Sleep Organisation in Depression and Schizophrenia: Index of Endogenous Periodicity of Sleep as a State Marker [Retracted]

Andrej Ilankovic, Aleksandar Damjanovic, Vera Ilankovic, Srdjan Milovanovic, Dusan Petrovic, Nikola Ilankovic


Background: Sleep disorders are frequent symptoms described in psychiatric patients with major depression or schizophrenia. These patients also exhibit changes in the sleep architecture measured by polysomnography (PSG) during sleep. The aim of the present study was to identify potential biomarkers that would facilitate the diagnosis based on polysomnography (PSG) measurements.

Subjects and Methods: 30 patients with schizophrenia, 30 patients with major depression and 30 healthy control subjects were investigated in the present study. The mean age in the group with schizophrenia was 36.73 (SD 6.43), in the group of patients with depression 40.77 (SD 7.66), in the healthy controls group 34.40 (SD 5.70). The gender distribution was as follows: 18 male, 12 female in the group with schizophrenia; in the group of patients with depression 11 male, 19 female; in the control group 16 male and 14 female. All subjects underwent polysomnography (PSG) for a minimum time of 8 hours according to the criteria of Rechtschaffen & Kales (1968). The following polysomnographic (PSG) parameters were analyzed: sleep latency (SL), total sleep time (TST), waking time after sleep onset (WTASO), number of awakenings (NAW), slow wave sleep (SWS), rapid eye movement sleep (REM), rapid eye movement sleep latency (REML), first REM period (REM 1), and first NREM period (NREM 1). We tested the potential of multiple sleep variables to predict diagnosis in different groups by using linear discriminate analysis (LDA).

Results: There were significant differences in polysomnography (PSG) variables between healthy control subjects and psychiatric patients (total sleep time, sleep latency, number of awakenings, time of awakening after sleep onset, REM 1 latency, REM 1 and index of endogenous periodicity). Importantly, LDA was able to predict the correct diagnosis in 88% of all cases.

Conclusions: The presented analysis showed commonalities and differences in polysomnography (PSG) changes in patients with major depressive disorder and in patients with schizophrenia. Our results underline the potential of polysomnography (PSG) measurements to facilitate diagnostic processes.


Sleep; Polysomnography; Schizophrenia; Depression; Biological Markers.

Full Text:



Miret M, Ayuso-Mateos JL, Sanchez-Moreno J, Vieta E: Depressive disorders and suicide: Epidemiology, risk factors, and burden. Neurosci Biobehav Rev. 2013.

Rössler W, Salize HJ, Van Os J, Riecher-Rössler A: Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol. 2005; 15: 399–409.

Benca RM, Obermeyer WH, Thisted RA, Gillin JC: Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psychiatry. 1992; 49: 651–68.

Tsuno N, Besset A, Ritchie K: Sleep and depression. J Clin Psychiatry. 2005; 66: 1254–69.

Steiger A, Kimura M: Wake and sleep EEG provide biomarkers in depression. J Psychiatr Res. 2010; 44: 242–52.

Ilankovic N, Marinkovic D, Bugarski D, Ignjatovic M: Models of exogenous and endogenous sleep perturbation as diagnostic and therapeutic predictors in depression. Methods Find Exp Clin Pharmacol. 1986; 8: 513–17.

Chouinard S, Poulin J, Stip E, Godbout R: Sleep in untreated patients with schizophrenia: a meta-analysis. Schizophr Bull. 2004; 30: 957–67.

Benson KL, Faull KF, Zarcone VP Jr: Evidence for the role of serotonin in the regulation of slow wave sleep in schizophrenia. Sleep. 1991; 14: 133–39.

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 Res. 1996; 60: 125–34.

Keshavan MS, Reynolds III CF, Miewald JM, Montrose DM, Sweeney JA, Vasko Jr RC, Kupfer DJ: Delta sleep deficits in schizophrenia: evidence from automated analyses of sleep data. Arch Gen Psychiatry. 1998; 55: 443.

Sarkar S, Katshu MZUH, Nizamie SH, Praharaj SK: Slow wave sleep deficits as a trait marker in patients with schizophrenia. Schizophr Res. 2010; 124: 127–33.

Ganguli R, Reynolds CF, Kupfer DJ: Electroencephalographic sleep in young, never-medicated schizophrenics. A comparison with delusional and nondelusional depressives and with healthy controls. Arch Gen Psychiatry. 1987; 44: 36–44.

Poulin J, Daoust AM, Forest G, Stip E, Godbout R: Sleep architecture and its clinical correlates in first episode and neuroleptic-naive patients with schizophrenia. Schizophr Res. 2003; 62: 147–53.

Gaillard JM, Iorio G, Campajola P, Kemali D: Temporal organization of sleep in schizophrenics and patients with obsessive-compulsive disorder. Advances in biological psychiatry. 1984; 15: 76-83.

