Sleep Disturbance During Smoking Cessation: Withdrawal or Side Effect of Treatment?

INTRODUCTION

The nicotine-metabolite ratio (NMR) predicts treatment response and is related to treatment side effect severity. Sleep disturbance may be one important side effect, but understanding sleep disturbance effects on smoking cessation is complicated by the fact that nicotine withdrawal also produces sleep disturbance.

AIMS

To evaluate the effects of withdrawal and treatment side effects on sleep disturbance.

METHODS

This is a secondary analysis of data from a clinical trial (Lerman et al., 2015) of 1,136 smokers randomised to placebo ( = 363), transdermal nicotine (TN; = 381), or varenicline ( = 392) and stratified based on NMR (559 slow metabolisers; 577 normal metabolisers). Sleep disturbance was assessed at baseline and at 1-week following the target quit date (TQD). We also examined whether sleep disturbance predicted 7-day point-prevalence abstinence at end-of-treatment (EOT).

RESULTS

The varenicline and TN groups exhibited greater increases in sleep disturbance (vs. placebo; treatment × time interaction; = 0.005), particularly among those who quit smoking at 1-week post-TQD. There was a main effect of NMR ( = 0.04), but no interactions with treatment. TN and varenicline attenuated withdrawal symptoms unrelated to sleep (vs. placebo). Greater baseline sleep disturbance predicted relapse at EOT ( = 0.004).

CONCLUSIONS

Existing treatments may not mitigate withdrawal-related sleep disturbance and adjunctive treatments that target sleep disturbance may improve abstinence rates.