{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:14:48Z","timestamp":1788441288354,"version":"build-2803163510"},"reference-count":128,"publisher":"IMR Press","issue":"4","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Alpha Psychiatry"],"abstract":"<jats:p>Background:Schizoaffective disorder (SZA) is a severe psychiatric condition characterized by overlapping affective and psychotic features; however, its sleep architecture remains poorly characterized. This systematic review and meta-analysis compared polysomnographic findings in drug-free patients with SZA with those of healthy controls (HC), patients with schizophrenia (SCZ), and patients with major depressive disorder (MDD).Methods:An extensive database search identified 40 studies. Nine case-control studies including 79 patients with SZA, 88 patients with SCZ, 79 HC, and 131 patients with MDD were included in the meta-analyses. Total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and rapid-eye-movement (REM) and non-REM (NREM) sleep variables were analyzed. The primary outcome measure was the standardized mean difference (SMD). Data were analyzed using a random-effects model. Publication bias was assessed using Egger\u2019s regression test and funnel plot asymmetry.Results:Compared with HC, patients with SZA showed reduced total sleep time, increased sleep latency and wakefulness after sleep onset, reduced REM sleep duration, shortened REM latency, and reduced stage 4 sleep duration and percentage. Patients with SZA differed from those with MDD only in exhibiting increased sleep latency, whereas no significant differences were observed between patients with SZA and those with SCZ.Conclusions:Polysomnographic abnormalities in SZA demonstrate a general pattern of sleep disruption compared with HC, without clear differentiation from SCZ or MDD. Overall, current evidence does not support sleep architecture as a reliable biomarker for distinguishing SZA from related psychotic or affective disorders. These findings should be considered exploratory, given the small sample sizes, limited number of available studies, and substantial heterogeneity across studies. Further research is needed to determine whether specific sleep measures may better distinguish SZA from other psychiatric conditions.<\/jats:p>","DOI":"10.31083\/ap52900","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:23:51Z","timestamp":1788438231000},"source":"Crossref","is-referenced-by-count":0,"title":["Polysomnographic Parameters in Schizoaffective Disorder: A Systematic Review and Meta-Analysis"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0997-9124","authenticated-orcid":true,"given":"Dario","family":"Morra","sequence":"first","affiliation":[{"name":"Department of Psychology, Universit\u00e0 degli Studi della Campania \u201cLuigi Vanvitelli\u201d, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9519-4351","authenticated-orcid":true,"given":"Gianluca","family":"Ficca","sequence":"additional","affiliation":[{"name":"Department of Psychology, Universit\u00e0 degli Studi della Campania \u201cLuigi Vanvitelli\u201d, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6523-5327","authenticated-orcid":true,"given":"Giuseppe","family":"Barbato","sequence":"additional","affiliation":[{"name":"Department of Psychology, Universit\u00e0 degli Studi della Campania \u201cLuigi Vanvitelli\u201d, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"J\u00e4ger M, Haack S, Becker T, Frasch K. Schizoaffective disorder--an ongoing challenge for psychiatric nosology. European Psychiatry. 2011; 26: 159\u2013165.","DOI":"10.1016\/j.eurpsy.2010.03.010"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Malaspina D, Owen MJ, Heckers S, Tandon R, Bustillo J, Schultz S, et al. Schizoaffective Disorder in the DSM-5. Schizophrenia Research. 2013; 150: 21\u201325.","DOI":"10.1016\/j.schres.2013.04.026"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Peterson DL, Webb CA, Keeley JW, Gaebel W, Zielasek J, Rebello TJ, et al. The reliability and clinical utility of ICD-11 schizoaffective disorder: A field trial. Schizophrenia Research. 2019; 208: 235\u2013241.","DOI":"10.1016\/j.schres.2019.02.011"},{"key":"ref4","unstructured":"Sovner RD, McHugh PR. Bipolar course in schizo-affective illness. Biological Psychiatry. 1976; 11: 195\u2013204."},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Rosenthal NE, Rosenthal LN, Stallone F, Dunner DL, Fieve RR. Toward the validation of RDC schizoaffective disorder. Archives of General Psychiatry. 1980; 37: 804\u2013810.","DOI":"10.1001\/archpsyc.1980.01780200082009"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Cheniaux E, Landeira-Fernandez J, Lessa Telles L, Lessa JLM, Dias A, Duncan T, et al. Does schizoaffective disorder really exist? A systematic review of the studies that compared schizoaffective disorder with schizophrenia or mood disorders. Journal of Affective Disorders. 