1
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Kaya-Akyüzlü D, Özkan-Kotiloğlu S, Danışman M, Bal C. OPRM1 rs2075572 has potential to affect plasma buprenorphine level in opioid users, but not OPRM1 rs562859. Neurosci Lett 2024; 834:137846. [PMID: 38821204 DOI: 10.1016/j.neulet.2024.137846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/02/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
OPRM1 gene encoding mu-opioid receptor (MOR) is the primary candidate gene for buprenorphine (BUP) pharmacogenetics. OPRM1 undergoes alternative splicing leading to multiple MOR subtypes. Thus, in the current study 2 SNPs (rs1799972 and rs562859) were selected due to evidence for their contribution to alternative splicing of OPRM1. The effects of 2 SNPs of OPRM1 gene on plasma buprenorphine and norbuprenorphine levels in a sample of 233 OUD patients receiving BUP/naloxone were examined. Polymorphisms were analyzed by PCR and RFLP. BUP and norbuprenorphine concentrations in plasma were measured by LC-MS/MS. OPRM1 rs2075572 GC + CC (0.12 ng/ml) had significantly higher plasma BUP level compared to GG (0.084 ng/ml) (p = 0.043). Although there was not a statistically significant difference between OPRM1 rs562859 genotypes (p = 0.46), patients with OPRM1 rs562859 CT + TT had higher plasma BUP and BUP-related values as compared to those with CC. In conclusion, the effect of OPRM1 rs2075572 on BUP levels in opioid users' plasma was shown in a Caucasian population for the first time. On the other hand, OPRM1 rs562859 seems not to influence the BUP pharmacology.
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Affiliation(s)
| | - Selin Özkan-Kotiloğlu
- Kırşehir Ahi Evran University, Faculty of Science and Art, Department of Molecular Biology and Genetics, Kırşehir, Turkey.
| | - Mustafa Danışman
- Ankara Training and Research Hospital AMATEM Clinic, Ankara, Turkey
| | - Ceylan Bal
- Ankara Yıldırım Beyazıt University, Department of Medical Biochemistry, Ankara, Turkey
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2
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Eacret D, Manduchi E, Noreck J, Tyner E, Fenik P, Dunn AD, Schug J, Veasey SC, Blendy JA. Mu-opioid receptor-expressing neurons in the paraventricular thalamus modulate chronic morphine-induced wake alterations. Transl Psychiatry 2023; 13:78. [PMID: 36869037 PMCID: PMC9984393 DOI: 10.1038/s41398-023-02382-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Disrupted sleep is a symptom of many psychiatric disorders, including substance use disorders. Most drugs of abuse, including opioids, disrupt sleep. However, the extent and consequence of opioid-induced sleep disturbance, especially during chronic drug exposure, is understudied. We have previously shown that sleep disturbance alters voluntary morphine intake. Here, we examine the effects of acute and chronic morphine exposure on sleep. Using an oral self-administration paradigm, we show that morphine disrupts sleep, most significantly during the dark cycle in chronic morphine, with a concomitant sustained increase in neural activity in the Paraventricular Nucleus of the Thalamus (PVT). Morphine binds primarily to Mu Opioid Receptors (MORs), which are highly expressed in the PVT. Translating Ribosome Affinity Purification (TRAP)-Sequencing of PVT neurons that express MORs showed significant enrichment of the circadian entrainment pathway. To determine whether MOR + cells in the PVT mediate morphine-induced sleep/wake properties, we inhibited these neurons during the dark cycle while mice were self-administering morphine. This inhibition decreased morphine-induced wakefulness but not general wakefulness, indicating that MORs in the PVT contribute to opioid-specific wake alterations. Overall, our results suggest an important role for PVT neurons that express MORs in mediating morphine-induced sleep disturbance.
