Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK.
Curr Opin Psychiatry. 2018 May;31(3):176-182. doi: 10.1097/YCO.0000000000000419.
The review is designed to give an overview of the latest developments in research exploring the relationship between sleep and psychosis, with particular attention paid to the evidence for a causal relationship between the two.
The most interesting avenues currently in pursuit are focused upon sleep spindle deficits which may hallmark an endophenotype; explorations of the continuum of psychotic experiences, and experimental manipulations to explore the evidence for bidirectional causality; inflammatory markers, psychosis and sleep disturbances and finally, treatment approaches for sleep in psychosis and the subsequent impact on positive experiences.
Globally, large surveys and tightly controlled sleep deprivation or manipulation experiments provide good evidence for a cause-and-effect relationship between sleep and subclinical psychotic experiences. The evidence for cause-and-effect using a interventionist-causal model is more ambiguous; it would appear treating insomnia improves psychotic experiences in an insomnia cohort but not in a cohort with schizophrenia. This advocates the necessity for mechanism-driven research with dimensional approaches and in depth phenotyping of circadian clock-driven processes and sleep regulating functions. Such an approach would lead to greater insight into the dynamics of sleep changes in healthy and acute psychosis brain states.
本文旨在概述探索睡眠与精神病学之间关系的最新研究进展，特别关注两者之间存在因果关系的证据。
目前最有趣的研究方向集中在睡眠纺锤波缺失上，这可能是一个内表型标志；探索精神病体验的连续体，以及实验性操作以探索双向因果关系的证据；炎症标志物、精神病和睡眠障碍，最后是精神病的睡眠治疗方法及其对阳性体验的后续影响。
总体而言，大型调查和严格控制的睡眠剥夺或操作实验为睡眠与亚临床精神病体验之间的因果关系提供了有力证据。使用干预性因果模型的因果关系证据则更为模糊；它似乎表明治疗失眠症可以改善失眠症患者的精神病体验，但不能改善精神分裂症患者的精神病体验。这表明需要进行机制驱动的研究，采用维度方法，并深入表型分析昼夜节律驱动的过程和睡眠调节功能。这种方法将有助于更深入地了解健康和急性精神病脑状态下睡眠变化的动态。
