Correlates of polysomnographic sleep changes in cocaine dependence: Self-administration and clinical outcomes

Abstract

Background Abstinence from chronic cocaine use is associated with abnormal sleep architecture. As sleep abnormalities are associated with clinical outcome in alcohol dependence, we hypothesized a similar relationship in cocaine dependence. Methods We report data from a cocaine self-administration study (N=12) and the placebo arm of a randomized clinical trial (N=20). Self-administration participants underwent three cocaine self-administration sessions during a three-week inpatient stay. Treatment participants underwent two weeks of inpatient followed by six weeks of outpatient treatment including once-weekly cognitive behavioral therapy. Measurements included polysomnography from early and late in abstinence during the inpatient stays. Clinical outcomes included amount of cocaine self-administered, urine tests, and self-reported use and withdrawal symptoms. Results Change in slow-wave sleep from early to late abstinence (ΔSWS; p=0.05), late abstinence rapid eye movement sleep (REM; p=0.002), and late abstinence total sleep time (p=0.02) were negatively correlated with the amount of cocaine self-administered. Early abstinence REM was positively correlated with withdrawal symptoms (p=0.02). Late abstinence REM was positively correlated with percent negative urines and maximum consecutive number of days abstinent (both p<0.001). ΔSWS was positively correlated with percent negative urines (p=0.03) and participants with increased SWS had greater percent negative urines (p=0.008) and maximum consecutive number of days abstinent (p=0.009). Conclusions Correlations between sleep deficits and amount of cocaine self-administered, clinical outcomes, and severity of withdrawal symptoms underscore the relevance of sleep in clinical outcomes in the treatment of cocaine dependence.

Life‐time history of insomnia and hypersomnia symptoms as correlates of alcohol, cocaine and heroin use and relapse among adults seeking substance use treatment in the United States from 1991 to 1994

“…Insomnia symptoms, hypersomnia symptoms, and both insomnia and hypersomnia symptoms were related to a higher likelihood of using cocaine 12-months post-treatment. These results add to a growing literature linking sleep and cocaine abstinence (31,49). The present study builds on these prior findings by providing evidence that a lifetime history of insomnia and hypersomnia symptoms are prospectively associated with post-treatment cocaine use in the context of a large, multisite community-based substance treatment study.…”

Modafinil and sleep architecture in an inpatient–outpatient treatment study of cocaine dependence

“…Abstinence on each day was determined from self-report, and accepted if it was consistent with urine toxicology screens. However, a single, missed urine was considered negative if the previous and subsequent urines were negative and the self-report from the subsequent session denied use for the intervening period (Angarita et al, 2014a). This technique was used to determine daily abstinence rates, as well as the maximum consecutive number of days abstinent for each participant during the 6-weeks of outpatient treatment.…”

“…Previous work has identified dramatic alterations in sleep architecture associated with chronic use as examples of targetable neurophysiological abnormalities (Angarita et al, 2014a, 2014b; Morgan and Malison, 2008; Morgan et al, 2010, 2006; Pace-Schott et al, 2005). These alterations include profound and largely stable deficits in slow-wave sleep as well as alterations in REM sleep and total sleep time (Angarita et al, 2014b; Matuskey et al, 2011; Morgan et al, 2010, 2006, 2008).…”

Sleep quality improves during treatment with repetitive transcranial magnetic stimulation (rTMS) in patients with cocaine use disorder: a retrospective observational study

“…Furthermore, in the first weeks of abstinence, polysomnography (PSG) shows worsening sleep, with reductions in duration of rapid eye movement sleep (REM), slow-wave sleep (SWS), and total sleep, and increases in sleep latency [3,[6][7][8][9]. These sleep abnormalities are long-lasting [6] and related to the severity of withdrawal symptoms and clinical outcomes [10]. However, the causal relationship between sleep disturbances and CUD still needs to be clarified [11].…”