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Affiliation(s)
- Darrell Eacret
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elisabetta Manduchi
- Department of Genetics and Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Julia Noreck
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma Tyner
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Polina Fenik
- Center for Sleep and Circadian Neurobiology and Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Amelia D Dunn
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Schug
- Department of Genetics and Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sigrid C Veasey
- Center for Sleep and Circadian Neurobiology and Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Julie A Blendy
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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3
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Huffman M, Cloeren M, Ware OD, Frey JJ, Greenblatt AD, Mosby A, Oliver M, Imboden R, Bazell A, Clement J, Diaz-Abad M. Poor Sleep Quality and Other Risk Factors for Unemployment Among Patients on Opioid Agonist Treatment. Subst Abuse 2022; 16:11782218221098418. [PMID: 35645566 PMCID: PMC9130817 DOI: 10.1177/11782218221098418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/17/2022] [Indexed: 12/01/2022]
Abstract
Purpose: Patients with opioid use disorder (OUD) face high rates of unemployment,
putting them at higher risk of treatment nonadherence and poor outcomes,
including overdose death. The objective of this study was to investigate
sleep quality and its association with other biopsychosocial risk factors
for unemployment in patients receiving opioid agonist treatment (OAT) for
OUD. Methods: Using a cross-sectional survey design, participants from 3 OAT programs for
OUD completed questionnaires to measure sleep quality (Pittsburgh Sleep
Quality Index [PSQI]); pain disability; catastrophic thinking; injustice
experience; quality of life; and self-assessed disability. Spearman’s rank
correlation was used to test for associations between sleep quality and
other study variables. Results: Thirty-eight participants completed the study, with mean age
45.6 ± 10.9 years, 27 (71.1%) males, and 16 (42.1%) reporting a high school
diploma/equivalent certification as the highest level of academic
attainment. Poor sleep quality (defined as PSQI > 5) was identified in 29
participants (76.3%) and was positively correlated with pain disability
(r = 0.657, P < .01), self-assessed
disability (r = 0.640, P < .001),
symptom catastrophizing (r = 0.499,
P < .001), and injustice experience
(r = 0.642, P < .001), and negatively
correlated with quality of life (r = −0.623,
P < .001). Conclusions: There was a high prevalence of poor sleep quality in patients with OUD on OAT
and this was associated with multiple known risk factors for unemployment.
These findings warrant the consideration of regular screening for sleep
problems and the inclusion of sleep-related interventions to improve sleep
quality, decrease the unemployment rate, and enhance the recovery process
for individuals with OUD undergoing OAT.
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Affiliation(s)
- Margo Huffman
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marianne Cloeren
- Division of Occupational and Environmental Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Orrin D Ware
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jodi J Frey
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Aaron D Greenblatt
- Departments of Psychiatry and Family & Community Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amanda Mosby
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Marc Oliver
- Division of Occupational and Environmental Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rachel Imboden
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Alicia Bazell
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Jean Clement
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Montserrat Diaz-Abad
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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4
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Magarbeh L, Gorbovskaya I, Le Foll B, Jhirad R, Müller DJ. Reviewing pharmacogenetics to advance precision medicine for opioids. Biomed Pharmacother 2021; 142:112060. [PMID: 34523422 DOI: 10.1016/j.biopha.2021.112060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Adequate opioid prescribing is critical for therapeutic success of pain management. Despite the widespread use of opioids, optimized opioid therapy remains unresolved with risk of accidental lethal overdosing. With the emergence of accumulating evidence linking genetic variation to opioid response, pharmacogenetic based treatment recommendations have been proposed. OBJECTIVE The aim of this review is to evaluate pharmacogenetic evidence and provide an overview on genes involved in the pharmacokinetics and pharmacodynamics of opioids. METHODS For this review, a systematic literature search of published articles was used in PubMed®, with no language restriction and between the time period of January 2000 to December 2020. We reviewed randomized clinical studies, study cohorts and case reports that investigated the influence of genetic variants on selected opioid pharmacokinetics and pharmacodynamics. In addition, we reviewed current CPIC clinical recommendations for pharmacogenetic testing. RESULTS Results of this review indicate consistent evidence supporting the association between selected genetic variants of CYP2D6 for opioid metabolism. CPIC guidelines include recommendations that indicate the avoidance of tramadol use, in addition to codeine, in CYP2D6 poor metabolizers and ultrarapid metabolizers, and to monitor intermediate metabolizers for less-than-optimal response. While there is consistent evidence for OPRM1 suggesting increased postoperative morphine dosing requirements in A118G G-allele carriers, the clinical relevance remains limited. CONCLUSION There is emerging evidence of clinical relevance of CYP2D6 and, to a lesser extent, OPRM1 polymorphism in personalized opioid drug dosing. As a result, first clinics have started to implement pharmacogenetic guidelines for CYP2D6 and codeine.