2008; 106: 209\u2013217.","DOI":"10.1016\/j.jad.2007.07.009"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Rink L, Pagel T, Franklin J, Baethge C. Characteristics and heterogeneity of schizoaffective disorder compared with unipolar depression and schizophrenia - a systematic literature review and meta-analysis. Journal of Affective Disorders. 2016; 191: 8\u201314.","DOI":"10.1016\/j.jad.2015.10.045"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Miller JN, Black DW. Schizoaffective disorder: A review. Annals of Clinical Psychiatry. 2019; 31: 47\u201353.","DOI":"10.1177\/104012371903100101"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Abrams DJ, Rojas DC, Arciniegas DB. Is schizoaffective disorder a distinct categorical diagnosis? A critical review of the literature. Neuropsychiatric Disease and Treatment. 2008; 4: 1089\u20131109.","DOI":"10.2147\/ndt.s4120"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Angst J, Felder W, Lohmeyer B. Course of schizoaffective psychoses: results of a followup study. Schizophrenia Bulletin. 1980; 6: 579\u2013585.","DOI":"10.1093\/schbul\/6.4.579"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Marneros A, Deister A, Rohde A. Psychopathological and social status of patients with affective, schizophrenic and schizoaffective disorders after long-term course. Acta Psychiatrica Scandinavica. 1990; 82: 352\u2013358.","DOI":"10.1111\/j.1600-0447.1990.tb01400.x"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Scully PJ, Owens JM, Kinsella A, Waddington JL. Schizophrenia, schizoaffective and bipolar disorder within an epidemiologically complete, homogeneous population in rural Ireland: small area variation in rate. Schizophrenia Research. 2004; 67: 143\u2013155.","DOI":"10.1016\/S0920-9964(03)00194-4"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Malhi GS, Green M, Fagiolini A, Peselow ED, Kumari V. Schizoaffective disorder: diagnostic issues and future recommendations. Bipolar Disorders. 2008; 10: 215\u2013230.","DOI":"10.1111\/j.1399-5618.2007.00564.x"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Marneros A, R\u00f6ttig S, Wenzel A, Bl\u00f6ink R, Brieger P. Affective and schizoaffective mixed states. European Archives of Psychiatry and Clinical Neuroscience. 2004; 254: 76\u201381.","DOI":"10.1007\/s00406-004-0462-9"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. Journal of Psychopharmacology (Oxford, England). 2010; 24: 81\u201390.","DOI":"10.1177\/1359786810385490"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Harrow M, Grossman LS, Herbener ES, Davies EW. Ten-year outcome: patients with schizoaffective disorders, schizophrenia, affective disorders and mood-incongruent psychotic symptoms. The British Journal of Psychiatry. 2000; 177: 421\u2013426.","DOI":"10.1192\/bjp.177.5.421"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Pinna F, Sanna L, Perra V, Pisu Randaccio R, Diana E, Carpiniello B, et al. Long-term outcome of schizoaffective disorder. Are there any differences with respect to schizophrenia? Rivista Di Psichiatria. 2014; 49: 41\u201349.","DOI":"10.1708\/1407.15624"},{"key":"ref18","unstructured":"Kraepelin E. Psychiatrie: Ein Lehrbuch f\u00fcr Studierende und \u00c4rzte. 6th edn In 6th edn. Johann Ambrosius Barth: Leipzig. 1899."},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Angst J. Historical aspects of the dichotomy between manic-depressive disorders and schizophrenia. Schizophrenia Research. 2002; 57: 5\u201313.","DOI":"10.1016\/s0920-9964(02)00328-6"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Kasanin J. The acute schizoaffective psychoses. 1933. The American Journal of Psychiatry. 1993; 151: 144\u2013154.","DOI":"10.1176\/ajp.151.6.144"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Santelmann H, Franklin J, Bu\u00dfhoff J, Baethge C. Test-retest reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression--a systematic review and meta-analysis. Bipolar Disorders. 2015; 17: 753\u2013768.","DOI":"10.1111\/bdi.12340"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Wilson JE, Nian H, Heckers S. The schizoaffective disorder diagnosis: a conundrum in the clinical setting. European Archives of Psychiatry and Clinical Neuroscience. 2014; 264: 29\u201334.","DOI":"10.1007\/s00406-013-0410-7"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Paul T, Javed S, Karam A, Loh H, Ferrer GF. A Misdiagnosed Case of Schizoaffective Disorder With Bipolar Manifestations. Cureus. 2021; 13: e16686.","DOI":"10.7759\/cureus.16686"},{"key":"ref24","unstructured":"Wy TJP, Saadabadi A. Schizoaffective Disorder. StatPearls In StatPearls. StatPearls Publishing: Treasure Island. 2025."},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Meltzer HY. Schizoaffective disorder: is the news of its nonexistence premature? Editor's introduction. Schizophrenia Bulletin. 1984; 10: 11\u201313.","DOI":"10.1093\/schbul\/10.1.11"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Tsuang MT, Simpson JC. Schizoaffective disorder: concept and reality. Schizophrenia Bulletin. 1984; 10: 14\u201325.","DOI":"10.1093\/schbul\/10.1.14"},{"key":"ref27","unstructured":"Lapierre YD. Schizophrenia and manic-depression: separate illnesses or a continuum? Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 1994; 39: S59\u201364."},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"J\u00e4ger M, Bottlender R, Strauss A, M\u00f6ller HJ. Fifteen-year follow-up of ICD-10 schizoaffective disorders compared with schizophrenia and affective disorders. Acta Psychiatrica Scandinavica. 2004; 109: 30\u201337.","DOI":"10.1111\/j.0001-690x.2004.00208.x"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Lake CR, Hurwitz N. Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease--there is no schizoaffective disorder. Current Opinion in Psychiatry. 2007; 20: 365\u2013379.","DOI":"10.1097\/YCO.0b013e3281a305ab"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Cheniaux E, Landeira-Fernandez J, Versiani M. The diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder and unipolar depression: interrater reliability and congruence between DSM-IV and ICD-10. Psychopathology. 2009; 42: 293\u2013298.","DOI":"10.1159\/000228838"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Kantrowitz JT, Citrome L. Schizoaffective disorder: a review of current research themes and pharmacological management. CNS Drugs. 2011; 25: 317\u2013331.","DOI":"10.2165\/11587630-000000000-00000"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Pavlichenko A, Petrova N, Stolyarov A. The Modern Concept of Schizoaffective Disorder: A Narrative Review. Consortium Psychiatricum. 2024; 5: 42\u201355.","DOI":"10.17816\/CP15513"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Madre M, Canales-Rodr\u00edguez EJ, Ortiz-Gil J, Murru A, Torrent C, Bramon E, et al. Neuropsychological and neuroimaging underpinnings of schizoaffective disorder: a systematic review. Acta Psychiatrica Scandinavica. 2016; 134: 16\u201330.","DOI":"10.1111\/acps.12564"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Gotra MY, Hill SK, Gershon ES, Tamminga CA, Ivleva EI, Pearlson GD, et al. Distinguishing patterns of impairment on inhibitory control and general cognitive ability among bipolar with and without psychosis, schizophrenia, and schizoaffective disorder. Schizophrenia Research. 2020; 223: 148\u2013157.","DOI":"10.1016\/j.schres.2020.06.033"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Dehelean L, Romosan AM, Bucatos BO, Papava I, Balint R, Bortun AMC, et al. Social and Neurocognitive Deficits in Remitted Patients with Schizophrenia, Schizoaffective and Bipolar Disorder. Healthcare (Basel, Switzerland). 2021; 9: 365.","DOI":"10.3390\/healthcare9040365"},{"key":"ref36","unstructured":"Radoni\u0107 E, Rados M, Kalember P, Bajs-Janovi\u0107 M, Folnegovi\u0107-Smalc V, Henigsberg N. Comparison of hippocampal volumes in schizophrenia, schizoaffective and bipolar disorder. Collegium Antropologicum. 2011; 35: 249\u2013252."},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Ivleva EI, Bidesi AS, Thomas BP, Meda SA, Francis A, Moates AF, et al. Brain gray matter phenotypes across the psychosis dimension. Psychiatry Research. 2012; 204: 13\u201324.","DOI":"10.1016\/j.pscychresns.2012.05.001"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Ivleva EI, Bidesi AS, Keshavan MS, Pearlson GD, Meda SA, Dodig D, et al. Gray matter volume as an intermediate phenotype for psychosis: Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP). The American Journal of Psychiatry. 2013; 170: 1285\u20131296.","DOI":"10.1176\/appi.ajp.2013.13010126"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Amann BL, Canales-Rodr\u00edguez EJ, Madre M, Radua J, Monte G, Alonso-Lana S, et al. Brain structural changes in schizoaffective disorder compared to schizophrenia and bipolar disorder. Acta Psychiatrica Scandinavica. 2016; 133: 23\u201333.","DOI":"10.1111\/acps.12440"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Lynham AJ, Cleaver SL, Jones IR, Walters JTR. A meta-analysis comparing cognitive function across the mood\/psychosis diagnostic spectrum. Psychological Medicine. 2022; 52: 323\u2013331.","DOI":"10.1017\/S0033291720002020"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Rieder RO, Mann LS, Weinberger DR, van Kammen DP, Post RM. Computed tomographic scans in patients with schizophrenia, schizoaffective, and bipolar affective disorder. Archives of General Psychiatry. 1983; 40: 735\u2013739.","DOI":"10.1001\/archpsyc.1983.01790060033004"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Hager B, Yang AC, Brady R, Meda S, Clementz B, Pearlson GD, et al. Neural complexity as a potential translational biomarker for psychosis. Journal of Affective Disorders. 2017; 216: 89\u201399.","DOI":"10.1016\/j.jad.2016.10.016"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Du Y, Hao H, Wang S, Pearlson GD, Calhoun VD. Identifying commonality and specificity across psychosis sub-groups via classification based on features from dynamic connectivity analysis. NeuroImage. Clinical. 