Introduction Disturbed sleep is a common feature of psychotic disorders that is also present in the clinical high risk (CHR) state. Evidence suggests a potential role of sleep disturbance in symptom progression, yet the interrelationship between sleep and CHR symptoms remains to be determined. To address this knowledge gap, we examined the association between disturbed sleep and CHR symptoms over time. Methods Data were obtained from the North American Prodrome Longitudinal Study (NAPLS)-3 consortium, including 688 CHR individuals and 94 controls (mean age 18.25, 46% female) for whom sleep was tracked prospectively for 8 months. We used Cox regression analyses to investigate whether sleep disturbances predicted conversion to psychosis up to >2 years later. With regressions and cross-lagged panel models, we analyzed longitudinal and bidirectional associations between sleep (the Pittsburgh Sleep Quality Index in conjunction with additional sleep items) and CHR symptoms. We also investigated the independent contribution of individual sleep characteristics on CHR symptom domains separately and explored whether cognitive impairments, stress, depression, and psychotropic medication affected the associations. Results Disturbed sleep at baseline did not predict conversion to psychosis. However, sleep disturbance was strongly correlated with heightened CHR symptoms over time. Depression accounted for half of the association between sleep and symptoms. Importantly, sleep was a significant predictor of CHR symptoms but not vice versa, although bidirectional effect sizes were similar. Discussion The critical role of sleep disturbance in CHR symptom changes suggests that sleep may be a promising intervention target to moderate outcome in the CHR state.

中文翻译：

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临床精神病高危人群的睡眠障碍

简介 睡眠障碍是精神病性障碍的一个共同特征，也存在于临床高危 (CHR) 状态。有证据表明睡眠障碍在症状进展中可能发挥作用，但睡眠与 CHR 症状之间的相互关系仍有待确定。为了解决这一知识差距，我们研究了睡眠障碍与 CHR 症状之间的关系。方法 数据来自北美前驱期纵向研究 (NAPLS)-3 联盟，包括 688 名 CHR 个体和 94 名对照者（平均年龄 18.25 岁，46% 女性），对他们的睡眠进行了 8 个月的前瞻性跟踪。我们使用 Cox 回归分析来研究睡眠障碍是否可以预测长达 2 年后转化为精神病。使用回归和交叉滞后面板模型，我们分析了睡眠（匹兹堡睡眠质量指数与其他睡眠项目）与 CHR 症状之间的纵向和双向关联。我们还分别调查了个体睡眠特征对 CHR 症状域的独立贡献，并探讨了认知障碍、压力、抑郁和精神药物是否会影响这些关联。结果 基线时的睡眠障碍并不能预测转化为精神病。然而，随着时间的推移，睡眠障碍与加重的 CHR 症状密切相关。抑郁症占睡眠和症状之间关联的一半。重要的是，睡眠是 CHR 症状的重要预测因素，但反之则不然，尽管双向效应大小相似。