Summary: People with obsessive-compulsive spectrum disorders (OCSDs), chronic tic disorders (CTDs), and attention-deficit/hyperactivity disorder (ADHD) frequently experience significant sleep disturbances. A recent narrative review suggests these problems may stem from disruptions in the cortico-striatal-thalamo-cortical (CSTC) neural circuit.
The review highlights how imbalances in key neurotransmitters—particularly dopamine and GABA—within CSTC circuitry are associated with both the core symptoms of these disorders and the sleep problems that commonly accompany them. The authors propose a bidirectional, potentially additive relationship: CSTC dysfunction contributes to disturbed sleep, and poor sleep in turn may worsen CSTC-related psychiatric symptoms.
Subjective reports, supported by a limited number of objective studies, point to delayed sleep onset, increased movement during sleep, and disrupted sleep spindles across these populations. Recognizing this neural connection could improve diagnosis and encourage personalized treatment strategies that address both psychiatric symptoms and sleep health.
Key Facts:
- CSTC Dysfunction: Dysregulation in the CSTC circuit may underlie both sleep disturbances and psychiatric symptoms in OCSDs, CTDs, and ADHD.
- Bidirectional Impact: Poor sleep can intensify CSTC-related symptoms, while CSTC disorders can alter sleep architecture and quality.
- Treatment Implications: Some effective psychiatric medications—such as selective serotonin reuptake inhibitors (SSRIs) for OCD and body dysmorphic disorder—can affect REM sleep, so clinicians should consider sleep effects when choosing therapies.
Source: Wolters Kluwer Health
Overview of the Review
The narrative review, published in the May issue of Harvard Review of Psychiatry, was conducted by Margaret D. Hall (Miami University), Erica Greenberg, MD, and Kevin Gipson, MD, MS (Massachusetts General Hospital), and colleagues. The team examined studies that investigated the relationship between CSTC neurocircuitry and sleep disturbances in OCSDs, CTDs, and ADHD.
Using searches of PubMed, Google Scholar, PsychInfo, and Web of Science for English-language articles published before August 2022, the authors identified 42 relevant papers: 23 on OCSDs, eight on CTDs, 10 on ADHD, and one covering both CTDs and ADHD. For the purposes of the review, OCSDs included obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), body-focused repetitive behavior (BFRB) disorders, and hoarding disorder. Chronic tic disorders included Tourette syndrome and chronic or persistent motor or vocal tic disorder.
Across studies, adults with CTDs or OCD consistently reported co-occurring sleep movement disorders. Children with OCD, ADHD, or CTDs also reported similar subjective sleep complaints. Although polysomnographic data were limited, available objective measures indicated patterns of sleep disturbance in OCD, BFRB disorders, and CTDs—particularly delayed sleep onset and disrupted sleep spindles.
The reviewers conclude that current evidence supports a bidirectional and potentially additive relationship: disordered sleep may be intrinsic to CSTC-related conditions, and poor sleep can impair functional connectivity and possibly induce structural changes in fronto-striatal circuitry, further worsening psychiatric symptoms.
Treatment Considerations
The review outlines three general treatment strategies for sleep disturbances in patients with CSTC-related conditions: (1) prioritize treatment of the underlying psychiatric condition with the expectation that sleep will improve, (2) directly treat sleep problems to indirectly reduce psychiatric symptoms, or (3) address both the psychiatric disorder and sleep concurrently. The optimal approach likely varies by individual, disorder, and the specific sleep issues involved.
Particular caution is recommended when treating children, since medications can alter sleep architecture. Clinicians should weigh the long-term consequences of modified sleep patterns against the risks of untreated psychopathology. Identifying treatments that both reduce core psychiatric symptoms and preserve or improve healthy sleep architecture is a critical goal for future research.
As an example, SSRIs—first-line treatments for OCD and BDD—are effective for core symptoms but commonly delay REM sleep onset and reduce REM sleep duration. Future studies should explore whether an SSRI’s clinical benefits are influenced by its impact on sleep architecture and whether observed sleep changes are medication-induced or reflect underlying CSTC-related sleep pathology.
About this mental health and sleep research news
Author: Josh DeStefano
Source: Wolters Kluwer Health
Contact: Josh DeStefano – Wolters Kluwer Health
Image credit: Neuroscience News
Original Research: Closed access. “Disrupted Cortico-Striato-Thalamo-Cortical Circuitry and Sleep Disturbances in Obsessive-Compulsive Spectrum, Chronic Tic, and Attention-Deficit/Hyperactivity Disorders” by Margaret D. Hall et al., Harvard Review of Psychiatry.
Abstract
Disrupted Cortico-Striato-Thalamo-Cortical Circuitry and Sleep Disturbances in Obsessive-Compulsive Spectrum, Chronic Tic, and Attention-Deficit/Hyperactivity Disorders
The bidirectional relationship between sleep and OCSDs, CTDs, and ADHD remains incompletely understood. To develop more effective interventions for individuals experiencing both neuropsychiatric symptoms and sleep disturbances, it is important to identify shared neural mechanisms that could be targeted therapeutically.
Current research implicates disrupted CSTC circuitry in the pathophysiology of CTDs, OCSDs, and ADHD. This review synthesizes the available literature on how CSTC-pathway dysfunction—and dysregulation of primary neurotransmitters such as dopamine and GABA—relates to sleep disorders observed in these conditions.
Findings consistently link CSTC disruptions to subjective reports of poor sleep and insomnia in adults, and to sleep movement disorders in adults with CTDs. Limited pediatric research shows some parallel patterns, but few studies have used polysomnography for objective sleep assessment. Future work should clarify the neural relationship between these neuropsychiatric conditions and sleep disturbances to better inform therapeutic targets and treatment sequencing—whether to prioritize the underlying condition, the sleep disturbance, or both.