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Poster #64 - During Day and Night: Childhood Psychotic Experiences and Sleep Problems

Thu, March 21, 9:30 to 10:45am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Background: Psychotic experiences compromise auditory and visual perceptive phenomena, such as hearing or seeing things that are not there, or delusional thoughts, in the absence of a psychotic disorder (Kelleher, Jenner, & Cannon, 2010). It is important to study childhood psychotic experiences because children, who report such symptoms in late childhood or early adolescence, have a 5 to 16 times higher risk for developing psychotic disorders in adulthood (Poulton et al., 2000). Studies using self- or mother-reported measures of sleep problems found that psychotic experiences co-occur with self-reported sleep problems (Jeppesen, Clemmensen, et al., 2015). Consistent with this, others report that psychotic experiences in adolescence often are preceded by severe nightmares in childhood (Fisher et al., 2014). While there is a rising interest in the role of sleep problems in the development of psychotic experiences, so far very few clinical studies and no population-based studies used objective measures of sleep to study this association. This study assessed whether psychotic experiences were associated with actigraphic sleep measures, symptoms of dyssomnia, nightmares, or other parasomnias.
Methods: This cross-sectional population-based study comprises 4149 children from the XXX. At age 10 years, psychotic experiences including hallucinatory phenomena were assessed by self-report; dyssomnia and parasomnia symptoms were assessed by mother- and child-report. Additionally, in a subsample at age 11 years, objective sleep parameters were measured using a tri-axial wrist accelerometer in N=814 children, who wore the accelerometer for nine consecutive days (five school days and four weekend days). The analyses were adjusted for child’s age, sex, ethnicity, gestational age, and maternal educational attainment and psychiatric problems.
Results: Psychotic experiences were not associated with objective sleep duration, sleep efficiency, arousal, or social jetlag. However, psychotic experiences were associated and hallucinatory phenomena were associated with self-reported dyssomnia (respectively, B = 2.45, 95%CI: 2.13 to 2.77, p<0.001; B = 2.02, 95%CI: 1.69 to 2.40, p<0.001), mother-reported dyssomnia (respectively, B = 3.48, 95%CI: 2.48 to 4.89, p<0.001; B = 2.31, 95%CI: 1.59 to 3.35, p<0.001) and mother-reported parasomnia, specifically nightmares (respectively, ORadjusted = 3.59, 95%CI: 2.66 to 4.83, ORadjusted = 2.74, 95%CI: 1.99 to 3.78).
Conclusions: Childhood psychotic experiences were not associated with objective sleep measures. We found that psychotic experiences were consistently associated with subjective sleep problems across multiple raters. Consistent with this, we observed a dose-response association, whereby more child-reported psychotic experiences were associated with higher levels of mother-reported dyssomnia and parasomnia. Taken together, our findings suggest that in the general pediatric population psychotic experiences co-occur with multi-rated sleep problems and most strongly with nightmares. This finding can contribute to a broader understanding of the relationship between psychotic-like experiences and sleep. Additionally, it stresses the role of nightmares as a potential risk-indicator of psychopathology. More research is needed to shed light on the potential etiologic or diagnostic role of nightmares in the development of psychotic phenomena.

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