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Correlates of sleep quality and excessive daytime sleepiness in people with opioid use disorder receiving methadone treatment

  • Psychiatrics • Original Article
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Abstract

Purpose

The aim of this study was to evaluate the prevalence and clinical correlates of impaired sleep quality and excessive daytime sleepiness among patients receiving methadone for opioid use disorder (OUD).

Methods

Patients receiving methadone (n = 164) completed surveys assessing sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daytime sleepiness (Epworth Sleepiness Scale [ESS]), and related comorbidities. We used bivariate and multivariable linear regression models to evaluate correlates of sleep quality and daytime sleepiness.

Results

Ninety percent of patients had poor sleep quality (PSQI >5), and the mean PSQI was high (11.0 ±4). Forty-six percent reported excessive daytime sleepiness (ESS > 10). In multivariable analyses, higher PSQI (worse sleep quality) was significantly associated with pain interference (coefficient = 0.40; 95% CI = 0.18–0.62; β = 0.31), somatization (coefficient = 2.2; 95% CI = 0.75–3.6; β = 0.26), and negatively associated with employment (coefficient = − 2.6; 95% CI = − 4.9 to − 0.19; β = − 0.17). Greater sleepiness was significantly associated with body mass index (coefficient = 0.32; 95% CI = 0.18–0.46; β = 0.33), and there was a non-significant association between sleepiness and current chronic pain (coefficient = 1.6; 95% CI = 0.26–3.5; β = 0.13; p value = 0.09).

Conclusions

Poor sleep quality and excessive daytime sleepiness are common in patients receiving methadone for OUD. Chronic pain, somatization, employment status, and obesity are potentially modifiable risk factors for sleep problems for individuals maintained on methadone. People with OUD receiving methadone should be routinely and promptly evaluated and treated for sleep disorders.

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References

  1. Volkow ND, Wang G-J, Telang F, Fowler JS, Logan J, Wong C, Ma J, Pradhan K, Tomasi D, Thanos PK, Ferre S, Jayne M (2008) Sleep deprivation decreases binding of [11C] raclopride to dopamine D2/D3 receptors in the human brain. J Neurosci 28:8454–8461

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Volkow ND, Tomasi D, Wang G-J, Telang F, Fowler JS, Logan J, Benveniste H, Kim R, Thanos PK, Ferre S (2012) Evidence that sleep deprivation downregulates dopamine D2R in ventral striatum in the human brain. J Neurosci 32:6711–6717

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Brower KJ, Perron BE (2010) Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances. Med Hypotheses 74:928–933

    Article  PubMed  Google Scholar 

  4. Stein MD, Herman DS, Bishop S, Lassor JA, Weinstock M, Anthony J, Anderson BJ (2004) Sleep disturbances among methadone maintained patients. J Subst Abus Treat 26:175–180

    Article  Google Scholar 

  5. Sharkey KM, Kurth ME, Corso RP, Brower KJ, Millman RP, Stein MD (2009) Home polysomnography in methadone maintenance patients with subjective sleep complaints. Am J Drug Alcohol Abuse 35:178–182

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wang D, Teichtahl H, Drummer O, Goodman C, Cherry G, Cunnington D, Kronborg I (2005) Central sleep apnea in stable methadone maintenance treatment patients. Chest. 128:1348–1356

    Article  PubMed  Google Scholar 

  7. Webster LR, Choi Y, Desai H, Webster L, Grant BJB (2007) Sleep-disordered breathing and chronic opioid therapy. Pain Med 9:425–432. https://doi.org/10.1111/j.1526-4637.2007.00343.x

    Article  Google Scholar 

  8. Walker JM, Farney RJ, Rhondeau SM, Boyle KM, Valentine K, Cloward TV, Shilling KC (2007) Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing. J Clin Sleep Med 3:455–461

