Sleep problems and cognitive behavior therapy in pediatric obsessive-compulsive disorder have bidirectional effects

• Children and adolescents with obsessive compulsive disorder have difficulties sleeping.
• CBT for the OCD is helpful not only for OCD, but for the sleep problems as well in most cases.
• A clinical picture complicated with comorbidity had no negative impact on sleep recovery.
• Worse sleep problems before therapy predicted an unfavourable outcome with regard to the OCD.

ObjectivesTo investigate the presence of sleep problems and their reaction to CBT in pediatric obsessive compulsive disorder (OCD). Moreover, we investigated whether sleep problems predict the outcome of CBT on OCD-symptoms.Methods269 children and adolescents, age 7–17 years, with DSM-IV primary OCD that took part in the first step of a stepwise treatment trial, were assessed with regard to both individual sleep problems and a sleep composite score (SCS) using the Child Behavior Checklist (CBCL). Their OCD symptoms were rated using the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS).ResultsWe found elevated symptoms of sleep deprivation and nightmares before treatment. However most sleep problems (e.g. nightmares (p = .03), too little sleep (p < .001), trouble sleeping (p < .001) and parasomnias p = .03)) as well as being over-tired (p < .001) reduced during CBT treatment. Co-morbidities had no effect on the reduction of SCS. Moreover, elevated levels of sleep problems using the SCS (p < .001), as well as any sleep problem at baseline (p < .001) predicted less effect of CBT on the OCD symptoms.ConclusionSleep problems in paediatric OCD are frequent and interfere with treatment outcome. They need to be assessed using better methods in future trials. Moreover, lack of resolution of sleep problems need to be recognized and treated as it seems probable that continued sleep problems may have a negative impact on CBT efficacy.