2020; 27: 102284.","DOI":"10.1016\/j.nicl.2020.102284"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Mazza MG, Capellazzi M, Tagliabue I, Lucchi S, Rossetti A, Clerici M. Neutrophil-lymphocyte, monocyte-lymphocyte and platelet-lymphocyte ratio in schizoaffective disorder compared to schizophrenia. General Hospital Psychiatry. 2019; 61: 86\u201387.","DOI":"10.1016\/j.genhosppsych.2019.06.013"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Jeannin J, Romeo B, Lestra V, Martelli C, Amirouche A, Benyamina A, et al. Could peripheral immunological markers discriminate schizophrenia and schizoaffective disorders from bipolar disorder? Journal of Psychiatric Research. 2026; 197: 59\u201365.","DOI":"10.1016\/j.jpsychires.2026.02.041"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Cardno AG, Marshall EJ, Coid B, Macdonald AM, Ribchester TR, Davies NJ, et al. Heritability estimates for psychotic disorders: the Maudsley twin psychosis series. Archives of General Psychiatry. 1999; 56: 162\u2013168.","DOI":"10.1001\/archpsyc.56.2.162"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Coryell W, Zimmerman M. The heritability of schizophrenia and schizoaffective disorder. A family study. Archives of General Psychiatry. 1988; 45: 323\u2013327.","DOI":"10.1001\/archpsyc.1988.01800280033005"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Lapens\u00e9e MA. A review of schizoaffective disorder: I. Current concepts. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 1992; 37: 335\u2013346.","DOI":"10.1177\/070674379203700507"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Laursen TM, Labouriau R, Licht RW, Bertelsen A, Munk-Olsen T, Mortensen PB. Family history of psychiatric illness as a risk factor for schizoaffective disorder: a Danish register-based cohort study. Archives of General Psychiatry. 2005; 62: 841\u2013848.","DOI":"10.1001\/archpsyc.62.8.841"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Fallin MD, Lasseter VK, Avramopoulos D, Nicodemus KK, Wolyniec PS, McGrath JA, et al. Bipolar I disorder and schizophrenia: a 440-single-nucleotide polymorphism screen of 64 candidate genes among Ashkenazi Jewish case-parent trios. American Journal of Human Genetics. 2005; 77: 918\u2013936.","DOI":"10.1086\/497703"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"Kendler KS, Ohlsson H, Sundquist J, Sundquist K. Profiles of Genetic Risks for Psychotic Disorders. JAMA Psychiatry. 2025; 82: 926\u2013933.","DOI":"10.1001\/jamapsychiatry.2025.1289"},{"key":"ref52","unstructured":"Marneros A. The psychotic \"continuum\". Psychiatrike = Psychiatriki. 2010; 21: 275\u2013276."},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"Guloksuz S, van Os J. The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum. Psychological Medicine. 2018; 48: 229\u2013244.","DOI":"10.1017\/S0033291717001775"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"Gama Marques J, Ouakinin S. Schizophrenia-schizoaffective-bipolar spectra: an epistemological perspective. CNS Spectrums. 2021; 26: 197\u2013201.","DOI":"10.1017\/S1092852919001408"},{"key":"ref55","unstructured":"Mu\u00f1oz-Negro JE, Cuadrado L, Cervilla JA. Current Evidences on Psychopharmacology of Schizoaffective Disorder. Actas Espanolas De Psiquiatria. 2019; 47: 190\u2013201."},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Canuso CM, Lindenmayer JP, Kosik-Gonzalez C, Turkoz I, Carothers J, Bossie CA, et al. A randomized, double-blind, placebo-controlled study of 2 dose ranges of paliperidone extended-release in the treatment of subjects with schizoaffective disorder. The Journal of Clinical Psychiatry. 2010; 71: 587\u2013598.","DOI":"10.4088\/JCP.09m05564yel"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"Canuso CM, Schooler N, Carothers J, Turkoz I, Kosik-Gonzalez C, Bossie CA, et al. Paliperidone extended-release in schizoaffective disorder: a randomized, controlled study comparing a flexible dose with placebo in patients treated with and without antidepressants and\/or mood stabilizers. Journal of Clinical Psychopharmacology. 2010; 30: 487\u2013495.","DOI":"10.1097\/JCP.0b013e3181eeb600"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"Palmese LB, DeGeorge PC, Ratliff JC, Srihari VH, Wexler BE, Krystal AD, et al. Insomnia is frequent in schizophrenia and associated with night eating and obesity. Schizophrenia Research. 2011; 133: 238\u2013243.","DOI":"10.1016\/j.schres.2011.07.030"},{"key":"ref59","doi-asserted-by":"publisher","unstructured":"Kaskie RE, Graziano B, Ferrarelli F. Schizophrenia and sleep disorders: links, risks, and management challenges. Nature and Science of Sleep. 2017; 9: 227\u2013239.","DOI":"10.2147\/NSS.S121076"},{"key":"ref60","doi-asserted-by":"publisher","unstructured":"Laskemoen JF, Simonsen C, B\u00fcchmann C, Barrett EA, Bjella T, Lagerberg TV, et al. Sleep disturbances in schizophrenia spectrum and bipolar disorders - a transdiagnostic perspective. Comprehensive Psychiatry. 2019; 91: 6\u201312.","DOI":"10.1016\/j.comppsych.2019.02.006"},{"key":"ref61","doi-asserted-by":"publisher","unstructured":"Alam A, Chengappa KNR, Ghinassi F. Screening for obstructive sleep apnea among individuals with severe mental illness at a primary care clinic. General Hospital Psychiatry. 