Effects of theta burst stimulation on sleep quality in psychiatric disorders: A systematic review

Sleep dysregulation affects a significant proportion of psychiatric patients, contributing to poorer clinical outcomes and quality of life. Theta burst stimulation (TBS) has recently emerged as a promising intervention for the treatment of depression and other psychiatric disorders, with recent evidence suggesting potential benefits for sleep. A systematic review was undertaken to assess the evidence for the effects of TBS on sleep outcomes in adults with psychiatric disorders. In accordance with PRISMA guidelines, Ovid Medline, APA PsycINFO, Embase, the Web of Science, Cochrane Library, and ClinicalTrials.gov were searched up to December 2, 2025. Randomized controlled trials (RCTs) or cohort studies reporting outcomes on a validated sleep scale were included. Fourteen studies met inclusion criteria and assessed 838 participants with diagnoses of major depressive episode, post-traumatic stress disorder, substance use disorder, somatic symptom disorder, anxiety disorder, obsessive compulsive disorder, or insomnia disorder. The majority of studies reported improvements in subjective sleep quality after TBS treatment. The association between sleep changes with concurrent improvements in other psychiatric symptoms was inconsistent. No serious adverse effects were reported. Seven RCTs raised some concerns for bias, while 1 RCT was rated as high risk of bias. All cohort studies were classified as having a critical risk of bias. Overall, these preliminary results suggest TBS may contribute to sleep benefits in psychiatric populations, however, methodological variability and lack of high-quality clinical trials limit the interpretability of these findings. Larger sham-controlled trials that include validated sleep scales are needed to further clarify the therapeutic potential of TBS.