Clinical, neurocognitive, neurobiological and functional correlates of sleep difficulties in individuals at-risk for psychosis and mania: A scoping review.

Sleep difficulties are highly prevalent among individuals with schizophrenia and bipolar disorder (BD), playing key roles in the onset, clinical presentation, and course of psychotic and manic episodes. However, less is known about sleep difficulties and their sequelae among individuals at-risk for psychosis and mania. Therefore, we conducted a scoping review of sleep disturbances among individuals at-risk for psychosis or mania. Employing PRISMA guidelines, 38 articles were identified documenting associations with clinical, neurocognitive, neurobiological and functional indicators. Specifically, individuals at-risk for psychosis and mania experience greater sleep disruptions compared to healthy controls characterized by increased nighttime activity, sleep variability, delayed onset of rapid eye movement sleep, and poorer sleep quality. For individuals at-risk for psychosis, sleep disturbances were linked to cognitive deficits, neural abnormalities, and attenuated psychotic symptoms, with the latter displaying strong associations with insomnia and sleep efficiency. Among individuals at-risk for mania, sleep problems manifested early in life and were associated with prodromal affective symptoms, with a bidirectional relationship between sleep and affective symptoms. Overall, results highlight the crucial role sleep difficulties play in both at-risk populations. We discuss the implications of these findings to the development of preventive interventions for individuals at-risk for psychosis and mania.