2012; 34: 660\u2013664.","DOI":"10.1016\/j.genhosppsych.2012.06.015"},{"key":"ref62","doi-asserted-by":"publisher","unstructured":"Annamalai A, Palmese LB, Chwastiak LA, Srihari VH, Tek C. High rates of obstructive sleep apnea symptoms among patients with schizophrenia. Psychosomatics. 2015; 56: 59\u201366.","DOI":"10.1016\/j.psym.2014.02.009"},{"key":"ref63","doi-asserted-by":"publisher","unstructured":"Poulin J, Chouinard S, Pampoulova T, Lecomte Y, Stip E, Godbout R. Sleep habits in middle-aged, non-hospitalized men and women with schizophrenia: a comparison with healthy controls. Psychiatry Research. 2010; 179: 274\u2013278.","DOI":"10.1016\/j.psychres.2009.08.009"},{"key":"ref64","doi-asserted-by":"publisher","unstructured":"Miller BJ, Parker CB, Rapaport MH, Buckley PF, McCall WV. Insomnia and suicidal ideation in nonaffective psychosis. Sleep. 2019; 42: zsy215.","DOI":"10.1093\/sleep\/zsy215"},{"key":"ref65","doi-asserted-by":"publisher","unstructured":"Petit JM, Strippoli MPF, Stephan A, Ranjbar S, Haba-Rubio J, Solelhac G, et al. Sleep spindles in people with schizophrenia, schizoaffective disorders or bipolar disorders: a pilot study in a general population-based cohort. BMC Psychiatry. 2022; 22: 758.","DOI":"10.1186\/s12888-022-04423-y"},{"key":"ref66","doi-asserted-by":"publisher","unstructured":"Tanr\u0131seven E, Sa\u011fta\u015f E, Topak OZ, G\u00fcnd\u00fcz M, Dogruyol CA. An evaluation of the differences in thalamic nuclei and subnuclei among patients with schizophrenia and schizoaffective disorder. Psychiatry Research. Neuroimaging. 2026; 361: 112250.","DOI":"10.1016\/j.pscychresns.2026.112250"},{"key":"ref67","doi-asserted-by":"publisher","unstructured":"Castelnovo A, D'Agostino A, Mayeli A, Albantakis L, Tononi G, Ferrarelli F. Sleep Spindle Abnormalities as Neurophysiological Biomarkers of Schizophrenia Spectrum Disorders: From Cellular Mechanisms and Neural Circuits to Clinical Implications. Biological Psychiatry. 2025; 98: 809\u2013818.","DOI":"10.1016\/j.biopsych.2025.06.014"},{"key":"ref68","doi-asserted-by":"publisher","unstructured":"Ferrarelli F, Tononi G. Reduced sleep spindle activity point to a TRN-MD thalamus-PFC circuit dysfunction in schizophrenia. Schizophrenia Research. 2017; 180: 36\u201343.","DOI":"10.1016\/j.schres.2016.05.023"},{"key":"ref69","doi-asserted-by":"publisher","unstructured":"Dimitriades ME, Schumacher E, Arudchelvam J, Fattinger S, Kurth S, Pugin F, et al. The infraslow fluctuation of sigma power during sleep in young individuals with schizophrenia. Schizophrenia Research. 2025; 285: 295\u2013303.","DOI":"10.1016\/j.schres.2025.09.029"},{"key":"ref70","doi-asserted-by":"publisher","unstructured":"Hauri P, Hawkins DR. Alpha-delta sleep. Electroencephalography and Clinical Neurophysiology. 1973; 34: 233\u2013237.","DOI":"10.1016\/0013-4694(73)90250-2"},{"key":"ref71","doi-asserted-by":"publisher","unstructured":"Lahmeyer HW, Val E, Gaviria FM, Prasad RB, Pandey GN, Rodgers P, et al. EEG sleep, lithium transport, dexamethasone suppression, and monoamine oxidase activity in borderline personality disorder. Psychiatry Research. 1988; 25: 19\u201330.","DOI":"10.1016\/0165-1781(88)90154-0"},{"key":"ref72","unstructured":"Benson KL, Berger PA, Zarcone VP. Sleep stage measures of psychopathology using Research Diagnostic Criteria. Sleep Research. 1980; 9: 161."},{"key":"ref73","doi-asserted-by":"publisher","unstructured":"Benson KL, Zarcone VP Jr. Testing the REM sleep phasic event intrusion hypothesis of schizophrenia. Psychiatry Research. 1985; 15: 163\u2013173.","DOI":"10.1016\/0165-1781(85)90073-3"},{"key":"ref74","doi-asserted-by":"publisher","unstructured":"Zarcone VP Jr, Benson KL, Berger PA. Abnormal rapid eye movement latencies in schizophrenia. Archives of General Psychiatry. 1987; 44: 45\u201348.","DOI":"10.1001\/archpsyc.1987.01800130047007"},{"key":"ref75","doi-asserted-by":"publisher","unstructured":"Zarcone VP Jr, Benson KL. Middle ear muscle activity (MEMA) in schizophrenia using a noninvasive technique. Sleep. 1995; 18: 266\u2013271.","DOI":"10.1093\/sleep\/18.4.266"},{"key":"ref76","doi-asserted-by":"publisher","unstructured":"Reich L, Weiss BL, Coble P, McPartland R, Kupfer DJ. Sleep disturbance in schizophrenia. A revisit. Archives of General Psychiatry. 1975; 32: 51\u201355.","DOI":"10.1001\/archpsyc.1975.01760190053006"},{"key":"ref77","unstructured":"Kupfer DJ, Foster FG. The sleep of psychotic patients: does it all look alike? Research Publications - Association for Research in Nervous and Mental Disease. 1975; 54: 143\u2013164."},{"key":"ref78","doi-asserted-by":"publisher","unstructured":"Kupfer DJ, Broudy D, Spiker DG, Neil JF, Coble PA. EEG sleep and affective psychoses: I. Schizoaffective disorders. Psychiatry Research. 1979; 1: 173\u2013178.","DOI":"10.1016\/0165-1781(79)90058-1"},{"key":"ref79","unstructured":"Coble PA, Kupfer DJ, Shaw DH. Distribution of REM latency in depression. Biological Psychiatry. 1981; 16: 453\u2013466."