Sleep in Children and Adolescents with Obsessive-Compulsive Disorder

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Key points

  • Sleep problems are not a core feature of obsessive-compulsive disorder (OCD), but emerging empirical data indicate some form of sleep disruption to be highly common.

  • Available research in both adult and child patients is limited in several important ways, including the use of subjective reports (particularly in children), high rates of comorbid depression, and concurrent use of psychotropic medication.

  • The presence of sleep disruption in OCD patients may compound severity and impairment of the

Sleep in adults with obsessive-compulsive disorder

Although studies are limited compared with other psychiatric conditions, such as depression, examination of objective sleep patterns in OCD has produced inconsistent results. In an initial examination by Insel and colleagues,15 14 patients with OCD, 14 age-matched patients with depression, and 14 age- and gender-matched controls were compared on objective measures of sleep. Significantly reduced total sleep time (TST), more awakenings, reduced stage 4 sleep, and shortened latency to rapid eye

Summary of adult-based studies

For the most part, adult findings are largely limited by the potential influence of co-occurring depression, the unclear impact of psychotropic medications on sleep architecture, and the collection of objective sleep data under laboratory (ie, artificial) conditions. As a result, conclusions that can be drawn from these studies remain tenuous. These studies suggest similarities in the sleep of patients with OCD and patient with depressive symptoms, not necessarily accounted for by high rates of

Sleep in children with obsessive-compulsive disorder

Sleep findings among adult OCD patients are equivocal; studies using objective sleep measures in children with OCD are relatively nonexistent. Most available studies have investigated the presence of sleep-related problems based on subjective child or parent reports. For example, Alfano and colleagues13 found that 54% of children with primary OCD (ages 7 to 14 years) reported trouble sleeping and 64% reported difficulty waking in the morning. Among a larger sample, Storch and colleagues14 found

Summary on pediatric findings

Sleep plays a critical role in early development.36 For youth with OCD, sleep problems during this period may compound the severity and burden of their illness. Unfortunately, the majority of available sleep research has been conducted in adult OCD patients, rendering unclear implications for children based on salient development differences in both OCD and sleep patterns during this period. Adult-based studies are also limited by high rates of comorbidity. Yet, because adult patients are more

Treatment of sleep problems comorbid with pediatric obsessive-compulsive disorder

The gold-standard nonpharmacologic treatment of OCD in adults and children is cognitive behavior therapy (CBT).39, 40 CBT has also been found to augment treatment outcomes for pediatric OCD where medical management (ie, selective serotonin reuptake inhibitors) is used.41 Unfortunately, data on whether CBT improves comorbid sleep problems in children and adolescents are lacking. There is recent recognition of a need for “empirical evaluation of underlying mechanisms and shared treatment effects

Summary

Subjective and objective measurement of sleep in children and adolescents experiencing OCD demonstrates a longer time taken to fall asleep (sleep-onset latency) and restricted total sleep duration that may also include frequent night awakenings. Presleep arousal may be implicated in such sleep disturbances, yet more research is needed to confirm this link. Although models have been presented to understand the relationship between sleep problems and anxiety in school-aged children,42 the authors

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    Funding Sources: None.

    Conflict of Interest: None.

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