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Affiliation(s)
- Leen Magarbeh
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ilona Gorbovskaya
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Reuven Jhirad
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Office of the Chief Coroner and Ontario Forensic Pathology Service, Toronto, ON, Canada
| | - Daniel J Müller
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
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5
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Wilkerson AK, McRae-Clark AL. A review of sleep disturbance in adults prescribed medications for opioid use disorder: potential treatment targets for a highly prevalent, chronic problem. Sleep Med 2021; 84:142-153. [PMID: 34153796 PMCID: PMC8503844 DOI: 10.1016/j.sleep.2021.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sleep disturbance in individuals prescribed medications for opioid use disorder (MOUD) is common, though the nature and progression of such concerns are difficult to discern due to differing terminology and assessment type between studies. Accurately identifying and treating sleep problems in this growing population has the potential to improve comorbidity and other MOUD outcomes. OBJECTIVE The aim of the present review is to provide an overview of sleep in individuals stabilized on MOUD. Specifically, the following aspects of sleep were reviewed: 1) prevalence of clinically significant sleep disturbance; 2) sleep disturbance compared to findings in those not prescribed MOUD; 3) correlates of sleep disturbance; 4) self-reported sleep compared to objective measures. METHOD Studies were identified using 6 large databases and included if they contained at least one measure of sleep during MOUD treatment as usual. Studies were excluded if they were case studies, not available in English, or participants were in withdrawal or detoxification. RESULTS Forty-two studies were included and categorized by type of sleep assessment: validated self-report questionnaire; provider-assessed; polysomnography; multi-method. Correlates were included if they were statistically significant (generally p < 0.05). CONCLUSIONS This review indicates there is a high prevalence of chronic self-reported sleep disturbance (eg, insomnia symptoms) in this population and suggests quantitative sleep parameters (eg, total sleep time) and respiratory problems during sleep are worse than in the general population. These sleep problems are correlated with psychiatric comorbidity and other substance use. Other correlates (eg, sociodemographic factors) require further study to draw definitive conclusions.
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Affiliation(s)
- Allison K Wilkerson
- Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, USA.
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6
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Wang D, Yee BJ, Grunstein RR, Chung F. Chronic Opioid Use and Central Sleep Apnea, Where Are We Now and Where To Go? A State of the Art Review. Anesth Analg 2021; 132:1244-1253. [PMID: 33857966 DOI: 10.1213/ane.0000000000005378] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Opioids are commonly used for pain management, perioperative procedures, and addiction treatment. There is a current opioid epidemic in North America that is paralleled by a marked increase in related deaths. Since 2000, chronic opioid users have been recognized to have significant central sleep apnea (CSA). After heart failure-related Cheyne-Stokes breathing (CSB), opioid-induced CSA is now the second most commonly seen CSA. It occurs in around 24% of chronic opioid users, typically after opioids have been used for more than 2 months, and usually corresponds in magnitude to opioid dose/plasma concentration. Opioid-induced CSA events often mix with episodes of ataxic breathing. The pathophysiology of opioid-induced CSA is based on dysfunction in respiratory rhythm generation and ventilatory chemoreflexes. Opioids have a paradoxical effect on different brain regions, which result in irregular respiratory rhythm. Regarding ventilatory chemoreflexes, chronic opioid use induces hypoxia that appears to stimulate an augmented hypoxic ventilatory response (high loop gain) and cause a narrow CO2 reserve, a combination that promotes respiratory instability. To date, no direct evidence has shown any major clinical consequence from CSA in chronic opioid users. A line of evidence suggested increased morbidity and mortality in overall chronic opioid users. CSA in chronic opioid users is likely to be a compensatory mechanism to avoid opioid injury and is potentially beneficial. The current treatments of CSA in chronic opioid users mainly focus on continuous positive airway pressure (CPAP) and adaptive servo-ventilation (ASV) or adding oxygen. ASV is more effective in reducing CSA events than CPAP. However, a recent ASV trial suggested an increased all-cause and cardiovascular mortality with the removal of CSA/CSB in cardiac failure patients. A major reason could be counteracting of a compensatory mechanism. No similar trial has been conducted for chronic opioid-related CSA. Future studies should focus on (1) investigating the phenotypes and genotypes of opioid-induced CSA that may have different clinical outcomes; (2) determining if CSA in chronic opioid users is beneficial or detrimental; and (3) assessing clinical consequences on different treatment options on opioid-induced CSA.
