Sleep and quality of life in obsessive-compulsive disorder

Abstract

Patients suffering from obsessive-compulsive disorder (OCD) scarcely complain primarily of insomnia. However, sleep disturbance is very common in this population as shown by epidemiological and polysomnographic studies. Clinical psychiatrists have to check for sleep disruptions through a careful medical history of the patient. Special attention will be paid to patients with checking of washing rituals who can delay their sleep during endless compulsive activities. To what extent these sleep problems are related to the pathophysiology of OCD or simply a consequence of the obsessive-compulsive symptoms remains to be addressed in future studies. In OCD, despite initial confusing findings, there is no specific alteration of the sleep structure. However, impaired sleep continuity, intrusion of wake during sleep, and reduction of sleep duration are constantly observed. Endocrine functions are also strongly modified during sleep of OCD sufferers. Adrenocorticotrophic hormone (ACTH) and cortisol are significantly elevated whereas sleep onset-related GH secretion is blunted in patients compared with healthy controls. Clinical experience suggests that the improvement of OCD is strongly linked to the decrease of sleep alterations but the specific impact of insomnia on the course of the illness and the quality of life (QOL) of patients has not been investigated precisely. Neurobiology shows that sleep regulation and OCD pathophysiology share common serotoninergic mechanisms, suggesting that their relationship is not fortuitous. Prescription of serotonin-acting antidepressant for OCD has to be reassessed to prevent further alteration of sleep structure. Actually, antidepressants active on OCD stimulate vigilance and could disrupt sleep continuity. From a therapeutic point of view, we need to determine the reciprocal effects of specific treatments (ODC or sleep focused) on the evolution of the other variables. It is likely that sleep care should facilitate OCD treatment and reciprocally. © 2008 Humana Press, Totowa, NJ.