Аннотация:
Introduction. Sleep disturbance is a common clinical symptom among patients with substance use disorders. Little is known about the association between sleep disturbance, anhedonia and relapse.
Aim: longitudinally examination of the sleep characteristics among patients with alcohol or opioid dependence to determine the risk factors of the relapse during early remission.
Method. The 24-week prospective cohort study in patients (n=150) admitted to the addition clinics to receive withdrawal therapy due to alcohol (ICD-10 code F10.2, dependence syndrome, F10.30, withdrawal syndrome, n=100, AD) or opioid (ICD-10 code F11.2, dependence syndrome, F11.30, withdrawal syndrome, n=50, OD) dependence with sleep disturbance (Insomnia Severity Index total score ≥8). Sleep characteristics were assessed by self-report and by actigraphy watch. Regression models were conducted to examine the change in sleep over time and to determine the relationship between sleep and relapse, and between sleep and anhedonia.
Results. The quality and the duration of sleep increased over time in both study groups (p<0,001). The risk of relapse/dropout was 9 times higher (95% CI: 4,27-17,30) in AD patients with poor quality of sleep AD group compared to those who did not and 2 times higher in OD group (95% CI: 1,10-5,17). The risk of relapse were higher among participant where sleep onset was after 12 pm (actigraphy data) in AD (RR = 2,01; 95%CI 1,00; 4,06) and in OD (RR = 11,23; 95%CI 3,05; 41,27) groups. In AD group decreased duration of total and slow-waves sleep, and the deep to light sleep ratio (actigraphy data) were associated with increased risk of the relapse at 23,5% , 35,6% and 63,4%, respectively (p<0,001). The quality of sleep was found to be negatively associated with anhedonia subscales: Lack of interest (F=46,85, p<0,001) and Lack of pleasure (F=52,84, p<0,001).
Conclusion. Quality of sleep and total sleep, particularly deep sleep, were associated with relapse to opioid use or heavy drinking and might predict relapse following detoxification. The quality of sleep and quantitative sleep variables are gradually improving in several weeks after the withdrawal therapy. Anhedonia is negatively correlated with the quality of sleep and might modulate the association between the quality of sleep and relapse in patients with opioid and alcohol dependence.
Ключевые слова:
sleep disorders, substance use disorders, alcoholism, anhedonia, relapse, actigraphy.