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Affiliation(s)
- David Wang
- From the Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
| | - Brendon J Yee
- From the Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
| | - Ronald R Grunstein
- From the Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
| | - Frances Chung
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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7
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Zahari Z, Lee CS, Ibrahim MA, Musa N, Mohd Yasin MA, Lee YY, Tan SC, Mohamad N, Ismail R. Influence of DRD2 Polymorphisms on the Clinical Outcomes of Opioiddependent Patients on Methadone Maintenance Therapy. J Pharm Bioallied Sci 2021; 12:S787-S803. [PMID: 33828379 PMCID: PMC8021064 DOI: 10.4103/jpbs.jpbs_248_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/21/2020] [Accepted: 03/08/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: Dopamine receptor D2 (DRD2) is one of the dopamine receptors that have been studied in relation to opioid dependence. It is possible, therefore, that DRD2 gene (DRD2) polymorphisms influence treatment outcomes of patients with opioid dependence. The objective of this study was to investigate the influence of DRD2 polymorphisms on the clinical outcomes of opioid-dependent patients on methadone maintenance therapy (MMT). Materials and Methods: Patients with opioid dependence (n = 148) were recruited from MMT clinics. Pain sensitivity, severity of the opiate withdrawal syndrome, and sleep quality were assessed using cold pressor test (CPT), Subjective Opiate Withdrawal Scale (SOWS-M), and Pittsburgh Sleep Quality Index (PSQI)-Malay, respectively. Deoxyribonucleic acid (DNA) was extracted from whole blood, and then was used for genotyping of Val96Ala, Leu141Leu, Val154Ile, Pro310Ser, Ser311Cys, TaqI A, -141C Ins/Del, and A-241G polymorphisms. Results: Among 148 patients, 8.1% (n = 12), 60.8% (n = 90), 27.7% (n = 41), and 29.1% (n = 43) had at least one risk allele for Ser311Cys, TaqI A, -141C Ins/Del, and A-241G polymorphisms, respectively. There were no significant differences in pain responses (pain threshold, tolerance, and intensity), SOWS, and PSQI scores between DRD2 polymorphisms. Conclusion: The common DRD2 polymorphisms are not associated with pain sensitivity, severity of the opiate withdrawal syndrome, and sleep quality in patients with opioid dependence on MMT. However, this may be unique for Malays. Additional research should focus on investigating these findings in larger samples and different ethnicity.
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Affiliation(s)
- Zalina Zahari
- Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Besut Campus, Terengganu, Malaysia.,Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Chee Siong Lee
- Emergency and Trauma Department, Hospital Sultanah Aminah, Johor, Malaysia
| | - Muslih Abdulkarim Ibrahim
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia.,Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Hawler, Iraq
| | - Nurfadhlina Musa
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia.,Human Genome Center, School of Medical Sciences, Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Mohd Azhar Mohd Yasin
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia.,Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Soo Choon Tan
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Nasir Mohamad
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia.,Centre for Research in Addiction (CentRenA), Universiti Sultan Zainal Abidin (UniSZA), Gong Badak Campus, Terengganu, Malaysia
| | - Rusli Ismail
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia.,Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA), Medical Campus, Terengganu, Malaysia
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8
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Rowsell L, Wu JGA, Yee BJ, Wong KKH, Sivam S, Somogyi AA, Grunstein RR, Wang D. The effect of acute morphine on sleep in male patients suffering from sleep apnea: Is there a genetic effect? An RCT Study. J Sleep Res 2020; 30:e13249. [PMID: 33319444 DOI: 10.1111/jsr.13249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 01/11/2023]
Abstract
Questionnaire-based studies have suggested genetic differences in sleep symptoms in chronic opioid users. The present study aims to investigate if there is a genetic effect on sleep architecture and quantitative electroencephalogram (EEG) in response to acute morphine. Under a randomized, double-blind, placebo-controlled, crossover design, 68 men with obstructive sleep apnea undertook two overnight polysomnographic studies conducted at least 1 week apart. Each night they received either 40 mg of controlled-release morphine or placebo. Sleep architecture and quantitative EEG were compared between conditions. Blood was sampled before sleep and on the next morning for genotyping and pharmacokinetic analyses. We analysed three candidate genes (OPRM1 [rs1799971, 118 A > G], ABCB1[rs1045642, 3435 C > T] and HTR3B [rs7103572 C > T]). We found that morphine decreased slow wave sleep and rapid eye movement sleep and increased stage 2 sleep. Those effects were less in subjects with HTR3B CT/TT than in those with CC genotype. Similarly, sleep onset latency was shortened in the ABCB1 CC subgroup compared with the CT/TT subgroup. Total sleep time was significantly increased in ABCB1 CC but not in CT/TT subjects. Sleep apnea and plasma morphine and metabolite concentration were not confounding factors for these genetic differences in sleep. With morphine, patients had significantly more active/unstable EEG (lower delta/alpha ratio) during sleep. No genetic effects on quantitative EEG were detected. In summary, we identified two genes (HTR3B and ABCB1) with significant variation in the sleep architecture response to morphine. Morphine caused a more active/unstable EEG during sleep. Our findings may have relevance for a personalized medicine approach to targeted morphine therapy.
