Sleep disorders in patients with obsessive-compulsive disorder: A systematic review of the literature

Patients with obsessive-compulsive disorder are presumed to be at higher risk of sleep disorders due to the potential interference that persistent thoughts and compulsions may exert on sleep. Although there are studies on sleep findings in patients with obsessive-compulsive disorder, there are few systematic reviews on the presence of sleep disorders in patients with obsessive-compulsive disorder for adults and children. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed to perform a comprehensive search of PubMed and Web of Science using the MeSH terms "obsessive-compulsive disorder" and "sleep wake disorders". The exclusion criteria included publications not in English, studies performed on non-humans, abstracts, reviews, and meta-analyses. After applying the exclusion criteria, 17 studies qualified for inclusion in this systematic review. Nine studies were written about children and eight on adults. In the adult studies, sleep questionnaires, actigraphy and dim light melatonin onset showed delayed circadian rhythm in those with obsessive-compulsive disorder. Several studies showed an increased prevalence of insomnia in adult patients with obsessive-compulsive disorder. Overall, these studies showed sleep-onset and maintenance insomnia, and poor sleep quality. In the paediatric studies, sleep questionnaires revealed that paediatric patients with obsessive-compulsive disorder have increased sleep-related problems, including poor sleep quality, difficulty initiating and maintaining sleep, nightmares and sleepwalking. Two studies using actigraphy demonstrated a decreased total sleep time, increased wake after sleep onset and increased duration of awakening. Studies also showed an improvement in sleep symptoms with cognitive behavioural therapy. The systematic review has shown increased sleep-related problems and poor sleep quality both in adult and paediatric patients with obsessive-compulsive disorder. All patients with obsessive-compulsive disorder should therefore be screened for sleep-related problems to help in the overall outcome of treatment plans.