Patients With Alcohol Use Disorder Have High Prevalence of Insomnia

A study published in Alcohol found that patients with alcohol use disorder (AUD) had an increased prevalence of insomnia. The study also found that sex, depression, and physical activity were all factors associated with insomnia in patients with AUD.

Insomnia has been found to affect as many as 36% to 91% of people with AUD. Insomnia and AUD likely have a bidirectional causal relationship wherein the amount of quality sleep can predict future consumption of alcohol and heavy consumption of alcohol can lead to insomnia, the authors noted. The aim of this study was to examine insomnia in patients with AUD in terms of prevalence, presentation, and development over time. The study also aimed to identify factors in patients with AUD that are associated with insomnia.

Data were collected in 3 treatment clinics in the eastern region of Norway between January 2018 and August 2019. The clinics offered long-term treatment stays from 1 to 9 months in duration for individuals with substance use disorder (SUD), most of whom had a diagnosis of AUD. Data collection was done when patients had been in the clinic for a median (IQR) of 7 (5-12) days and reported abstinence from alcohol for 19 (12-30) days.

All patients completed the Sleep Condition Indicator (SCI) questionnaire to collect subjective data on sleep quality. The questionnaire asks about the occurrence of sleep onset delay, nighttime awakenings, number of nights with problematic sleep, self-rated sleep quality, effect on mood, effect on concentration, overall effect of poor sleep, and duration of sleep problems in the previous month. Scores ranged from 0 to 32, with lower scores indicating lesser quality of sleep.

Baseline data included an interview, biometric measures, blood sampling, structured interviews, and questionnaires. Depressive symptoms were measured with the Beck Depression Inventory (BDI). The Mini International Neuropsychiatric Interview was used to diagnose AUD, SUD, and anxiety disorders. Severity of alcohol dependence was measured with the Severity of Dependence Scale (SDS). Level of physical activity was also assessed with the International Physical Activity Questionnaire short version.

There were 87 patients included in the descriptive and baseline analyses, and there were 94 participants included in the longitudinal analyses. There were 47 (54%) of participants who had SCI scores indicating insomnia at baseline. There were 24 (35%) and 15 (37%) patients who reported insomnia after 6-week and 6-month follow-up periods, respectively. Patients with insomnia scored lower on all SCI items, with most patients having problems with sleep onset and time spent awake after awakening during the night.

There were 21 (34%) patients who had insomnia at baseline and follow-up, 13 (21%) who reported insomnia at baseline and not follow-up, 1 (2%) who had insomnia at follow-up but not at baseline, and 27 (44%) who did not have insomnia at all.

There were fewer men in the group of patients with insomnia compared with the group who did not (64% vs 88%). Physical activity was also less common in patients with insomnia compared with those without (21% vs 70%). Patients with insomnia had more depressive symptoms compared with those without (median [IQR] BDI score, 21 [13-29] vs 11 [4-19]). Patients with insomnia also had a higher dependence on alcohol (median [IQR] SDS score, 11 [8-13] vs 10 [7-11]).

Logistic regression models were used in the study. Unadjusted models found that being female, higher dependence severity, experiencing trauma in adulthood, higher levels of depressive symptoms, and lower physical activity were all factors that increased odds of probable insomnia. A multivariable model found that depressive symptoms (odds ratio [OR], 1.11; 95% CI, 1.02-1.20), reduced physical activity (OR, 0.09; 95% CI, 0.02-0.35), and female sex (OR, 0.18; 95% CI, 0.03-0.94) were associated with insomnia.

There were some limitations to this study. Follow-up material was missing data, which limited the power of the longitudinal analyses and could have introduced a bias toward better sleep. Emotional abuse and neglect were not addressed and could have acted as confounders to sleep problems. A bias toward higher functioning level in the included patients is possible due to the exclusion of those who did not return their questionnaire. Lastly, information on specific treatment targets and progress was not available.

The researchers concluded that patients with AUD have a higher prevalence of insomnia, with insomnia associated with female sex, depressive symptoms, and level of physical activity.

Reference

Bolstad I, Toft H, Lien L, Moe JS, Rolland B, Bramness JG. Longitudinal determinants of insomnia among patients with alcohol use disorder. Alcohol. Published online November 7, 2022. doi:10.1016/j.alcohol.2022.11.002