Sleep and Cognition in Schizophrenia

  • Parisa Adimi Naghan Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Javad Setareh Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
Keywords: Cognition, Schizophrenia, Sleep


Background and Objective: Schizophrenia (SCZ) affects both genders with similar rates. It usually appears in the second to the third decades of one’s life. Schizophrenia is marked by a wide spectrum of symptoms, which functionally impair patients. The symptoms are categorized as positive, negative, or cognitive deficits. Among them, cognitive disturbance is highly valued. However, the relationship between sleep and cognition in patients with schizophrenia has been less widely considered. In this study, we aimed to review the relationship between sleep and cognition in patients with schizophrenia.

Materials and Methods: We considered selected key words (e.g. Cognition, Schizophrenia, and Sleep), and searched the online databases at the first step with defined time window of 2010 to the present; while at the second step, the incomplete knowledge was completed from 1990 to 2010. Among them, articles related to our research objectives were selected for further review.

Results: Cognitive functions including memory, attention, reasoning, decision-making, and many other elements are tightly related to quality of sleep. Moreover, sleep deficit exacerbate the symptoms of schizophrenia. It is known that cognitive function is dependent on certain activities in brain that occur during sleep. A body of research has indicated that the slow wave sleep, rapid eye movement (REM) sleep, K-complex, and also sleep spindle are at least partly explained by these functions.

Conclusion: In the light of these findings, study of brain activity via electroencephalogram (EEG) during sleep is a reasonable objective method for assessment of sleep-related cognitive markers in patients with schizophrenia. 


Kim J, Lee Y, Han D, et al. The utility of quantitative electroencephalography and integrated visual and auditory continuous performance test as auxiliary tools for the attention deficit hyperactivity disorder diagnosis. Clin Neurophysiol 2015; 126: 532-40.

NCBI. Cognition [Online]. [cited 2018]; Available from: URL:

Kar SK, Jain M. Current understandings about cognition and the neurobiological correlates in schizophrenia. J Neurosci Rural Pract 2016; 7: 412-8.

Bhakta SG, Chou HH, Rana B, et al. Effects of acute memantine administration on MATRICS consensus cognitive battery performance in psychosis: Testing an experimental medicine strategy. Psychopharmacology (Berl) 2016; 233: 2399-410.

Lystad JU, Falkum E, Haaland VO, et al. Neurocognition and occupational functioning in schizophrenia spectrum disorders: The MATRICS Consensus Cognitive Battery (MCCB) and workplace

assessments. Schizophr Res 2016; 170: 143-9.

Madre M, Canales-Rodriguez EJ, Ortiz-Gil J, et al. uropsychological and neuroimaging underpinnings of schizoaffective disorder: A systematic review. Acta Psychiatr Scand 2016; 134: 16-30.

Coyle JT, Balu DT, Puhl MD, et al. History of the concept of disconnectivity in schizophrenia. Harv Rev Psychiatry 2016; 24: 80-6.

Owen MJ, Sawa A, Mortensen PB. Schizophrenia. Lancet 2016; 388: 86-97.

Sheffield JM, Barch DM. Cognition and restingstate functional connectivity in schizophrenia. Neurosci Biobehav Rev 2016; 61: 108-20.

Kim YK, Choi J, Park SC. A novel biopsychosocial-behavioral treatment model in schizophrenia. Int J Mol Sci 2017; 18.

Schulz SC, Murray A. Assessing cognitive impairment in patients with schizophrenia. J Clin Psychiatry 2016; 77: 3-7.

Hurford IM, Marder SR, Keefe RS, et al. A brief cognitive assessment tool for schizophrenia: Construction of a tool for clinicians. Schizophr Bull 2011; 37: 538-45.

Kristian Hill S, Buchholz A, Amsbaugh H, et al. Working memory impairment in probands with schizoaffective disorder and first degree relatives of schizophrenia probands extend beyond deficits predicted by generalized neuropsychological impairment. Schizophr Res 2015; 166: 310-5.

Ventura J, Wood RC, Hellemann GS. Symptom domains and neurocognitive functioning can help differentiate social cognitive processes in schizophrenia: A meta-analysis. Schizophr Bull 2013; 39: 102-11.

Wu JQ, Chen DC, Tan YL, et al. Cognitive impairments in first-episode drug-naive and chronic medicated schizophrenia: MATRICS consensus cognitive battery in a Chinese Han population. Psychiatry Res 2016; 238: 196-202.

