Stellate Ganglion Block and Sleep Disorders: A Narrative Review

Abstract

Background: Sleep disorders affect a substantial proportion of the global population and are associated with increased morbidity, mortality, and societal risk. Insomnia, obstructive sleep apnea, circadian rhythm disorders, and stress-related sleep disruption are increasingly recognized as disorders of autonomic, neuroimmune, and circadian dysregulation. Conventional therapies, while effective for many patients, are limited by adherence, side effects, and incomplete symptom resolution.

Aims: This review examines the neurobiological basis of sleep regulation, the role of sympathetic hyperactivity in sleep disorders, and the emerging evidence supporting stellate ganglion block (SGB) as an adjunctive intervention for sleep dysfunction.

Methods: A narrative review was conducted synthesizing preclinical, neurobiological, and clinical studies evaluating sleep regulation, autonomic-neuroimmune interactions, and the effects of stellate ganglion block on sleep outcomes. Key databases were reviewed for studies involving SGB, sleep disorders, circadian regulation, and inflammatory signaling.

Results: Sleep disorders are characterized by hyperarousal driven by sympathetic overactivity, dysregulated hypothalamic-pituitary-adrenal axis signaling, altered melatonin secretion, inflammatory cytokine activation, and orexin-mediated wake stabilization. The stellate ganglion occupies a central position in these networks via sympathetic control of pineal melatonin release, hypothalamic stress circuitry, and noradrenergic arousal pathways. Preclinical and clinical studies demonstrate that SGB reduces sympathetic tone, suppresses pro-inflammatory cytokines, normalizes melatonin rhythms, and improves subjective and objective sleep measures across multiple populations.

Conclusion: Stellate ganglion block represents a promising adjunctive therapy for sleep disorders characterized by autonomic hyperarousal. Its rapid, non-daily mechanism of action and favorable safety profile support further investigation in controlled trials.