Characterizing Sleep Disorders in People with Opioid Use Disorder

Introduction/

Background:
Problems with sleep are reported at a higher rate in populations with opioid use disorder (OUD) compared to populations without OUD. Recent studies have shown that opioids disrupt the physiologic sleep architecture1, that sleep disturbance persists despite medication for OUD2, and that poor sleep quality is a risk factor for relapse3. However, there is a limited understanding of which specific factors in OUD populations impact sleep disturbance. The purpose of this analysis was to systematically evaluate sleep in an opioid-using population, and to understand the association of sleep with drug use practices and mental health comorbidities.

Methods:
Participants were recruited to a longitudinal cohort investigation of individuals with OUD evaluating natural history and associated complications. The sample population consisted of 63 people from two clinic locations in Washington, D.C. and Baltimore, MD. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), a 19-item self-report questionnaire that measures sleep quality and disturbances over the last four weeks, with disordered sleep defined as a score of >= 5, and sleep components of trouble falling asleep or trouble staying asleep. Mental health comorbidities were assessed using the Patient Health Questionnaire – 9 (PHQ-9) for depression, the General Anxiety Disorder – 7 (GAD-7) for anxiety, and the Diagnostic and Statistical Manual of Mental Disorders 5 Cross Cutting Survey (DSM-5) for psychosis and mania. Demographics and drug use practices were assessed using self-reported survey data and urine drug screen, respectively. A two-tailed Fischer’s exact test was used to analyze the relationship between these factors and sleep.

Results:
The cohort of 63 individuals was 71.4% male (45), 90% Black/African American (57), with mean age 58.9 years. Nearly all were on medication for OUD (MOUD) (93.7%), with 81.4% (48) of those being on buprenorphine-naloxone. Sixty-seven percent (42) of the cohort met PSQI criteria for disordered sleep, while 44 individuals (71%) met component criteria for trouble falling asleep, 46 individuals (73%) for trouble staying asleep, and 33 individuals (53%) for both trouble falling and staying asleep.

Injection opioid use (p=0.38), daily or more opioid use (p=1.0), and alcohol use (p=1.0) were not associated with disordered sleep. In contrast, there were statistically significant associations between disordered sleep and depression (p < 0.0001), anxiety (p < 0.0001), mania (p=0.007), psychosis (p=0.036), and cocaine use (p=0.024). There were also significant associations between trouble falling asleep or trouble staying asleep, respectively, with depression (p=0.0001;p=0.0008), anxiety (p=0.003;p=0.0008), and mania (p=0.035; p=0.007). .

Conclusion:
In this OUD cohort study, the majority met criteria for disordered sleep, with more than two-thirds having trouble falling or staying asleep. The strong association between sleep and mental health comorbidities found in this investigation supports the need to diagnose and treat sleep disorders in individuals with OUD. Further investigation is needed to assess if interventions to impact sleep may improve mental health and OUD outcomes in this vulnerable population.

References: 1. Tripathi, R., et al., Opioids and sleep – a review of literature. Sleep Medicine, 2020. 67: p. 269-275.
2. Fathi, H.R., et al., Crosstalk between Sleep Disturbance and Opioid Use Disorder: A Narrative Review. Addict Health 2020; 12(2): p. 140-58.
3. Chrobok, A.I., et al., Sleeping Patterns in Patients with Opioid Use Disorder: Effects of Opioid Maintenance Treatment and Detoxification. Journal of Psychoactive Drugs. 2020; 52(3): p. 203-210.