Sleep quality and quality of life in people with non-affective psychosis: A systematic review of relationships across phases and age groups.
Catherine E Taylor, Lee D Mulligan
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In 30 seconds
This PRISMA-guided systematic review examined associations between sleep quality and quality of life (QoL) in people with non-affective psychosis across illness phases and age groups. Eighteen studies involving 4711 participants were included; 15 focused on chronic psychosis, two on first-episode psychosis (FEP), and one on ultra-high-risk (UHR) states. Across chronic and FEP samples, poorer subjective sleep quality was generally associated with lower QoL, although findings varied by QoL domain and sometimes did not persist after covariate adjustment. Evidence in UHR was inconclusive, and no studies addressed later-onset psychosis.
Key findings
- The review included 18 studies (n = 4711), predominantly in chronic psychosis (n = 15); two studied FEP and one studied UHR.
- In chronic psychosis and FEP, poorer subjective sleep quality was generally associated with lower QoL.
- Associations varied across QoL domains and were not always retained after adjustment for covariates.
- UHR evidence was inconclusive, and no studies examined late-onset or very late-onset schizophrenia.
Why it matters
Sleep quality may be relevant to the lived impact of psychosis, not only to sleep symptoms themselves. The review suggests a recurring relationship with QoL in chronic psychosis and FEP, while highlighting uncertainty about its consistency and direction. Recognising these evidence gaps can help frame assessment and research without assuming that improving sleep will necessarily improve QoL.
What to keep in mind
The evidence was heterogeneous in sleep and QoL measures, analytic methods, and covariate adjustment. Most studies involved chronic psychosis, with little evidence for FEP or UHR and none for later-onset psychosis.