Sleep quality and quality of life in people with non-affective psychosis: A systematic review of relationships across phases and age groups.

Sleep disturbance is common in non-affective psychosis and can impact quality of life (QoL). However, evidence for the relationship between sleep quality and QoL across psychosis phases and age groups has not been systematically reviewed. Following PRISMA guidelines (PROSPERO CRD42025626830), a search was conducted across Medline, Embase, PsycINFO, and Web of Science (October 2025). Eligible peer-reviewed studies included individuals with non-affective psychosis, late onset or very late onset schizophrenia (LOS / VLOS), or ultra-high risk (UHR) states that reported associations between sleep quality and QoL. Methodological quality was appraised using the Mixed Methods Appraisal Tool, and findings were narratively synthesised. Eighteen studies (n = 4711) met inclusion criteria. Most involved individuals with chronic psychosis (n = 15), with few in first episode psychosis (FEP) (n = 2) and UHR groups (n = 1). No studies examined LOS or VLOS. Across chronic and FEP samples, poorer subjective sleep quality was generally associated with lower QoL. However, there was significant heterogeneity across studies, including variability in sleep and QoL tools, analytic approaches, and covariate adjustment. Associations also varied across QoL domains and were not always retained after controlling for covariates. Evidence for UHR populations was inconclusive, and no data were available for later-onset psychosis. In conclusion, poor sleep quality appears to be a correlate of reduced QoL in FEP and chronic psychosis. Further longitudinal research is needed to clarify the nature and direction of this relationship, incorporate objective sleep measures, and extend investigation to underrepresented psychosis phases and age groups.