},{"key":"ref80","doi-asserted-by":"publisher","unstructured":"Benson KL, Zarcone VP Jr, Faull KF, Barchas JD, Berger PA. REM sleep eye movement activity and CSF concentrations of 5-hydroxyindoleacetic acid in psychiatric patients. Psychiatry Research. 1983; 8: 73\u201378.","DOI":"10.1016\/0165-1781(83)90141-5"},{"key":"ref81","doi-asserted-by":"publisher","unstructured":"Kupfer DJ, Wyatt RJ, Synder F, Davis JM. Chlorpromazine and sleep in psychiatric patients. Archives of General Psychiatry. 1971; 24: 185\u2013189.","DOI":"10.1001\/archpsyc.1971.01750080089015"},{"key":"ref82","unstructured":"Gillin JC, van Kammen DP, Post R, Bunney WE Jr. Effects of prolonged administration of pimozide on sleep-EEG patterns in psychiatric patients. Communications in Psychopharmacology. 1977; 1: 225\u2013232."},{"key":"ref83","doi-asserted-by":"publisher","unstructured":"Gillin JC, van Kammen DP, Bunney WE Jr. Pimozide attentuates d-amphetamine-induced sleep changes in man. Life Sciences. 1978; 22: 1805\u20131810.","DOI":"10.1016\/0024-3205(78)90596-9"},{"key":"ref84","doi-asserted-by":"publisher","unstructured":"Keshavan MS, Reynolds CF 3rd, Miewald JM, Montrose DM. A longitudinal study of EEG sleep in schizophrenia. Psychiatry Research. 1996; 59: 203\u2013211.","DOI":"10.1016\/0165-1781(95)02810-2"},{"key":"ref85","doi-asserted-by":"publisher","unstructured":"Benson KL, Sullivan EV, Lim KO, Lauriello J, Zarcone VP Jr, Pfefferbaum A. Slow wave sleep and computed tomographic measures of brain morphology in schizophrenia. Psychiatry Research. 1996; 60: 125\u2013134.","DOI":"10.1016\/0165-1781(96)02705-9"},{"key":"ref86","doi-asserted-by":"publisher","unstructured":"Nishino S, Mignot E, Benson KL, Zarcone VP Jr. Cerebrospinal fluid prostaglandins and corticotropin releasing factor in schizophrenics and controls: relationship to sleep architecture. Psychiatry Research. 1998; 78: 141\u2013150.","DOI":"10.1016\/s0165-1781(98)00012-2"},{"key":"ref87","doi-asserted-by":"publisher","unstructured":"Keshavan MS, Reynolds CF 3rd, Miewald MJ, Montrose DM, Sweeney JA, Vasko RC Jr, et al. Delta sleep deficits in schizophrenia: evidence from automated analyses of sleep data. Archives of General Psychiatry. 1998; 55: 443\u2013448.","DOI":"10.1001\/archpsyc.55.5.443"},{"key":"ref88","doi-asserted-by":"publisher","unstructured":"Rotenberg P, Indurski R, Kimhi J, Hadjez Y, Gutman E, Shamir Y, et al. The relationship between objective sleep variables and subjective sleep estimation in schizophrenia. International Journal of Psychiatry in Clinical Practice. 2000; 4: 63\u201367.","DOI":"10.1080\/13651500050518415"},{"key":"ref89","doi-asserted-by":"publisher","unstructured":"Armitage R, Cole D, Suppes T, Ozcan ME. Effects of clozapine on sleep in bipolar and schizoaffective disorders. Progress in Neuro-psychopharmacology & Biological Psychiatry. 2004; 28: 1065\u20131070.","DOI":"10.1016\/j.pnpbp.2004.05.048"},{"key":"ref90","doi-asserted-by":"publisher","unstructured":"Kluge M, Schacht A, Himmerich H, Rummel-Kluge C, Wehmeier PM, Dalal M, et al. Olanzapine and clozapine differently affect sleep in patients with schizophrenia: results from a double-blind, polysomnographic study and review of the literature. Schizophrenia Research. 2014; 152: 255\u2013260.","DOI":"10.1016\/j.schres.2013.11.009"},{"key":"ref91","doi-asserted-by":"publisher","unstructured":"G\u00f6der R, Graf A, Ballhausen F, Weinhold S, Baier PC, Junghanns K, et al. Impairment of sleep-related memory consolidation in schizophrenia: relevance of sleep spindles? Sleep Medicine. 2015; 16: 564\u2013569.","DOI":"10.1016\/j.sleep.2014.12.022"},{"key":"ref92","doi-asserted-by":"publisher","unstructured":"Kaskie RE, Graziano B, Ferrarelli F. Topographic deficits in sleep spindle density and duration point to frontal thalamo-cortical dysfunctions in first-episode psychosis. Journal of Psychiatric Research. 2019; 113: 39\u201344.","DOI":"10.1016\/j.jpsychires.2019.03.009"},{"key":"ref93","doi-asserted-by":"publisher","unstructured":"Gerstenberg M, Furrer M, Tesler N, Franscini M, Walitza S, Huber R. Reduced sleep spindle density in adolescent patients with early-onset schizophrenia compared to major depressive disorder and healthy controls. Schizophrenia Research. 2020; 221: 20\u201328.","DOI":"10.1016\/j.schres.2019.11.060"},{"key":"ref94","doi-asserted-by":"publisher","unstructured":"Denis D, Baran B, Mylonas D, Spitzer C, Raymond N, Talbot C, et al. Sleep oscillations and their relations with sleep-dependent memory consolidation in early course psychosis and first-degree relatives. Schizophrenia Research. 2024; 274: 473\u2013485.","DOI":"10.1016\/j.schres.2024.10.026"},{"key":"ref95","doi-asserted-by":"publisher","unstructured":"Gillin JC, Schulz SC, van Kammen DP, Balow JE, Bunney WE Jr. EEG sleep patterns in schizophrenic patients undergoing hemodialysis. Psychiatry Research. 1981; 5: 287\u2013291.","DOI":"10.1016\/0165-1781(81)90075-5"},{"key":"ref96","unstructured":"Glassman JN, Darko D, Gillin JC. Medication-induced somnambulism in a patient with schizoaffective disorder. The Journal of Clinical Psychiatry. 