Bora E, Lin A, Wood SJ, et al. Cognitive deficits in youth with familial and clinical high risk to psychosis: A systematic review and meta-analysis. Acta Psychiatr Scand 2014; 130: 1-15.

Ramakrishnan M, Sartory G, van Beekum A, et al. Sleep-related cognitive function and the K-complex in schizophrenia. Behav Brain Res 2012; 234: 161-6.

Geige A, Achermann P, Jenni OG. Sleep, intelligence and cognition in a developmental context: Differentiation between traits and state-dependent aspects. Progress in Brain Research 2010; 185: 167-79.

Zaytseva Y, Korsakova N, Agius M, et al. Neurocognitive functioning in schizophrenia and during the early phases of psychosis: Targeting cognitive remediation interventions. Biomed Res Int 2013; 2013: 819587.

Porter VR, Buxton WG, Avidan AY. Sleep, cognition and dementia. Curr Psychiatry Rep 2015; 17: 97.

Samson DR, Nunn CL. Sleep intensity and the

evolution of human cognition. Evol Anthropol 2015; 24: 225-37.

Van Laethem M, Beckers DG, Kompier MA, et al. Bidirectional relations between work-related stress, sleep quality and perseverative cognition. J Psychosom Res 2015; 79: 391-8.

Van Someren EJ, Cirelli C, Dijk DJ, et al. Disrupted sleep: From molecules to cognition. J Neurosci 2015; 35: 13889-95.

Mizuseki K, Miyawaki H. Hippocampal information processing across sleep/wake cycles. Neurosci Res 2017; 118: 30-47.

Poe GR. Sleep Is for Forgetting. J Neurosci 2017; 37: 464-73. 26. Lo JC, Sim SK, Chee MW. Sleep reduces false memory in healthy older adults. Sleep 2014; 37: 66571, 671A.

Mander BA, Rao V, Lu B, et al. Prefrontal atrophy, disrupted NREM slow waves and impaired hippocampal-dependent memory in aging. Nat Neurosci 2013; 16: 357-64.

Landmann N, Kuhn M, Piosczyk H, et al. The reorganisation of memory during sleep. Sleep Med Rev 2014; 18: 531-41.

Casey SJ, Solomons LC, Steier J, et al. Slow wave and REM sleep deprivation effects on explicit and implicit memory during sleep. Neuropsychology 2016; 30: 931-45.

Plihal W, Born J. Effects of early and late nocturnal sleep on declarative and procedural memory. J Cogn Neurosci 1997; 9: 534-47.

Plihal W, Born J. Effects of early and late nocturnal sleep on priming and spatial memory. Psychophysiology 1999; 36: 571-82. 32. Logothetis NK, Eschenko O, Murayama Y, et al. Hippocampal-cortical interaction during periods of subcortical silence. Nature 2012; 491: 547-53.

Sutherland GR, McNaughton B. Memory trace reactivation in hippocampal and neocortical neuronal ensembles. Curr Opin Neurobiol 2000; 10: 180-6.

Buzsaki G. Hippocampal sharp wave-ripple: A cognitive biomarker for episodic memory and planning. Hippocampus 2015; 25: 1073-188.

Axmacher N, Mormann F, Fernandez G, et al. Memory formation by neuronal synchronization. Brain Res Rev 2006; 52: 170-82.

Clemens Z, Fabo D, Halasz P. Overnight verbal memory retention correlates with the number of sleep spindles. Neuroscience 2005; 132: 529-35.

Tamaki M, Matsuoka T, Nittono H, et al. Fast sleep spindle (13-15 hz) activity correlates with sleepdependent improvement in visuomotor performance. Sleep 2008; 31: 204-11.

Gardner RJ, Kersante F, Jones MW, et al. Neural oscillations during non-rapid eye movement sleep as biomarkers of circuit dysfunction in schizophrenia. Eur J Neurosci 2014; 39: 1091-106.

Paulsen JS, Heaton RK, Sadek JR, et al. The nature of learning and memory impairments in schizophrenia. J Int Neuropsychol Soc 1995; 1: 88-99.

Fioravanti M, Bianchi V, Cinti ME. Cognitive deficits in schizophrenia: An updated metanalysis of the scientific evidence. BMC Psychiatry 2012; 12: 64.

Velligan DI, Bow-Thomas CC, Mahurin RK, et al. Do specific neurocognitive deficits predict specific domains of community function in schizophrenia? J Nerv Ment Dis 2000; 188: 518-24.

Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry 1996; 153: 321-30.

Dark F, Cairns A, Harris A. Cognitive remediation: The foundation of psychosocial treatment of schizophrenia. Aust N Z J Psychiatry 2013; 47: 505-7.

Bechi M, Bosia M, Spangaro M, et al. Combined social cognitive and neurocognitive rehabilitation strategies in schizophrenia: Neuropsychological and psychopathological influences on Theory of Mind improvement. Psychol Med 2015; 45: 3147-57.

Tao J, Zeng Q, Liang J, et al. Effects of cognitive rehabilitation training on schizophrenia: 2 years of follow-up. Int J Clin Exp Med 2015; 8: 16089-94.

Zierhut K, Bogerts B, Schott B, et al. The role of hippocampus dysfunction in deficient memory encoding and positive symptoms in schizophrenia. Psychiatry Res 2010; 183: 187-94.

Luthi A. Sleep spindles: Where they come from, what they do. Neuroscientist 2014; 20: 243-56.

Bonjean M, Baker T, Bazhenov M, et al. Interactions between core and matrix thalamocortical projections in human sleep spindle synchronization. J Neurosci 2012; 32: 5250-63.

Woodward ND, Karbasforoushan H, Heckers S. Thalamocortical dysconnectivity in schizophrenia. Am J Psychiatry 2012; 169: 1092-9.

Welsh RC, Chen AC, Taylor SF. Lowfrequency BOLD fluctuations demonstrate altered thalamocortical connectivity in schizophrenia. Schizophr Bull 2010; 36: 713-22.

Astori S, Wimmer RD, Prosser HM, et al. The Ca(V)3.3 calcium channel is the major sleep spindle pacemaker in thalamus. Proc Natl Acad Sci U S A 2011; 108: 13823-8.

Manoach DS, Pan JQ, Purcell SM, et al.

Reduced sleep spindles in schizophrenia: A treatable endophenotype that links risk genes to impaired cognition? Biol Psychiatry 2016; 80: 599-608.

Mulligan LD, Haddock G, Emsley R, et al. High resolution examination of the role of sleep disturbance in predicting functioning and psychotic symptoms in schizophrenia: A novel experience sampling study. J Abnorm Psychol 2016; 125: 788-97.

Bian Y, Wang ZX, Han XL, et al. Sleep state misperception in schizophrenia: Are negative symptoms at work? Compr Psychiatry 2016; 67: 33-8.

Guenole F, Chevrier E, Stip E, et al. A microstructural study of sleep instability in drug-naive patients with schizophrenia and healthy controls: Sleep spindles, rapid eye movements, and muscle atonia. Schizophr Res 2014; 155: 31-8.

Tesler N, Gerstenberg M, Franscini M, et al. Reduced sleep spindle density in early onset schizophrenia: a preliminary finding. Schizophr Res 2015; 166: 355-7.

Vukadinovic Z. Sleep spindle reductions in schizophrenia and its implications for the development of cortical body map. Schizophr Res 2015; 168: 589-90.

Young A, Wimmer RD. Implications for the thalamic reticular nucleus in impaired attention and sleep in schizophrenia. Schizophr Res 2017; 180: 44-7.

Behrendt RP. Dysregulation of thalamic sensory "transmission" in schizophrenia: Neurochemical vulnerability to hallucinations. J Psychopharmacol 2006; 20: 356-72.

Ferrarelli F, Tononi G. Reduced sleep spindle activity point to a TRN-MD thalamus-PFC circuit dysfunction in schizophrenia. Schizophr Res 2017; 180: 36-43.

Govindaiah G, Wang T, Gillette MU, et al. Regulation of inhibitory synapses by presynaptic D(4) dopamine receptors in thalamus. J Neurophysiol 2010; 104: 2757-65.

Ferrarelli F, Huber R, Peterson MJ, et al. Reduced sleep spindle activity in schizophrenia patients. Am J Psychiatry 2007; 164: 483-92.

Tsekou H, Angelopoulos E, Paparrigopoulos T, et al. Sleep EEG and spindle characteristics after combination treatment with clozapine in drug-resistant schizophrenia: A pilot study. J Clin Neurophysiol 2015; 32: 159-63.

How to Cite
Adimi Naghan P, Setareh J. Sleep and Cognition in Schizophrenia. J Sleep Sci. 2(3-4):89-94.
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