title: 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.
authors.affiliation: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit of the Connecticut Mental Health Center, New Haven, CT, United States. Electronic address: Gustavo.angarita@yale.edu.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Angarita
authors.affiliation: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit of the Connecticut Mental Health Center, New Haven, CT, United States.
authors.forename: Sofija V
authors.initials: SV
authors.lastname: Canavan
authors.affiliation: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit of the Connecticut Mental Health Center, New Haven, CT, United States.
authors.forename: Erica
authors.initials: E
authors.lastname: Forselius
authors.affiliation: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit of the Connecticut Mental Health Center, New Haven, CT, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bessette
authors.affiliation: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit of the Connecticut Mental Health Center, New Haven, CT, United States.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects / Q000494:pharmacology; D003042:Cocaine / Q000009:adverse effects* / Q000494:pharmacology*; D019970:Cocaine-Related Disorders / Q000503:physiopathology* / Q000523:psychology* / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000187:drug effects*; D012646:Self Administration; D012893:Sleep Wake Disorders / Q000139:chemically induced* / Q000503:physiopathology; D015813:Substance Abuse Detection; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology* / Q000523:psychology*
chemical_list: D000779:Anesthetics, Local; D003042:Cocaine
keywords: Abstinence; Clinical outcomes; Cocaine; Polysomnography; Self-administration; Sleep