Salas Joanne, Miller Mary Beth, Scherrer Jeffrey F, Moore Rachel, McCrae Christina S, Sullivan Mark D, Bucholz Kathleen K, Copeland Laurel A, Ahmedani Brian K, Schneider F David, Lustman Patrick J
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Harry S. Truman Memorial Veterans' Administration Medical Center, Columbia, Missouri.
Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri.
J Opioid Manag. 2020;16(5):317-328. doi: 10.5055/jom.2020.0587.
Insomnia commonly co-occurs with depression, chronic pain, and opioid use. Both insomnia and chronic opioid analgesic use (OAU) are independent risk factors for a new depression episode (NDE). This study determined if the association between longer OAU duration and NDE was stronger in those with versus without insomnia.
Retrospective cohort.
Veterans Health Administration electronic medical records (2000-2012).
New opioid users in follow-up (2002-2012), free of depression for two years prior to follow-up, and aged 18-80 (n = 70,997).
NDE was ≥ 2 ICD-9 codes in a 12-month period. Insomnia before OAU initiation was ≥1 ICD-9 code. Cox proportional hazard models stratified on insomnia assessed the relationship between initiating a 1-30, 31-90, or > 90 day period of OAU and NDE while controlling for confounders using inverse probability of treatment-weighted propensity scores (PS).
Compared to 1-30 day OAU, 31-90 day was associated with NDE in those without (HR = 1.20; 95 percent CI: 1.12-1.28) but not with insomnia (HR = 1.06; 95 percent CI: 0.86-1.32). Results showed a stronger effect of chronic (>90) OAU in those with insomnia (HR = 1.59; 95 percent CI: 1.27-1.98) compared to those without (HR = 1.31; 95 percent CI: 1.21-1.42). However, all stratum-specific effects were not significantly different (p = 0.136).
Although stratum-specific risks were statistically similar, there was evidence for a trend that chronic OAU is a stronger risk factor for NDE in those with versus without insomnia. Providers are encouraged to monitor sleep impairment among patients on opioid therapy, as sleep may be associated with greater risk for NDE in patients with chronic OAU.
失眠常与抑郁症、慢性疼痛和阿片类药物使用同时出现。失眠和慢性阿片类镇痛药物使用（OAU）都是新发抑郁发作（NDE）的独立危险因素。本研究确定了在伴有和不伴有失眠的人群中，较长的OAU持续时间与NDE之间的关联是否更强。
回顾性队列研究。
退伍军人健康管理局电子病历（2000 - 2012年）。
随访期间的新阿片类药物使用者（2002 - 2012年），随访前两年无抑郁症，年龄在18 - 80岁（n = 70,997）。
NDE定义为在12个月内有≥2个国际疾病分类第九版（ICD - 9）编码。OAU开始前的失眠定义为≥1个ICD - 9编码。基于失眠进行分层的Cox比例风险模型评估了开始1 - 30天、31 - 90天或> 90天的OAU与NDE之间的关系，同时使用治疗加权倾向评分（PS）的逆概率来控制混杂因素。
与1 - 30天的OAU相比，31 - 90天的OAU在无失眠者中与NDE相关（风险比[HR] = 1.20；95%置信区间[CI]：1.12 - 1.28），但在失眠者中不相关（HR = 1.06；95% CI：0.86 - 1.32）。结果显示，与无失眠者（HR = 1.31；95% CI：1.21 - 1.42）相比，慢性（> 90天）OAU在失眠者中的影响更强（HR = 1.59；95% CI：1.27 - 1.98）。然而，所有分层特定效应差异均无统计学意义（p = 0.136）。
尽管分层特定风险在统计学上相似，但有证据表明存在一种趋势，即慢性OAU在伴有失眠的人群中比不伴有失眠的人群中是NDE的更强危险因素。鼓励医疗服务提供者监测接受阿片类药物治疗患者的睡眠障碍情况，因为睡眠可能与慢性OAU患者发生NDE的风险更高有关。