1986; 47: 523\u2013524."},{"key":"ref97","doi-asserted-by":"publisher","unstructured":"Keshavan MS, Reynolds CF 3rd, Ganguli R, Brar J, Houck P. Electroencephalographic sleep and cerebral morphology in functional psychoses: a preliminary study with computed tomography. Psychiatry Research. 1991; 39: 293\u2013301.","DOI":"10.1016\/0165-1781(91)90095-7"},{"key":"ref98","doi-asserted-by":"publisher","unstructured":"Keshavan MS, Reynolds CF, Montrose D, Miewald J, Kupfer DJ. Trait-like abnormalities in the sleep of patients with psychoses. Clinical Neuropharmacology. 1992; 15: 297A\u2013298A.","DOI":"10.1097\/00002826-199201001-00154"},{"key":"ref99","doi-asserted-by":"publisher","unstructured":"Douglass AB, Shipley JE, Haines RF, Scholten RC, Dudley E, Tapp A. Schizophrenia, narcolepsy, and HLA-DR15, DQ6. Biological Psychiatry. 1993; 34: 773\u2013780.","DOI":"10.1016\/0006-3223(93)90066-m"},{"key":"ref100","doi-asserted-by":"publisher","unstructured":"Keshavan MS, Reynolds CF, Montrose D, Miewald J, Downs C, Sabo EM. Sleep and suicidality in psychotic patients. Acta Psychiatrica Scandinavica. 1994; 89: 122\u2013125.","DOI":"10.1111\/j.1600-0447.1994.tb01498.x"},{"key":"ref101","doi-asserted-by":"publisher","unstructured":"Keshaven MS, Reynolds CF 3rd, Miewald J, Montrose D. Slow-wave sleep deficits and outcome in schizophrenia and schizoaffective disorder. Acta Psychiatrica Scandinavica. 1995; 91: 289\u2013292.","DOI":"10.1111\/j.1600-0447.1995.tb09784.x"},{"key":"ref102","doi-asserted-by":"publisher","unstructured":"Baandrup L, Glenth\u00f8j BY, Jennum PJ. Objective and subjective sleep quality: Melatonin versus placebo add-on treatment in patients with schizophrenia or bipolar disorder withdrawing from long-term benzodiazepine use. Psychiatry Research. 2016; 240: 163\u2013169.","DOI":"10.1016\/j.psychres.2016.04.031"},{"key":"ref103","doi-asserted-by":"publisher","unstructured":"Yamashita H, Horiguchi J, Mizuno S, Kuramoto Y, Yamawaki S, Inami Y. A case of neuroleptic-induced unilateral akathisia with periodic limb movements in the opposite side during sleep. Psychiatry and Clinical Neurosciences. 1999; 53: 291\u2013293.","DOI":"10.1046\/j.1440-1819.1999.00524.x"},{"key":"ref104","doi-asserted-by":"publisher","unstructured":"Wetter TC, Brunner J, Bronisch T. Restless legs syndrome probably induced by risperidone treatment. Pharmacopsychiatry. 2002; 35: 109\u2013111.","DOI":"10.1055\/s-2002-31514"},{"key":"ref105","doi-asserted-by":"publisher","unstructured":"Weinhold SL, Lechinger J, Timm N, Hansen A, Ngo HVV, G\u00f6der R. Auditory stimulation in-phase with slow oscillations to enhance overnight memory consolidation in patients with schizophrenia? Journal of Sleep Research. 2022; 31: e13636.","DOI":"10.1111\/jsr.13636"},{"key":"ref106","doi-asserted-by":"publisher","unstructured":"Giedke H, Geilenkirchen R, Hauser M. The timing of partial sleep deprivation in depression. Journal of Affective Disorders. 1992; 25: 117\u2013128.","DOI":"10.1016\/0165-0327(92)90074-g"},{"key":"ref107","doi-asserted-by":"publisher","unstructured":"Keshavan MS, Mahadik SP, Reynolds CF 3rd, Mukerjee S, Korenovsky A, Houck P, et al. Plasma cholinesterase isozymes and REM latency in schizophrenia. Psychiatry Research. 1992; 43: 23\u201329.","DOI":"10.1016\/0165-1781(92)90138-s"},{"key":"ref108","unstructured":"Itil TM, Hsu W, Holden JM, Gannon P. Digital computer sleep prints in lobotomized and nonlobotomized schizophrenics. Biological psychiatry. 1970; 2: 141\u2013152."},{"key":"ref109","doi-asserted-by":"publisher","unstructured":"Antrobus JS, Dement W, Fisher C. Patterns of dreaming recall: An EEG study. The Journal of Abnormal and Social Psychology. 1964; 69: 341\u2013344. https:\/\/psycnet.apa.org\/doi\/","DOI":"10.1037\/h0044495"},{"key":"ref110","doi-asserted-by":"publisher","unstructured":"ITIL TM. PENTOTHAL INDUCED CHANGES IN EEG AS A PROGNOSTIC INDEX IN DRUGS THERAPY OF PSYCHOTIC PATIENTS. The American Journal of Psychiatry. 1965; 121: 996\u20131002.","DOI":"10.1176\/ajp.121.10.996"},{"key":"ref111","doi-asserted-by":"publisher","unstructured":"Morra D, Barbato G. REM sleep in schizophrenia: a systematic review and meta-analysis. Sleep Medicine Reviews. 2025; 83: 102134.","DOI":"10.1016\/j.smrv.2025.102134"},{"key":"ref112","unstructured":"Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ. Cochrane handbook for systematic reviews of interventions. Cochrane: London. 2024."},{"key":"ref113","doi-asserted-by":"publisher","unstructured":"Clayton PJ. Schizoaffective disorders. The Journal of Nervous and Mental Disease. 1982; 170: 646\u2013650.","DOI":"10.1097\/00005053-198211000-00002"},{"key":"ref114","doi-asserted-by":"publisher","unstructured":"Kongsakon R, Thavichachart N, Chung KF, Lim L, Azucena B, Rondain E, et al. Evaluation of sleep profile in schizophrenia patients treated with extended-release paliperidone: an open-label prospective study in Southeast Asia. Psychology Research and Behavior Management. 