Habitual Khat and Concurrent Khat and Tobacco Use Are Associated With Subjective Sleep Quality

Abstract

IntroductionKhat (Catha edulis) is widely used in East Africa and the Middle East, often in combination with tobacco smoking. Sleep disturbance has been linked with habitual khat use; however, no systematic attempt has been made to test the hypothesis that use of khat and khat and tobacco in combination are related to sleep disturbance. Sleep disturbances are associated with dysregulations in emotional and physiological functions and can increase health risks.MethodsWe developed and used the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) to conduct a cross-sectional study in Yemen examining subjective sleep quality in 151 concurrent users of khat and tobacco, 141 khat-only users, and 92 nonusers. Measures on subjective mood were also collected. A series of analyses of variance and χ2 tests were conducted to test whether khat and tobacco use was linked with sleep disturbances.ResultsConcurrent users of tobacco and khat and khat-only users showed greater sleep disturbances than nonusers as assessed by the PSQI global scores (all P values < .001) and component scores. PSQI scores were correlated with negative and positive mood (all P values < .004).ConclusionSleep disturbances may be 1 mechanism of the link between khat, tobacco, and negative health outcomes. Our findings may be useful in developing targeted prevention and harm-reduction strategies to minimize health care burdens associated with these substances. Our study also provides initial support for the Arabic version of PSQI.

Level of khat dependence, use patterns, and psychological correlates in Yemen: a cross-sectional investigation

“…The finding of an increased likelihood of impaired sleep in khat dependent individuals is consistent with clinical observations of khat users (10,17) as well as evidence from other investigations of habitual khat users (19,32). It is certainly possible that impaired sleep quality and/or sleep quantity may also increase the likelihood of negative affect in khat dependent individuals, therefore interacting in a synergistic manner.…”

“…Good PSQI test-retest reliability has been reported (31). With the permission of the PSQI authors, we translated the original English version into Arabic and then back-translated into English (32). A total score was used in the current analysis.…”

Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern Ethiopia

“…The growing research evidence shows that khat is a risk factor for different cardio-vascular disorders such as hypertension, ischemic heart diseases, and stroke 3,4 . Khat is also a risk factor for poor oral health 5 , psychosis 6 , mental distress 7 , anemia 8 , poor quality of life 9 , disturbed sleep pattern [10][11][12] , and duodenal ulcer 13 .…”

Khat use and related addiction, mental health an physical disorders: the need to address a growing risk

“…As with mental health, adverse effects are commonly linked with prolonged or excessive use. However, the major shortcoming of this literature is that other explanations for the physical disorders have not been systematically ruled out, for example tobacco smoking which is frequently combined with khat use (15,21) and the agrochemical content in the leaves (44,45). The negative physical consequences associated with khat use include mucosal problems (46), oral lesions (47), gastric cancers and duodenal ulcers (42), hypertension (48), cardiovascular complications (49), stroke (50), sexual dysfunction (51), hepatoxicity (52) and reduced birth weight of infants born to khat-chewing mothers (53), to mention just a few.…”

“…Basic research studies have found evidence of altered stress response (18), cognitive deficits (19,20) and insomnia (21) in habitual khat users. Research has shown that prolonged exposure to khat may lead to a long-lasting sensitization to the effects of other drugs (22).…”