Home Polysomnography in Methadone Maintenance Patients with Subjective Sleep Complaints

Abstract

Objective Most patients in methadone maintenance treatment (MMT) complain of poor sleep which is potentially linked to relapse, yet few studies have examined their sleep using polysomnography (PSG), and none to our knowledge have employed home PSG. Standard sleep laboratory research protocols often require two consecutive PSG nights because of inter-night variability in sleep attributed to first-night adaptation to a novel sleep environment and recording procedures. The purpose of this study was to assess the stability of sleep measures across two consecutive nights of home PSG in opioid-dependent MMT patients. Methods Home PSG was performed in 50 MMT patients with subjective sleep complaints. Participants were 54% female and 82% white with mean age = 36.8 years, median methadone dose = 100 mg/day, and median MMT duration = 286 days. Results Thirty-six participants completed two consecutive nights of at-home PSG and 14 completed one. For the former group, no differences in sleep measures were found across recordings. The one-night group had significantly less total sleep time, Stage 2 sleep, REM sleep, and shorter REM latency than the two-night group. Conclusions Home PSG is a viable method for recording sleep in opioid-dependent MMT patients, and was stable across consecutive nights of study. Two nights of home PSG for MMT patients, therefore, are not necessarily required and confidence in the reliability of data from one night of recording can be assumed. Excluding MMT research participants with only one PSG may exclude patients with the worst sleep – precisely the group that most warrants investigation.

Obstructive sleep apnea is more common than central sleep apnea in methadone maintenance patients with subjective sleep complaints

“…Whether sleep disturbances contribute to relapse in MMT patients is not known. Subjective sleep complaints in MMT patients have been corroborated by polysomnographic studies by our group (Sharkey et al, 2009) and others (Wang and Teichtahl, 2007) demonstrating sleep abnormalities such as decreased REM and decreased slow wave sleep.…”

Trazodone for sleep disturbance during methadone maintenance: A double-blind, placebo-controlled trial

“…Neither duration nor dose of methadone treatment is associated with subjective sleep disturbance, but severity of sleep symptoms in methadone-maintained persons has been associated with comorbid psychiatric disorders, chronic pain, and other drug use (Peles et al, 2006; Stein et al, 2004). Subjective sleep complaints in this population have been corroborated by polysomnographic studies by our group and others (Sharkey et al, 2009; Wang and Teichtahl, 2007), demonstrating sleep abnormalities such as decreased REM and decreased slow wave sleep. Methadone patients also have high rates of sleep disordered breathing, both central sleep apnea and obstructive sleep apnea, although neither accounts for complaints of disturbed sleep (Sharkey et al, 2010; Teichtahl et al, 2001; Wang et al, 2005).…”

“…Objective sleep was measured using standard PSG techniques as previously described (Kurth et al, 2009; Sharkey et al, 2010; Sharkey et al, 2009) including electroencephalography, electrooculography, and electromyography. Respiration was monitored with nasal/oral airflow, nasal pressure transducers, pulse oximetry, and intercostal and abdominal respiration belts.…”

Assessing sleep in opioid dependence: A comparison of subjective ratings, sleep diaries, and home polysomnography in methadone maintenance patients

“…Objective sleep was measured using standard PSG techniques as previously described (Kurth et al, 2009; Sharkey et al, 2009; Sharkey et al, 2010) including electroencephalography, electrooculography, and electromyography. Respiration was monitored with nasal/oral airflow, nasal pressure transducers, pulse oximetry, and intercostal and abdominal respiration belts.…”

“…A role for sleep disturbance in addiction has been found in cocaine users (Morgan et al, 2006; Morgan et al, 2010), methadone patients (Stein et al, 2004; Peles et al, 2006; Kurth et al, 2009; Sharkey et al, 2009; Trksak et al, 2010), and alcohol dependent patients (Brower et al, 1998; Conroy et al, 2006). Among alcohol dependent patients in early recovery, for example, sleep disturbances and perceived sleep disruption are related to future alcohol use (Brower et al, 1998; Conroy et al, 2006).…”