Jus K, Bouchard M, Jus AK, Villeneuve A, Lachance R: Sleep EEG studies in untreated, long-term schizophrenic patients. Arch Gen Psychiatry. 1973; 29: 386–90.

Kempenaers C, Kerkhofs M, Linkowski P, Mendlewicz J: Sleep EEG variables in young schizophrenic and depressive patients. Biol Psychiatry. 1988; 24: 833–38.

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 Res. 1998; 78: 141–50.

Riemann D, Kammerer J, Löw H, Schmidt MH: Sleep in adolescents with primary major depression and schizophrenia: a pilot study. J Child Psychol Psychiatry. 1995; 36: 313–26.

Van Cauter E, Linkowski P, Kerkhofs M, Hubain P, L’Hermite-Balériaux M, Leclercq R, Brasseur M, Copinschi G, Mendlewicz J: Circadian and sleep-related endocrine rhythms in schizophrenia. Arch Gen Psychiatry. 1991; 48: 348–56.

Tandon R, Lewis C, Taylor SF, Shipley JE, DeQuardo JR, Jibson M, Goldman M: Relationship between DST nonsuppression and shortened REM latency in schizophrenia. Biol Psychiatry. 1996; 40: 660–63.

Yang C, Winkelman JW: Clinical significance of sleep EEG abnormalities in chronic schizophrenia. Schizophr Res. 2006; 82: 251–60.

Pillai V, Kalmbach DA, Ciesla JA: A meta-analysis of electroencephalographic sleep in depression: evidence for genetic biomarkers. Biol Psychiatry. 2011; 70: 912–919.

Friess E, Modell S, Brunner H, Tagaya H, Lauer CJ, Holsboer F, Ising M: The Munich vulnerability study on affective disorders: microstructure of sleep in high-risk subjects. Eur Arch Psychiatry Clin Neurosci. 2008; 258: 285–91.

Modell S, Ising M, Holsboer F, Lauer CJ: The Munich Vulnerability Study on Affective Disorders: stability of polysomnographic findings over time. Biol Psychiatry. 2002; 52: 430–37.

Modell S, Ising M, Holsboer F, Lauer CJ: The Munich vulnerability study on affective disorders: premorbid polysomnographic profile of affected high-risk probands. Biol Psychiatry. 2005; 58, 694–699.

Team R et al: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna: Austria, 2010.

World Health Organisation. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. W H O.

Kupfer DJ, Reynolds III CF: Sleep and psychiatric disorders: a meta-analysis. Arch Gen Psychiatry. 1992; 49: 669.

Haro R., Drucker-Colín R: Effects of long-term administration of nicotine and fluoxetine on sleep in depressed patients. Arch Med Res. 2004; 35: 499–506.

Jobert M, Jähnig P, Schulz H: Effect of two antidepressant drugs on REM sleep and EMG activity during sleep. Neuropsychobiology. 1999; 39: 101–109.

Riemann D, Velthaus S, Laubenthal S, Müller WE, Berger M: REM-suppressing effects of amitriptyline and amitriptyline-N-oxide after acute medication in healthy volunteers: results of two uncontrolled pilot trials. Pharmacopsychiatry. 1990; 23: 253–58.

Landsness EC, Goldstein MR, Peterson MJ, Tononi G, Benca RM: Antidepressant Effects of Selective Slow Wave Sleep Deprivation in Major Depression: A High-Density EEG Investigation. J Psychiatr Res. 2011; 45: 1019–26.

Cohrs S: Sleep disturbances in patients with schizophrenia: impact and effect of antipsychotics. CNS Drugs. 2008; 22: 939–62.

Zhang L, Samet J, Caffo B, Bankman I, Punjabi NM: Power spectral analysis of EEG activity during sleep in cigarette smokers. Chest. 2008; 133: 427–32.

Tarokh L, Van Reen E, Acebo C, LeBourgeois M, Seifer R, Fallone G, Carskadon MA: Adolescence and parental history of alcoholism: insights from the sleep EEG. Alcohol Clin Exp Res. 2012; 36: 1530–41.

Nicholson AN, Turner C, Stone BM, Robson PJ: Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults. J Clin Psychopharmacol. 2004; 24: 305–13.

Riemann D, Berger M, Voderholzer U: Sleep and depression--results from psychobiological studies: an overview. Biol Psychol. 2001;57(1-3):67-103.


Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


  • There are currently no refbacks.

Copyright (c) 2013 Andrej Ilankovic, Aleksandar Damjanovic, Vera Ilankovic, Srdjan Milovanovic, Dusan Petrovic, Nikola Ilankovic

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


Published by: Id Design 2012/DOOEL Skopje, Republic of Macedonia