Documented poor sleep among methadone-maintained patients is associated with chronic pain and benzodiazepine abuse, but not with methadone dose.
Following the findings of perceived poor sleep and of chronic pain among former heroin addicts, current methadone maintenance treatment (MMT) patients, and its possible relation to methadone dose, we studied these patients' objective sleep parameters. Former heroin addicts maintained on "Low" (n=19, <80 mg/d) or "High" (n=25, >150 mg/d) methadone doses, underwent one-night polysomnography (PSG). Patients filled Pittsburgh Sleep Quality Index (PSQI) and chronic pain questionnaires, and current drug abuse was assessed by urine tests.


RESULTS
Of the 44 patients, 18 (40.9%) had chronic pain, while 24 (54.5%) abused BDZ. "High" vs. "Low" methadone dose groups had more years of opiate abuse and lower % of NREM (non rapid eye movement) deep sleep (stages 3-4) with no other differences between groups. Years of opiate abuse and NREM stages 3-4 inversely correlated (R=-0.34, p=0.03). Chronic vs. non-chronic pain patients had lower sleep efficiency and sleep time, and higher wake stage. BDZ abusers vs. no-BDZ abusers had shorter % of NREM stages 3-4, shorter REM % and longer % of NREM light sleep (stage 2). Perceived sleep (as assessed by the PSQI) was worse among the chronic pain group and among the BDZ abusers.


CONCLUSIONS
Patients with chronic pain or BDZ abuse presented both perceived and objective poorer sleep, regardless of methadone dosage. Sleep evaluation and treatment should address these two prevalent conditions in order to improve MMT patients' quality of sleep (and of life) and overall treatment outcome.
Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. einatp@tasmc.health.gov.il
Einat
E
Peles
Shaul
S
Schreiber
Miriam
M
Adelson
D000328:Adult; D001569:Benzodiazepines; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects*; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D010146:Pain / Q000150:complications*; D017286:Polysomnography; D011569:Psychiatric Status Rating Scales; D012894:Sleep Stages / Q000187:drug effects; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
D009294:Narcotics; D001569:Benzodiazepines; D008691:Methadone