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Abstract

Study Objectives:

To group participants according to markers of risk for severe mental illness based on subsyndromal symptoms reported in early adulthood and evaluate attributes of sleep across these risk categories.

Methods:

An online survey of sleep and psychiatric symptomatology (The Oxford Sleep Survey) was administered to students at one United Kingdom university. 1403 students (undergraduate and postgraduate) completed the survey. The median age was 21 (interquartile range = 20–23) and 55.60% were female. The cross-sectional data were used to cluster participants based on dimensional measures of psychiatric symptoms (hallucinations, paranoia, depression, anxiety, and (hypo)mania). High, medium, and low symptom groups were compared across sleep parameters: insomnia symptoms, nightmares, chronotype, and social jet lag.

Results:

Insomnia symptoms, nightmares frequency, and nightmare-related distress increased in a dose-response manner with higher reported subsyndromal psychiatric symptoms (low, medium, and high). The high-risk group exhibited a later chronotype (mid sleep point for free days) than the medium- or low-risk group. The majority of participants (71.7%) in the high-risk group screened positive for insomnia and the median nightmare frequency was two per 14 days (moderately severe pathology).

Conclusions:

Insomnia, nightmares, and circadian phase delay are associated with increased subsyndromal psychiatric symptoms in young people. Each is a treatable sleep disorder and might be a target for early intervention to modify the subsequent progression of psychiatric disorder.

Significance

Young adulthood corresponds to a developmental stage where the symptoms of severe mental illness (SMI; e.g. paranoid thoughts, hallucinatory experiences and hypomanic mood) begin to emerge and are readily identified. Whilst sleep disruption has been associated with the later development of SMI, a detailed examination of specific sleep disorder symptoms and their association with risk for SMI has not been carried out. This study characterised sleep across three risk categories for SMI. Insomnia and nightmare severity increased in a dose response manner with increased risk for SMI. The impact of treating these sleep disorder symptoms on the subsequent development of SMI is a clear next step for research.

chronotype, cluster analysis, insomnia, nightmares, severe mental illness, sleep, social jet lag
© 2016 Associated Professional Sleep Societies, LLC.
Topic:
Subject
Insomnia
Issue Section:
Insomnia
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