Sleep disturbances are associated with psychosis in schizophrenia spectrum Disorders: An umbrella review

Sleep is essential for optimal cognitive and physical functioning, but sleep disturbances, affecting 30-80 % of schizophrenia (SCZ) patients, can exacerbate psychotic symptoms. The literature on the link between sleep disturbances and psychosis in SCZ is complex and heterogeneous, requiring further research and systematic analysis.

The aim was to systematically synthesize and evaluate systematic and meta-analysis reviews investigating the relationship between sleep and psychosis in SCZ.

The search was conducted in English-language peer-reviewed journals up to June 2, 2025, using multiple databases and relevant terms. The AMSTAR-2 and ROBIS tools were used to evaluate the quality and risk of bias of the included reviews, and data were independently extracted and analyzed by two researchers. The study followed the PRIOR checklist.

Of 47 systematic and meta-analysis reviews on the association between sleep and psychosis in SCZ, 20 were included based on specific criteria. SCZ patients have disturbed sleep, including reduced sleep time, increased sleep onset, and decreased slow-wave sleep, which can be associated with suicidality, worse functional outcomes, and reduced quality of life. Sleep disorders, such as insomnia and restless leg syndrome, are linked to impaired cognitive functioning, worse psychiatric symptoms, and reduced quality of life in SCZ patients, with specific genetic variations being associated with these sleep disorders.

Sleep disturbances in SCZ patients can negatively impact cognitive functioning, psychiatric symptoms, and quality of life, and are associated with specific genetic variations, thus highlighting the importance of addressing sleep disturbances in the treatment of SCZ.