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Ishizuka et al. Neuroimmunol Neuroinflammation 2018;5:15 Neuroimmunology and
DOI: 10.20517/2347-8659.2018.14 Neuroinflammation

Commentary Open Access

Sleep disturbance and treatment adherence:
commentary on the study by Bosch et al. (2016)

Kanako Ishizuka , Toshiya Inada 1,2
1
1 Department of Psychiatry, Nagoya University Hospital, Nagoya-shi 466-8560, Japan.
2 Department of Psychiatry and Psychobiology, Nagoya University Graduate School of Medicine, Nagoya-shi 466-8550, Japan.
Correspondence to: Dr. Toshiya Inada, Department of Psychiatry and Psychobiology, Nagoya University Graduate School of Medicine,
Tsurumai-cho 65, Aichi, Showa-ku, Nagoya-shi 466-8550, Japan. E-mail: toshiya.inada@gmail.com
How to cite this article: Ishizuka K, Inada T. Sleep disturbance and treatment adherence: commentary on the study by Bosch et al.
(2016). Neuroimmunol Neuroinflammation 2018;5:15. http://dx.doi.org/10.20517/2347-8659.2018.14
Received: 28 Mar 2018 Accepted: 28 Mar 2018 Published: 26 Apr 2018

Science Editor: Athanassios P. Kyritsis Copy Editor: Guang-Zhe Zhu Production Editor: Huan-Liang Wu

Treatment adherence is essential for optimizing healthcare outcomes, especially in individuals with
[1,2]
schizophrenia or depression . Previous studies identified several factors that predict treatment adherence,
including psychiatric diagnoses, patients’ characteristics, side-effects of psychotropic agents, symptom relief,
[3-5]
and the patient-doctor relationship . However, specific predisposing factors for treatment nonadherence
[6]
in patients with psychiatric disorders is unknown. The present study by Bosch et al. focused on the
quality of sleep as one of the factors that could help to explain treatment nonadherence in patients
with schizophrenia or depression. Their findings show that in patients with schizophrenia, more severe
negative symptoms and better quality of sleep was associated with better treatment adherence. By contrast,
in patients with depression, symptom severity or quality of sleep was not associated with treatment
adherence.

The present study is noteworthy for its uncomplicated design with the use of well-established and
standardized rating scales, making it easily replicated anywhere throughout the world. In addition,
the merit of the current study findings can also be easily applied to actual clinical settings because all
participants are outpatients of a clinic, at which most patients with schizophrenia and depression have
been treated.

[6]
However, as Bosch et al. noted the study’s findings must be interpreted carefully. For example, treatment
adherence was measured by self-reported sleep logs. Although self-reporting is a convenient survey
method, it can produce unreliable responses that are influenced by such factors as psychiatric symptoms,
cognitive function, premorbid characteristics and pharmacological intervention, which may preclude

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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