The sleep gap in deep brain stimulation in psychiatry: A systematic review

Deep brain stimulation (DBS) has emerged as a promising intervention for individuals with treatment-resistant psychiatric disease. While sleep plays a significant role in psychiatric health, the extent to which it impacts DBS patients is not known.

To quantify the number and type of studies that report sleep effects in DBS for psychiatric indications, and to report how sleep is impacted after DBS.

A systematic review was conducted using PubMed. We performed a search using the MeSH terms "deep brain stimulation" OR "DBS" plus each disease of interest. Inclusion criteria were human studies using DBS for psychiatric indications including case reports, case series, cohort studies, or clinical trials.

A total of 3873 studies were screened, and 302 met inclusion criteria. Main diagnoses of included studies featured 163 obsessive-compulsive disorder (OCD), 113 depression, 12 substance use disorder, 7 schizophrenia, 6 post-traumatic stress disorder, and 1 anxiety disorder. 4 studies used the Pittsburgh Sleep Quality Index, 3 documented sleep as an adverse event, 1 used a wearable monitor, 1 utilized local field potentials from DBS, 3 used subscales of the Hamilton Depression Rating Scale, 1 used nocturnal electroencephalography (EEG), and 3 used self-reported scales. Ultimately, 5 studies reported improved sleep, 2 studies worsened sleep, and 6 studies reported no effect on sleep after DBS.

Despite the critical role of sleep in psychiatric health, a very limited number of studies measure sleep outcomes after DBS. Furthermore, methods vary widely, ranging from subjective self-reports to objective physiological recordings. These findings highlight the need for standardized sleep assessments in future DBS research to better understand its impact on psychiatric outcomes. Current data is underpowered and the impact of DBS on sleep for psychiatric indications remains unknown.