Nocturnal sleep architecture disturbances in early methadone treatment patients
Introduction
As a long-acting μ-opioid agonist, methadone has been used in the treatment of opioid dependence for several decades (Kreek et al., 2002). It blocks heroin withdrawal symptoms and does not produce euphoric or sedative effects (Kleber, 2003). Methadone treatment (MT) is now widely considered as an effective treatment for opiate dependence (National Consensus Development Panel, 1998, Kreek et al., 2002, Mattick et al., 2003). However, during MT, patients often complain about sleep disturbances such as insomnia, inadequate sleep quality and quantity, excessive day-time sleepiness and fatigue (Stein et al., 2004, Peles et al., 2006).
Sleep architecture abnormalities in patients undergoing methadone maintenance treatment have also been documented by studies using polysomnography (Kay, 1975, Staedt et al., 1996, Teichtahl et al., 2001, Wang et al., 2005, Wang and Teichtahl, 2007). Such abnormalities may appear in the early stage of MT, but the data on this issue have been limited. Oyefeso et al. (1997) investigated subjective sleep parameters of opiate addicts at the time of admission into methadone detoxification programme and found that patients dependent on opiates were more likely to report difficulty initiating and maintaining sleep as well as inadequate sleep quality and quantity. However, given the absence of polysomnography in the study, the sleep architecture in the early stage of MT remains unclear. It is well documented that sleep disturbance can have a profound impact on quality of life, health and even mortality (Wiley and Camacho, 1980, Kuppermann et al., 1995). If sleep disturbances are not ameliorated in substance-dependent patients, these patients may have an increased risk of relapse (Landolt and Gillin, 2001, Beaujouan et al., 2005).
Many factors in early MT, such as opiate withdrawal, methadone substitution and benzodiazepine use are known to be associated with sleep disturbance. Lewis reported that heroin suppresses human rapid eye movement (REM) sleep, while REM sleep immediately increased after opiate withdrawal (Lewis et al., 1970). According to Howe's finding, REM sleep was still decreased in acute heroin-abstinent patients compared with normal controls (Howe et al., 1980). Other studies showed methadone has an effect on human electroencephalogram (EEG) and sleep EEG (Feinstein, 1975, Kay et al., 1979, Pickworth et al., 1981, Dimsdale et al., 2007). A recent study found an inverse correlation between sleep quality and methadone dose as well as serum methadone levels (Peles et al., 2006).
Patients' sleep parameters in early MT, which play an important role in treatment retention and outcomes, have remained largely unexplored. In the present study, we evaluated patients' perceived quality of sleep using the Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989) and the Epworth sleepiness scale (ESS; Johns, 1991), then objectively recorded their nocturnal sleep architecture with polysomnography (PSG) to ascertain characteristics of sleep in early MT.
Section snippets
Subjects
All subjects provided written informed consent to participate in the study, which was approved by the institutional research ethics committees of the Beijing Anding Hospital, Capital Medical University. MT patients were selected from inpatients of the National Drug Dependence Treatment Centre at Beijing Anding Hospital and screened when admitted for methadone treatment. All were male (female patients were excluded because: (a) the proportion of female patients (20–30%) was small; (b) to
Results
All patients underwent one polysomnographic recording. Nineteen control subjects took the test once, and one was recorded twice because the first recorded sleep time was less than 90% of his usual sleep time. Analyses showed that there was no significant difference in age or Body mass index (BMI) between the MT patients and the healthy controls (Table 1).
Discussion
This study used a cross-sectional, case–control design to closely investigate the sleep patterns in patients in the early state of methadone treatment. We found that, compared with healthy controls, MT patients had lower sleep efficiency (P < 0.01), shorter total sleep time (P < 0.01), shorter slow wave sleep (SWS) (P < 0.01) and more frequent awakenings (P < 0.01). The PSQI and ESS scores in patients were significantly higher than the controls (P < 0.01). ESS scores of the patients were associated with
Acknowledgements
This study was supported by grants from the Major State Basic Research Program of P.R. China (973): 2003CB515400 and the Public Health Bureau of Beijing: 2004-J-058. The authors wish to thank all the participants for their time and co-operation. The authors also wish to thank the anonymous reviewers.
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Le Xiao and Yi-lang Tang contributed equally to this study.