences in variability were quantified using the mean-scaled coefficient of variation ratio (CVR). A wald-type test compared effect-sizes between disorders. Results: Thirty studies reporting on 967 patients and 803 controls were included. Compared to controls, both schizophrenia and bipolar groups had significantly longer total sleep time (mean difference (minutes) [95%CI] = 99.9 [66.8, 133.1] and 31.1 [19.3, 42.9], respectively), time in bed (MD = 77.8 [13.7, 142.0] and 50.3 [20.3, 80.3]), but also greater sleep latency (16.5 [6.1, 27.0] and 2.6 [0.5, 4.6]) and reduced motor activity (SMD [95%CI] = -0.86 [-1.22, -0.51] and -0.75 [-1.20, -0.29]). Effect sizes were significantly greater in schizophrenia compared to the bipolar disorder group for total sleep time, sleep latency, and wake after sleep onset. CVR was significantly elevated in both diagnoses for total sleep time, time in bed, and relative amplitude. Conclusions: In both disorders, longer overall sleep duration, but also disturbed initiation, continuity and reduced motor activity were found. Common, modifiable factors may be associated with these sleep-circadian phenotypes, and advocate for further development of transdiagnostic interventions that target them.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Meyer, Nicholas
Faulkner, Sophie M.
McCutcheon, Robert A.
Pillinger, Toby
MacCabe, James H.
Date : 11 February 2020
Funders : Medical Research Council (MRC), National Institute for Health Research (NIHR), Health Education England, Wellcome Trust
Grant Title : Medical Research Council Clinical Research Training Fellowship
Uncontrolled Keywords : transdiagnostic; actigraphy; accelerometry; psychosis; SMI
Depositing User : James Marshall
Date Deposited : 19 Feb 2020 10:52
Last Modified : 19 Feb 2020 10:52

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