Boston University Medical School, Boston Medical Center, Child and Adolescent Psychiatry, 850 Harrison Avenue, Dowling 7, Boston, MA, 02118, USA.
Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, 2(nd) Floor, Cambridge, MA, 02141, USA; Department of Psychiatry, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
Sleep Med. 2018 Feb;42:31-37. doi: 10.1016/j.sleep.2017.12.009. Epub 2018 Jan 9.
Sleep Disturbances (SDs) are a symptom common to mental health disorders (MHD) and substance use disorders (SUD). We aimed to identify the value of SD as a predictor for subsequent treatment of illicit drug and alcohol use disorders (SUDs) in primary care and relative to the predictive value of mental health disorders (MHDs).
We used electronic health records data from ambulatory primary care in a safety net Boston area healthcare system from 2013 to 2015 (n = 83,920). SUD (separated into illicit drug use disorder and alcohol use disorder) and MHD were identified through ICD-9 codes and medical record documentation. We estimated Cox proportional hazard models to examine the risk of SUD across four comparison groups (SD only, SD and MHD, MHD only, and neither SD nor MHD).
Compared to patients with no sleep or MHD, patients with SD had a greater risk for subsequent SUD treatment. Approximately one-fifth of patients with SD were treated for an illicit drug use disorder and approximately 12% were treated for alcohol use disorder. Risk for SUD treatment, estimated at over 30% by the end of the study, was greatest for patients with a MHD, either alone or comorbid with SD. Risk was greater for older patients and men, and lower for minority patients.
SD and MHD, individually and comorbid, significantly predict subsequent treatment of illicit drug and alcohol use disorder in primary care. Screening and evaluation for SD should be a routine practice in primary care to help with identifying potential SUD risk.
睡眠障碍（SDs）是精神健康障碍（MHD）和物质使用障碍（SUD）的常见症状。我们旨在确定 SD 作为预测后续治疗非法药物和酒精使用障碍（SUD）在初级保健中的价值，并与精神健康障碍（MHD）的预测价值相对比。
我们使用了 2013 年至 2015 年期间，在波士顿地区医疗保健系统的一个初级保健机构中使用电子健康记录数据（n=83920）。通过 ICD-9 代码和医疗记录文档，确定了 SUD（分为非法药物使用障碍和酒精使用障碍）和 MHD。我们估计了 Cox 比例风险模型，以研究四个比较组（仅 SD、SD 和 MHD、仅 MHD 和既无 SD 也无 MHD）之间的 SUD 风险。
与无睡眠或 MHD 的患者相比，SD 患者后续治疗 SUD 的风险更高。大约五分之一的 SD 患者接受了非法药物使用障碍的治疗，约 12%的患者接受了酒精使用障碍的治疗。在研究结束时，预计 SUD 治疗的风险超过 30%，对于仅患有 MHD 或与 SD 共病的患者而言，风险最大。年龄较大的患者和男性风险较高，少数民族患者风险较低。
SD 和 MHD，单独或共病，显著预测了初级保健中非法药物和酒精使用障碍的后续治疗。SD 的筛查和评估应成为初级保健的常规实践，以帮助识别潜在的 SUD 风险。