2017; 10: 323\u2013327.","DOI":"10.2147\/PRBM.S132272"},{"key":"ref115","doi-asserted-by":"publisher","unstructured":"Luthringer R, Staner L, Noel N, Muzet M, Gassmann-Mayer C, Talluri K, et al. A double-blind, placebo-controlled, randomized study evaluating the effect of paliperidone extended-release tablets on sleep architecture in patients with schizophrenia. International Clinical Psychopharmacology. 2007; 22: 299\u2013308.","DOI":"10.1097\/YIC.0b013e3281c55f4f"},{"key":"ref116","doi-asserted-by":"publisher","unstructured":"Jackson D, Turner R. Power analysis for random-effects meta-analysis. Research Synthesis Methods. 2017; 8: 290\u2013302.","DOI":"10.1002\/jrsm.1240"},{"key":"ref117","doi-asserted-by":"publisher","unstructured":"Thase ME, Kupfer DJ, Ulrich RF. Electroencephalographic sleep in psychotic depression. A valid subtype? Archives of General Psychiatry. 1986; 43: 886\u2013893.","DOI":"10.1001\/archpsyc.1986.01800090076010"},{"key":"ref118","doi-asserted-by":"publisher","unstructured":"Kupfer DJ, Heninger GR. REM activity as a correlate of mood changes throughout the night. Electroencephalographic sleep patterns in a patient with a 48-hour cyclic mood disorder. Archives of General Psychiatry. 1972; 27: 368\u2013373.","DOI":"10.1001\/archpsyc.1972.01750270072011"},{"key":"ref119","doi-asserted-by":"publisher","unstructured":"Sitaram N, Nurnberger JI Jr, Gershon ES, Gillin JC. Cholinergic regulation of mood and REM sleep: potential model and marker of vulnerability to affective disorder. The American Journal of Psychiatry. 1982; 139: 571\u2013576.","DOI":"10.1176\/ajp.139.5.571"},{"key":"ref120","doi-asserted-by":"publisher","unstructured":"Kheirkhah M, Duncan WC Jr, Yuan Q, Wang PR, Jamalabadi H, Leistritz L, et al. REM density predicts rapid antidepressant response to ketamine in individuals with treatment-resistant depression. Neuropsychopharmacology. 2025; 50: 941\u2013946.","DOI":"10.1038\/s41386-025-02066-7"},{"key":"ref121","doi-asserted-by":"publisher","unstructured":"Del Giudice R, Stefanelli R, Donati F, Nistic\u00f2 V, Casetta C, Castelnovo A, et al. Elevated gamma activity in left frontotemporal regions preceding sleep signals emotional arousal in Bipolar Disorders: Insights from a high-density EEG investigation. Journal of Affective Disorders. 2026; 394: 120517.","DOI":"10.1016\/j.jad.2025.120517"},{"key":"ref122","doi-asserted-by":"publisher","unstructured":"Santelmann H, Franklin J, Bu\u00dfhoff J, Baethge C. Diagnostic shift in patients diagnosed with schizoaffective disorder: a systematic review and meta-analysis of rediagnosis studies. Bipolar Disorders. 2016; 18: 233\u2013246.","DOI":"10.1111\/bdi.12388"},{"key":"ref123","doi-asserted-by":"publisher","unstructured":"Saleh C, Diederich NJ, Schroeder LA, Schmidt M, R\u00fcegg S, Khatami R. Time to reconsider REM density in sleep research. Clinical Neurophysiology. 2022; 137: 63\u201365.","DOI":"10.1016\/j.clinph.2022.02.011"},{"key":"ref124","doi-asserted-by":"publisher","unstructured":"Barbato G. Is REM Density a Measure of Arousal during Sleep? Brain Sciences. 2023; 13: 378.","DOI":"10.3390\/brainsci13030378"},{"key":"ref125","doi-asserted-by":"publisher","unstructured":"Pieters LE, Deenik J, Hoogendoorn AW, van Someren EJW, van Harten PN. Sleep and physical activity patterns in relation to daily-life symptoms in psychosis: An actigraphy and experience sampling study. Psychiatry Research. 2025; 344: 116320.","DOI":"10.1016\/j.psychres.2024.116320"},{"key":"ref126","doi-asserted-by":"publisher","unstructured":"Thelagathoti RK, Siu KC, Ali HH, Fernando RM. Integrated Analysis of Circadian and Sleep Signatures in Depression and Schizophrenia Using Multi-Day Actigraphy. Bioengineering (Basel, Switzerland). 2026; 13: 383.","DOI":"10.3390\/bioengineering13040383"},{"key":"ref127","doi-asserted-by":"publisher","unstructured":"Garyfalli V, Kalisperakis E, Smyrnis A, Lazaridi M, Karantinos T, Mantas A, et al. Smartwatch-Derived Digital Phenotypes Relate to Psychopathology Dimensions in Patients With Psychotic Spectrum Disorders: Longitudinal Observational Study. JMIR Mental Health. 2025; 12: e75774.","DOI":"10.2196\/75774"},{"key":"ref128","doi-asserted-by":"publisher","unstructured":"Vecchio I, Mifsud L, Castro E Almeida S, Passecker J. Diagnostic digital phenotyping in schizophrenia-spectrum disorders: a systematic review. NPJ Digital Medicine. 2025; 9: 16.","DOI":"10.1038\/s41746-025-02194-w"}],"container-title":["Alpha Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/AP\/27\/4\/10.31083\/AP52900","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:24:04Z","timestamp":1788438244000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/AP\/27\/4\/10.31083\/AP52900"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":128,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"alternative-id":["S2757-8038(26)03605-0"],"URL":"https:\/\/doi.org\/10.31083\/ap52900","relation":{},"ISSN":["2757-8038"],"issn-type":[{"value":"2757-8038","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"article-number":"52900"}}