Sleep and physical activity patterns in relation to daily-life symptoms in psychosis: An actigraphy and experience sampling study

Sleep disturbances and reduced physical activity (PA) are important risk factors for poor physical and mental health outcomes in people with psychosis. However, the precise interrelations between sleep, PA and psychopathology remain unclear. This study combined experience sampling (ESM) and actigraphy in thirty-two patients with a schizophrenia spectrum disorder to investigate interrelations of day-to-day variations in actigraphic estimates of PA and sleep and psychotic and affective symptoms. Multilevel mixed-models show that subjects reported more positive affect on more physically active days. Unexpectedly, participants reported worse next-day negative affect and/or psychotic symptoms after nights with higher sleep continuity, as consistently indicated by sleep efficiency and the mean duration of bouts of wake and sleep. Lastly, PA was higher after nights with higher sleep continuity and shorter total sleep duration. These results highlight that modifiable lifestyle factors such as PA and sleep have an intricate, but clinically relevant relationship with psychotic and affective symptoms. Future studies are needed to further examine the complex effects of these behaviors in order to develop effective, targeted treatment strategies to improve clinical outcome in psychosis.