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Disrupted sleep is one of the prominent but often overlooked presenting symptoms in the clinical course of psychotic disorders. The aims of this study were to examine the prevalence of sleep disturbances, particularly insomnia and nightmares, and their prospective associations with the risk of suicide attempts in patients with schizophrenia-spectrum disorders. A naturalistic longitudinal study was conducted in outpatients diagnosed with schizophrenia-spectrum disorders recruited from the psychiatric outpatient clinic of a regional university-affiliated public hospital in Hong Kong. A detailed sleep questionnaire was completed by 388 patients at baseline in May–June 2006. Relevant clinical information was extracted from clinical case notes from June 2007–October 2014. Prevalence of frequent insomnia and frequent nightmares was 19% and 9%, respectively. Baseline frequent insomnia was significantly associated with an increased incidence of suicide attempts during the follow-up period (adjusted hazard ratio = 4.63, 95% confidence interval 1.40–15.36, P < 0.05). Nightmare complaint alone did not predict the occurrence of suicide attempts, but the comorbidity of nightmares and insomnia was associated with the risk of suicide attempt over follow-up (adjusted HR = 11.10, 95% confidence interval: 1.68–73.43, P < 0.05). Sleep disturbances are common in patients with schizophrenia-spectrum disorders. The association between sleep disturbances and suicidal risk underscores the need for enhanced clinical attention and intervention on sleep disturbances in patients with schizophrenia. Suicide is the leading cause of premature death among patients with schizophrenia. Timely identification of the individuals at risk of suicide remains a major challenge for clinicians. This is the first study to illustrate the risk over time of suicidal behaviors in relation to sleep complaints in individuals with schizophrenia spectrum disorders. Sleep disturbances, including insomnia and nightmares, were found to predict an increased risk of suicide attempts in outpatients with schizophrenia spectrum disorders. This prognostic implication underscores the need to timely assess and address sleep disturbances in this clinical population. Future research is needed to examine the efficacy of sleep-focused treatments in managing sleep disturbances in the context of psychotic disorders.
Li et al. (Tue,) studied this question.