    Article  PubMed  PubMed Central  Google Scholar 

  9. Moldofsky H (2001) Sleep and pain. Sleep Med Rev 5:385–396

    Article  PubMed  Google Scholar 

  10. Madden LM, Farnum SO, Eggert KF, Quanbeck AR, Freeman RM, Ball SA et al (2018) An investigation of an open-access model for scaling up methadone maintenance treatment. Addiction 113:1450–1458. https://doi.org/10.1111/add.14198

    Article  PubMed  Google Scholar 

  11. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213. https://doi.org/10.1016/0165-1781(89)90047-4

    Article  CAS  PubMed  Google Scholar 

  12. Buysse DJ, Hall ML, Strollo PJ, Kamarck TW, Owens J, Lee L, Reis SE, Matthews KA (2008) Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med 4:563–571

    Article  PubMed  PubMed Central  Google Scholar 

  13. Johns MW (1994) Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep. 17:703–710. https://doi.org/10.1093/sleep/17.8.703

    Article  CAS  PubMed  Google Scholar 

  14. Johns M, Hocking B (1997) Daytime sleepiness and sleep habits of Australian workers. Sleep. 20:844–849. https://doi.org/10.1093/sleep/20.10.844

    Article  CAS  PubMed  Google Scholar 

  15. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131:485–491

    Article  CAS  PubMed  Google Scholar 

  16. Cleeland CS, Ryan KM (1994) Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 23(2):129–138

  17. Derogatis LR (2001) BSI 18, Brief Symptom Inventory 18: administration, scoring and procedures manual: NCS Pearson, Incorporated;

  18. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396

    Article  CAS  PubMed  Google Scholar 

  19. Russell DW (1996) UCLA Loneliness Scale (version 3): reliability, validity, and factor structure. J Pers Assess 66:20–40

    Article  CAS  PubMed  Google Scholar 

  20. Spector IP, Carey MP, Steinberg L (1996) The Sexual Desire Inventory: development, factor structure, and evidence of reliability. J Sex Marital Ther 22:175–190

    Article  CAS  PubMed  Google Scholar 

  21. Holmberg D, Blair KL (2009) Sexual desire, communication, satisfaction, and preferences of men and women in same-sex versus mixed-sex relationships. J Sex Res 46:57–66

    Article  PubMed  Google Scholar 

  22. Sharkey KM, Kurth ME, Anderson BJ, Corso RP, Millman RP, Stein MD (2011) Assessing sleep in opioid dependence: a comparison of subjective ratings, sleep diaries, and home polysomnography in methadone maintenance patients. Drug Alcohol Depend 113:245–248

    Article  PubMed  Google Scholar 

  23. Dunn KE, Finan PH, Tompkins DA, Strain EC (2018) Frequency and correlates of sleep disturbance in methadone and buprenorphine-maintained patients. Addict Behav 76:8–14

    Article  PubMed  Google Scholar 

  24. Peles E, Schreiber S, Adelson M (2006) Variables associated with perceived sleep disorders in methadone maintenance treatment (MMT) patients. Drug Alcohol Depend 82:103–110

    Article  CAS  PubMed  Google Scholar 

  25. Baldassarri SR, Fiellin DA, Savage ME, Madden LM, Beitel M, Dhingra LK, Fucito L, Camenga D, Bollampally P, Barry DT (2019) Electronic cigarette and tobacco use in individuals entering methadone or buprenorphine treatment. Drug Alcohol Depend 197:37–41. https://doi.org/10.1016/j.drugalcdep.2018.12.012

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Gauthier EA, Guzick SE, Brummett CM, Baghdoyan HA, Lydic R (2011) Buprenorphine disrupts sleep and decreases adenosine concentrations in sleep-regulating brain regions of Sprague Dawley rat. Anesthesiology 115:743–753

    Article  CAS  PubMed  Google Scholar 

  27. Staedt J, Wassmuth F, Stoppe G, Hajak G, Rodenbeck A, Poser W, Rüther E (1996) Effects of chronic treatment with methadone and naltrexone on sleep in addicts. Eur Arch Psychiatry Clin Neurosci 246:305–309

