Age and Sex as Moderators of Sleep Architecture in Schizophrenia, Bipolar Disorder, and Unipolar Depression: A Case-Control Polysomnographic Systematic Review and Meta-Regression.

Sleep architecture alterations have been shown in major psychiatric disorders, but the contribution of demographic factors to between-study heterogeneity remains insufficiently characterized. This study reports a transdiagnostic systematic review and meta-regression of case-control polysomnographic studies comparing schizophrenia, bipolar disorder, and unipolar depression with healthy controls. The factors age and sex as possible moderators across harmonized case-control polysomnographic studies have been analyzed. Eligible studies reported diagnostic criteria, treatment status, age, and sex. Because the UD literature encompassed developmentally distinct populations, pediatric/adolescent and adult studies were analyzed separately. Standardized mean differences were synthesized using random-effects models with REML estimation. Univariable mixed-effects meta-regressions assessed study-level mean age and sex composition as moderators within each diagnostic group. Study-level mean age and sex composition significantly moderated delta sleep effect sizes in drug-naive schizophrenia, while study-level mean age significantly moderated REM time in drug-free schizophrenia. In bipolar disorder, study-level mean age moderated REM sleep time effect sizes during mania, whereas sex composition moderated delta sleep and REM density effect sizes. In UD, study-level mean age moderated total sleep time, and sex composition moderated wake after sleep onset only in pediatric/adolescent studies, whereas no significant moderation was observed in adult samples. No significant moderator effects were identified during bipolar depression. Overall, demographic composition explained only a modest proportion of between-study heterogeneity. Interpretation is limited by the ecological nature of study-level meta-regression and residual study heterogeneity.