Juda Myriam, Pater Joanna, Mistlberger Ralph E, Schütz Christian G
Sleep and Circadian Neuroscience Laboratory, Department of Psychology, Simon Fraser University, Burnaby, Canada.
Behavioral Reward Affect + Impulsivity Neuroscience (BRAIN) Lab, Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, Canada.
J Dual Diagn. 2023 Jan-Mar;19(1):26-39. doi: 10.1080/15504263.2022.2157694. Epub 2022 Dec 29.
Mental health and substance use disorders are commonly associated with disrupted sleep and circadian rest-activity rhythms. How these disorders in combination relate to sleep and circadian organization is not well studied. We provide here the first quantitative assessment of sleep and rest-activity rhythms in inpatients with complex concurrent disorders, taking into account categories of substance use (stimulant stimulant and opioid use) and psychiatric diagnosis (psychotic disorder and mood disorder). We also explore how sleep and rest-activity rhythms relate to psychiatric functioning. A total of 44 participants (10 female) between the age of 20-60 years (median = 29 years) wore wrist accelerometers over 5-70 days and completed standardized questionnaires assessing chronotype and psychiatric functioning (fatigue, psychiatric symptom severity, and impulsiveness). To examine potential influences from treatment, we computed (1) length of stay; (2) days of abstinence from stimulants and opioids as a measure of withdrawal; and (3) a sedative load based on prescribed medications. Participants exhibited a sustained excessive sleep duration, frequent nighttime awakenings, and advanced rest-activity phase related to sedative load. Sleep disruptions were elevated in participants with a history of opioid use. Patients with a psychotic disorder showed the longest sleep and most fragmented and irregular rest-activity patterns. Non-parametric circadian rhythm analysis revealed a high rhythm amplitude by comparison with population norms, and this was associated with greater psychiatric symptom severity. Psychiatric symptom severity was also associated with greater fatigue and later MCTQ chronotype. This pilot study provides initial information on the prevalence and severity of sleep and circadian rhythm disturbances in individuals with severe concurrent disorders. The results underline the need for further studies to start to understand the role of sleep in the disease and recovery process in this understudied population.
心理健康和物质使用障碍通常与睡眠及昼夜休息 - 活动节律紊乱有关。这些障碍合并出现时如何与睡眠和昼夜节律组织相关联，目前尚未得到充分研究。我们在此首次对患有复杂并发障碍的住院患者的睡眠及休息 - 活动节律进行了定量评估，同时考虑了物质使用类别（兴奋剂和阿片类药物使用）和精神科诊断（精神病性障碍和情绪障碍）。我们还探讨了睡眠和休息 - 活动节律与精神功能的关系。共有44名年龄在20至60岁之间（中位数 = 29岁）的参与者（10名女性）佩戴腕部加速度计5至70天，并完成了评估昼夜类型和精神功能（疲劳、精神症状严重程度和冲动性）的标准化问卷。为了检验治疗的潜在影响，我们计算了：（1）住院时间；（2）停用兴奋剂和阿片类药物的天数作为戒断指标；（3）基于处方药物的镇静负荷。参与者表现出持续的睡眠时间过长、夜间频繁觉醒，以及与镇静负荷相关的休息 - 活动相位提前。有阿片类药物使用史的参与者睡眠中断情况更为严重。患有精神病性障碍的患者睡眠最长，休息 - 活动模式最碎片化且不规则。非参数昼夜节律分析显示，与总体标准相比，节律幅度较高，这与更严重的精神症状相关。精神症状严重程度还与更高的疲劳程度和更晚的慕尼黑生物钟类型问卷（MCTQ）昼夜类型有关。这项初步研究提供了有关严重并发障碍个体中睡眠和昼夜节律紊乱的患病率和严重程度的初步信息。结果强调需要进一步研究，以开始了解睡眠在这一研究不足的人群的疾病和康复过程中的作用。
