title: A prospective, longitudinal study of sleep disturbance and comorbidity in opiate dependence (the ANRS Methaville study).
abstract: OBJECTIVE
  Sleep disturbance is frequent in opioid-dependent patients. To date, no data are available about the impact of methadone maintenance treatment on sleep disturbance. Using 1-year follow-up data from the Methaville trial, we investigated the impact of methadone initiation and other correlates on sleep disturbance in opioid-dependent patients.
  
  
  METHODS
  Sleep disturbance severity was evaluated using two items from different scales (Center for Epidemiological Studies Depression Scale for depression and Opiate Treatment Index). We assessed the effect of methadone and other correlates on sleep disturbance severity during follow-up (months 0, 6, and 12) using a mixed multinomial logistic regression model.
  
  
  RESULTS
  We included 173 patients who had 1-year follow-up data on sleep disturbance, corresponding to 445 visits. At enrolment, 60.5 % reported medium to severe sleep disturbance. This proportion remained stable during methadone treatment: 54.0 % at month 6 and 55.4 % at month 12. The final multivariate model indicated that younger patients (odds ratio (OR) [95 % CI] 0.95 [0.90-1.00]), patients with pain (OR [95 % CI] 2.45 [1.13-5.32]), patients with high or very high nicotine dependence (OR [95 % CI] 5.89 [2.41-14.39]), and patients at suicidal risk (2.50 [1.13-5.52]) had a higher risk of severe sleep disturbance. Because of collinearity between suicidal risk and attention deficit hyperactivity disorder (ADHD) symptoms, ADHD was not associated with sleep disturbance in the final model. Receiving methadone treatment had no significant effect on sleep disturbance.
  
  
  CONCLUSIONS
  Sleep disturbance is frequent among opioid-dependent patients. It can be regarded as an important signal of more complex psychiatric comorbidities such as suicidal risk and ADHD. However, sleep disturbance should not be considered an obstacle to methadone maintenance treatment (MMT) initiation or continuation.
authors.affiliation: INSERM U912-ORS PACA, 27 boulevard Jean Moulin, 13005, Marseille, France. Sandra.nordmann@inserm.fr.|Université Aix Marseille, IRD, UMR-S912, Marseille, France. Sandra.nordmann@inserm.fr.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France. Sandra.nordmann@inserm.fr.
authors.forename: Sandra
authors.initials: S
authors.lastname: Nordmann
authors.affiliation: INSERM U912-ORS PACA, 27 boulevard Jean Moulin, 13005, Marseille, France.|Université Aix Marseille, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lions
authors.affiliation: INSERM U912-ORS PACA, 27 boulevard Jean Moulin, 13005, Marseille, France.|Université Aix Marseille, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vilotitch
authors.affiliation: INSERM, Research Unit 669, Paris, France.|Université Paris-Sud and Université Paris Descartes, UMR-S0669, Paris, France.|Centre Pierre Nicole, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Michel
authors.affiliation: INSERM U912-ORS PACA, 27 boulevard Jean Moulin, 13005, Marseille, France.|Université Aix Marseille, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Mora
authors.affiliation: INSERM U912-ORS PACA, 27 boulevard Jean Moulin, 13005, Marseille, France.|Université Aix Marseille, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.affiliation: INSERM U912-ORS PACA, 27 boulevard Jean Moulin, 13005, Marseille, France.|Université Aix Marseille, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Maradan
authors.affiliation: Oppelia, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Morel
authors.affiliation: INSERM U912-ORS PACA, 27 boulevard Jean Moulin, 13005, Marseille, France.|Université Aix Marseille, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
authors.forename: Perrine
authors.initials: P
authors.lastname: Roux
authors.affiliation: INSERM U912-ORS PACA, 27 boulevard Jean Moulin, 13005, Marseille, France.|Université Aix Marseille, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
authors.forename: M Patrizia
authors.initials: MP
authors.lastname: Carrieri
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012893:Sleep Wake Disorders / Q000150:complications* / Q000503:physiopathology
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D008691:Methadone
keywords: Mental disorders; Methadone; Opioid substitution treatment; Opioid-related disorders; Sleep disorder