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Sleep reductions associated with illicit opioid use and clinic-hour changes during opioid agonist treatment for opioid dependence: Measurement by electronic diary and actigraphy.

ABSTRACT: Sleep problems are commonly reported during opioid agonist treatment (OAT) for opioid use disorders. Inpatient studies have found both sleep disturbances and improved sleep during OAT. Illicit opioids can also disrupt sleep, but it is unclear how they affect sleep in outpatients receiving OAT. Therefore, we used electronic diary entries and actigraphy to measure sleep duration and timing in opioid-dependent participants (n?=?37) treated with methadone (n?=?15) or buprenorphine (n?=?22). For 16?weeks, participants were assigned to attend our clinic under different operating hours in a crossover design: Early hours (07:00-09:00) vs. Late hours (12:00-13:00) for 4?weeks each in randomized order, followed for all participants by our Standard clinic hours (07:00-11:30) for 8?weeks. Throughout, participants made daily electronic diary self-reports of their sleep upon waking; they also wore a wrist actigraph for 6 nights in each of the three clinic-hour conditions. Drug use was assessed by thrice-weekly urinalysis. In linear mixed models controlling for other sleep-relevant factors, sleep duration and timing differed by drug use and by clinic hours. Compared to when non-using, participants slept less, went to bed later, and woke later when using illicit opioids and/or both illicit opioids and cocaine. Participants slept less and woke earlier when assigned to the Early hours. These findings highlight the role OAT clinic schedules can play in structuring the sleep/wake cycles of OAT patients and clarify some of the circumstances under which OAT patients experience sleep disruption in daily life.

SUBMITTER: Bertz JW

PROVIDER: S-EPMC6756187 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Sleep reductions associated with illicit opioid use and clinic-hour changes during opioid agonist treatment for opioid dependence: Measurement by electronic diary and actigraphy.

Bertz Jeremiah W JW Epstein David H DH Reamer David D Kowalczyk William J WJ Phillips Karran A KA Kennedy Ashley P AP Jobes Michelle L ML Ward Greg G Plitnick Barbara A BA Figueiro Mariana G MG Rea Mark S MS Preston Kenzie L KL

Journal of substance abuse treatment 20190814

Sleep problems are commonly reported during opioid agonist treatment (OAT) for opioid use disorders. Inpatient studies have found both sleep disturbances and improved sleep during OAT. Illicit opioids can also disrupt sleep, but it is unclear how they affect sleep in outpatients receiving OAT. Therefore, we used electronic diary entries and actigraphy to measure sleep duration and timing in opioid-dependent participants (n = 37) treated with methadone (n = 15) or buprenorphine (n = 22). For 16 w ...[more]

PMID: 31540611

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Project description:Background:Among people living in detention, substance use is highly prevalent, including opioid dependence. Opioid agonist treatment (OAT) has been established as an evidence-based, first-line treatment for opioid dependence. Despite high prevalence of opioid dependence, conclusive data regarding its prevalence and the OAT practice in German prisons is scarce; rather, the existing data widely diverges concerning the rates of people in detention receiving OAT. Materials and Methods:We conducted a cross-sectional survey of all detention facilities in Berlin. On the date of data collection, a full census of the routine records was completed based on the medical documentation system. For each opioid dependent individual, we extracted sociodemographic data (i.e., age, sex, and non-/German nationality, whether people experienced language-related communication barriers), information about OAT, comorbidities (HIV, hepatitis C, schizophrenia), and the detention center, as well as the anticipated imprisonment duration and sentence type. The data was first analyzed descriptively and secondly in an evaluative-analytical manner by analyzing factors that influence the access to OAT of people living in detention. Results:Among the 4,038 people in detention in the Berlin custodial setting under investigation, we identified a 16% prevalence of opioid dependence. Of the opioid-dependent individuals, 42% received OAT; 31% were treated with methadone, 55% were treated with levomethadone, and 14% were treated with buprenorphine. Access to OAT seemed mainly dependent upon initial receipt of OAT at the time of imprisonment, detention duration, the prisons in which individuals were detained, German nationality, and sex. The overall prevalence of HIV was 4-8%, hepatitis C was 31-42%, and schizophrenia was 5%. Conclusions:The prevalence of opioid dependence and access to OAT remains a major health issue in the custodial setting. OAT implementation must be especially intensified among male, non-German, opioid-dependent individuals with a short detention period. Treatment itself must be diversified regarding the substances used for OAT, and institutional treatment differences suggest the need for a consistent treatment approach and the standardized implementation of treatment guidelines within local prison's standard operating procedures. Testing for infectious diseases should be intensified among opioid-dependent people living in detention to address scarcely known infection statuses and high infection rates.

Project description:Purpose:The sleep diary is the gold standard of self-reported sleep duration, but its comparability to sleep questionnaires is uncertain. The purpose of this study was to compare self-reported sleep duration between a sleep diary and a sleep questionnaire and to test whether sleep-related disorders were associated with diary-questionnaire differences in sleep duration. Participants and methods:We compared self-reported sleep duration from 5,432 questionnaire-sleep diary pairs in a longitudinal cohort of 1,516 adults. Participants reported sleep information in seven-day sleep diaries and in questionnaires. Research staff abstracted average sleep durations for three time periods (overall; weekday; weekend) from diaries and questionnaires. For each time period, we evaluated diary-questionnaire differences in sleep duration with Welch's two-sample t-tests. Using linear mixed effects regression, we regressed overall diary-questionnaire sleep duration difference on several participant characteristics: reporting any insomnia symptoms, having sleep apnea, sex, body mass index, smoking status, Short Form-12 Physical Health Composite Score, and Short Form-12 Mental Health Composite Score. Results:The average diary-reported overall sleep duration (7.76 hrs) was longer than that of the questionnaire (7.07 hrs) by approximately 41 mins (0.69 hrs, 95% confidence interval: 0.62, 0.76 hrs). Results were consistent across weekday- and weekend-specific differences. Demographic-adjusted linear mixed effects models tested whether insomnia symptoms or sleep apnea were associated with diary-questionnaire differences in sleep duration. Insomnia symptoms were associated with a 17 min longer duration on the diary relative to the questionnaire (?=0.28 hrs, 95% confidence interval: 0.22, 0.33 hrs), but sleep apnea was not significantly associated with diary-questionnaire difference. Female sex was associated with greater diary-questionnaire duration differences, whereas better self-reported health was associated with lesser differences. Conclusion:Diaries and questionnaires are somewhat disparate methods of assessing subjective sleep duration, although diaries report longer duration relative to questionnaires, and insomnia symptoms may contribute to greater perceived differences.

Dataset Information

Sleep reductions associated with illicit opioid use and clinic-hour changes during opioid agonist treatment for opioid dependence: Measurement by electronic diary and actigraphy.

Publications

Sleep reductions associated with illicit opioid use and clinic-hour changes during opioid agonist treatment for opioid dependence: Measurement by electronic diary and actigraphy.

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