    Article  CAS  PubMed  Google Scholar 

  28. Cronin A, Keifer JC, Baghdoyan HA, Lydic R (1995) Opioid inhibition of rapid eye movement sleep by a specific mu receptor agonist. Br J Anaesth 74:188–192

    Article  CAS  PubMed  Google Scholar 

  29. Xiao L, Tang Y-l, Smith AK, Xiang Y-t, Sheng L-x, Chi Y et al (2010) Nocturnal sleep architecture disturbances in early methadone treatment patients. Psychiatry Res 179:91–95

    Article  PubMed  Google Scholar 

  30. Farney RJ, McDonald AM, Boyle KM, Snow GL, Nuttall RT, Coudreaut MF et al (2013) Sleep disordered breathing in patients receiving therapy with buprenorphine/naloxone. Eur Respir J 42:394–403

    Article  CAS  PubMed  Google Scholar 

  31. Hassamal S, Miotto K, Wang T, Saxon AJ (2016) A narrative review: the effects of opioids on sleep disordered breathing in chronic pain patients and methadone maintained patients. Am J Addict 25:452–465

    Article  PubMed  Google Scholar 

  32. Meijer RR, de Vries RM, van Bruggen V (2011) An evaluation of the Brief Symptom Inventory–18 using item response theory: which items are most strongly related to psychological distress? Psychol Assess 23:193–202

    Article  PubMed  Google Scholar 

  33. Sharkey KM, Kurth ME, Anderson BJ, Corso RP, Millman RP, Stein MD (2010) Obstructive sleep apnea is more common than central sleep apnea in methadone maintenance patients with subjective sleep complaints. Drug Alcohol Depend 108:77–83

    Article  PubMed  PubMed Central  Google Scholar 

  34. Drummond SPA, Paulus MP, Tapert SF (2006) Effects of two nights sleep deprivation and two nights recovery sleep on response inhibition. J Sleep Res 15:261–265

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank the APT Foundation research staff for the administration of the survey and data collection.

Funding

This study was funded by the National Institute on Drug Abuse (K23DA045957; K23 DA024050).

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455 South, New Haven, CT, 06520, USA

    Stephen R. Baldassarri, Andrey Zinchuk, Nancy S. Redeker, Lynn M. Madden & H. Klar Yaggi

  2. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Mark Beitel, Lindsay M. S. Oberleitner, Danilo Carrasco & Declan T. Barry

  3. Child Study Center, Yale School of Medicine, New Haven, CT, USA

    Mark Beitel & Declan T. Barry

  4. APT Foundation, New Haven, CT, USA

    Mark Beitel, Danilo Carrasco, Nathan Lipkind & Declan T. Barry

  5. VA CT Health Care System Clinical Epidemiology Research Center (CERC), West Haven, CT, USA

    Andrey Zinchuk & H. Klar Yaggi

  6. Yale School of Nursing, Orange, CT, USA

    Nancy S. Redeker

  7. Department of Psychology, University of Bridgeport, Bridgeport, CT, USA

    David E. Oberleitner

  8. Department of Psychology, Western Connecticut State University, Danbury, CT, USA

    Lindsay M. S. Oberleitner

  9. Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA

    Lynn M. Madden, David A. Fiellin, Lori A. Bastian & Kevin Chen

  10. Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA

    Lori A. Bastian

  11. National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA

    Kevin Chen

Authors
  1. Stephen R. Baldassarri
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  14. Declan T. Barry
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Corresponding author

Correspondence to Stephen R. Baldassarri.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Baldassarri, S.R., Beitel, M., Zinchuk, A. et al. Correlates of sleep quality and excessive daytime sleepiness in people with opioid use disorder receiving methadone treatment. Sleep Breath 24, 1729–1737 (2020). https://doi.org/10.1007/s11325-020-02123-z

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  • DOI: https://doi.org/10.1007/s11325-020-02123-z

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