Impact of Sleep on Mood & Psychotic Symptoms in Early & Emerging Psychosis

Background: The relationship between sleep and psychosis is well-established, with sleep disturbances being one of the earliest signs of an emerging psychotic disorder. Those at clinical high-risk (CHR) for psychosis are known to experience more fragmented sleep, which in turn increases the severity of psychotic and mood symptoms. Experience sampling is a useful method through which to understand the relationship between sleep and daily fluctuations in mood and psychosis. A better understanding of these within-day symptom dynamics may clarify the role of sleep in clinical trajectories for at-risk youth. Thus, this study used a phone app to capture real-time symptom changes alongside Fitbit & self-reported sleep monitoring to characterize symptom dynamics in early & emerging psychosis. Methods: 34 adolescents at CHR or in the early stages of a psychotic disorder completed daily surveys about their mood & experiences. Using experience sampling methods, participants received 6 semi-random surveys each day over the course of 3 weeks via a mobile phone app and wore a Fitbit to measure activity & sleep. Sleep duration and quality were calculated for all participants and compared against data from healthy controls (n=15). Moment-to-moment changes in mood were also calculated for all participants and compared across diagnostic groups. Multi-level linear and logistic regressions of affect variability and psychosis were conducted to demonstrate the effect of sleep on these symptoms. Results: We report results within and across diagnostic groups on sleep, affect variability, and psychotic symptoms. Psychosis-spectrum individuals were more likely to report poorer sleep quality (F= 3.57, p=0.04) and less time asleep (F=4.86, p=0.01) than controls. Poorer sleep quality was moderately correlated with negative affect (r=-0.40). Conclusions: Experience sampling via mobile phone apps is a uniquely effective method to monitor sleep as it relates to moment-to-moment symptom changes among those with early and emerging psychosis. These data may better characterize the role of sleep in early psychosis and present sleep as a potential treatment target to improve clinical trajectories