Short communicationAssessing sleep in opioid dependence: A comparison of subjective ratings, sleep diaries, and home polysomnography in methadone maintenance patients
Introduction
Sleep may impact drug use, treatment compliance, intervention efficacy, and relapse risk through behavioral and physiologic mechanisms. A role for sleep disturbance in addiction has been found in cocaine users (Morgan et al., 2006, Morgan et al., 2010), methadone patients (Stein et al., 2004, Peles et al., 2006, Kurth et al., 2009, Sharkey et al., 2009, Trksak et al., 2010), and alcohol-dependent patients (Brower et al., 1998, Conroy et al., 2006). Among alcohol-dependent patients in early recovery, for example, sleep disturbances and perceived sleep disruption are related to future alcohol use (Brower et al., 1998, Conroy et al., 2006).
Patients in methadone maintenance therapy (MMT) for opioid dependence frequently report sleep complaints (Oyefeso et al., 1997, Stein et al., 2004, Peles et al., 2006). One potential pathway to sleep disruption in MMT patients is opioid-induced reduction of the nucleoside adenosine in the basal forebrain (Nelson et al., 2009). The notion that reduced adenosine – a neurochemical modulator of the homeostatic drive for sleep – may be responsible for sleep disturbances in MMT patients is further supported by the observation that MMT patients fail to show typical recovery responses after a sleep-deprivation challenge (Trksak et al., 2010). Comorbid psychiatric disorders, chronic pain, and other drug use may also contribute to sleep complaints in MMT patients (Stein et al., 2004, Peles et al., 2006).
Comparisons of subjective and objective sleep measures in non-drug dependent individuals with and without insomnia have shown that self-reported sleep can differ substantially from physiologic recordings (Carskadon et al., 1976, Spinweber et al., 1985, Hauri and Wisbey, 1992, Silva et al., 2007). Whether subjective sleep complaints reflect objective sleep measures in MMT patients is unknown. In order to establish associations between subjective and objective sleep measures in MMT patients, we compared one week of sleep diaries to one night of polysomnography (PSG), a morning questionnaire following PSG, and the Pittsburgh Sleep Quality Inventory (PSQI).
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Participants
As part of a clinical trial of a pharmacological insomnia treatment, we recruited 137 patients from 8 MMT clinics in Rhode Island from 2006 to 2009 (see Kurth et al. (2009) for details).
Inclusion criteria were: insomnia (PSQI > 5 at screening; Buysse et al., 1989), intent to continue MMT for 6 months, fluency in English, and stable housing. Exclusion criteria were: psychotic symptoms, diagnosis of bipolar disorder, schizophrenia, schizoaffective or schizophreniform disorder, trazodone use in the
Results
The 62 participants had a mean age of 39.2 ± 8.3 years (range 21–56), and included 38 women and 54 non-Hispanic Caucasian participants. Median MMT enrollment duration was 13 months. Methadone dose ranged from 21 mg to 285 mg with a mean of 107.9 ± 51.7 mg (median = 100 mg). Of those with valid urine drug tests on the PSG night (n = 55), we observed the following rates of drug use: benzodiazepines: 41.8% (n = 23); cocaine: 27.8% (n = 15); tetrahydrocannabinoids: 20.0% (n = 11), and opiates: 14.8% (n = 8).
Average
Discussion
Most patients in MMT for opioid dependence report sleep difficulties, but no previous study has assessed whether subjective complaints of sleep disruption in MMT patients are correlated with objective sleep disturbance. Our data comparing PSG sleep with a morning sleep questionnaire demonstrate that MMT patients are reliable in reporting their sleep duration within a short time frame. In addition, this short-term consistency is reflected in sleep reported at other time points. Subjective sleep
Role of funding source
This work was funded by NIH R01 DA 020479 to MDS. Dr. Stein is the recipient of a NIDA Mid-Career Award K24-DA00512. NIH/NIDA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Contributors
Michael D. Stein designed the study. Michael D. Stein and Richard P. Millman wrote the protocol. Megan E. Kurth managed participant recruitment and data collection. Richard P. Corso recruited participants and collected data. Authors Stein, Millman, Kurth, Anderson, and Sharkey planned the data analyses. Bradley J. Anderson performed the statistical analyses. Katherine M. Sharkey wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
No conflict declared.
Acknowledgements
The authors thank Raynald Joseph, Jill MacCormack, Roberta Fish, Braulio Lopez, Laura DiMaio, Celeste Caviness, Meredith Sims, John Murray, and Carol Carlisle for assistance with this project.
References (23)
- et al.
Sleep loss and sleepiness: current issues
Chest
(2008) - et al.
The pittsburgh sleep quality index: a new instrument for psychiatric practice and research
Psychiatry Res.
(1989) - et al.
Sleep, sleep-dependent procedural learning and vigilance in chronic cocaine users: evidence for occult insomnia
Drug Alcohol Depend.
(2006) - et al.
Subjective sleep–wake parameters in treatment-seeking opiate addicts
Drug Alcohol Depend.
(1997) - et al.
Variables associated with perceived sleep disorders in methadone maintenance treatment (MMT) patients
Drug Alcohol Depend.
(2006) - et al.
Obstructive sleep apnea is more common than central sleep apnea in methadone maintenance patients with subjective sleep complaints
Drug Alcohol Depend.
(2010) - et al.
Sleep disturbances among methadone maintained patients
J. Subst. Abuse Treat.
(2004) - et al.
Effects of sleep deprivation on sleep homeostasis and restoration during methadone-maintenance: a [31]P MRS brain imaging study
Drug Alcohol Depend.
(2010) - et al.
Polysomnographic and subjective sleep predictors of alcoholic relapse
Alcohol. Clin. Exp. Res.
(1998) - et al.
Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia
Am. J. Psychiatry
(1976)
Perception of sleep in recovering alcohol-dependent patients with insomnia: relationship with future drinking
Alcohol. Clin. Exp. Res.
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