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Affiliation(s)
- Luke Rowsell
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Sydney, Australia
| | - Justin Guang-Ao Wu
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Sydney, Australia
| | - Brendon J Yee
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital (work performed), Sydney Local Health District, Camperdown, Australia
| | - Keith K H Wong
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital (work performed), Sydney Local Health District, Camperdown, Australia
| | - Sheila Sivam
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital (work performed), Sydney Local Health District, Camperdown, Australia
| | - Andrew A Somogyi
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Ronald R Grunstein
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital (work performed), Sydney Local Health District, Camperdown, Australia
| | - David Wang
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, the University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital (work performed), Sydney Local Health District, Camperdown, Australia
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9
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Chrobok AI, Krause D, Winter C, Plörer D, Martin G, Koller G, Adorjan K, Canolli M, Adam R, Wagner EM, Peles E, Paul D, Vogel T, Pogarell O. Sleeping Patterns in Patients with Opioid Use Disorder: Effects of Opioid Maintenance Treatment and Detoxification. J Psychoactive Drugs 2020; 52:203-210. [PMID: 32299305 DOI: 10.1080/02791072.2020.1751900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the study was to explore whether abstinent patients on recent opioid detoxification or on opioid maintenance treatment suffer from sleeping problems. 199 patients on opioid maintenance treatment (methadone, diacetylmorphine and buprenorphine) or recent opioid detoxification were included in this exploratory cross-sectional study. We used the Pittsburgh Sleep Quality Index (PSQI) and the Regensburger Insomnia Scale (RIS) in order to assess potential sleeping problems. There was a significant effect of the condition "opioid maintenance" or "recent opioid detoxification" on the total score of PSQI and RIS. All opioid maintenance drugs used by the study population were associated with more sleeping problems compared to the detoxification group when calculated with RIS values. Recently abstinent patients (opioid detoxification) displayed significantly fewer sleep disturbances than opioid-maintained patients. Since sleeping problems can seriously impair treatment success and quality of life, screening for sleep disturbances and their subsequent treatment is of pronounced relevance.
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Affiliation(s)
- Agnieszka I Chrobok
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Daniela Krause
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Catja Winter
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Diana Plörer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Gabriele Martin
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Gabriele Koller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Minavere Canolli
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Roland Adam
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Elias M Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
| | - Einat Peles
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Dietmar Paul
- Opioid Addiction Outpatient Clinic, Department of Addiction, Buergerhospital , Frankfurt/Main, Germany
| | - Thomas Vogel
- Opioid Addiction Outpatient Clinic, Department of Addiction, Buergerhospital , Frankfurt/Main, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich, Germany
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Zahari Z, Ibrahim MA, Musa N, Tan SC, Mohamad N, Ismail R. Sleep quality and OPRM1 polymorphisms: a cross-sectional study among opioid-naive individuals. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000117217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Zalina Zahari
- Universiti Sultan Zainal Abidin, Malaysia; Universiti Sains Malaysia, Malaysia
| | | | | | | | - Nasir Mohamad
- Universiti Sains Malaysia, Malaysia; Universiti Sultan Zainal Abidin, Malaysia
| | - Rusli Ismail
- Universiti Sains Malaysia, Malaysia; Universiti Sultan Zainal Abidin, Malaysia
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Li DJ, Chung KS, Wu HC, Hsu CY, Yen CF. Factors affecting the dose of methadone among patients receiving methadone maintenance therapy in Taiwan. Am J Addict 2018; 27:225-230. [DOI: 10.1111/ajad.12712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dian-Jeng Li
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
- Graduate Institute of Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Kuan-Shang Chung
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
| | - Hung-Chi Wu
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
| | - Chih-Yao Hsu
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
| | - Cheng-Fang Yen
- Graduate Institute of Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Psychiatry; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
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Zahari Z, Lee CS, Ibrahim MA, Musa N, Mohd Yasin MA, Lee YY, Tan SC, Mohamad N, Ismail R. Relationship between CYP2B6*6 and cold pressor pain sensitivity in opioid dependent patients on methadone maintenance therapy (MMT). Drug Alcohol Depend 2016; 165:143-50. [PMID: 27289271 DOI: 10.1016/j.drugalcdep.2016.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/22/2016] [Accepted: 05/30/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND CYP2B6 polymorphisms contribute to inter-individual variations in pharmacokinetics of methadone. Increased pain sensitivity is frequently reported by opioid dependent patients on methadone maintenance therapy (MMT). It is possible, therefore, that genetic polymorphisms in CYP2B6, which affects the metabolism of methadone, influence pain sensitivity among patients on MMT. This study investigated CYP2B6 polymorphisms and pain sensitivity in this group. METHODS The cold pressor pain responses of 148 opioid dependent patients receiving MMT were evaluated using the cold pressor test (CPT). DNA was extracted from whole blood and subjected to polymerase chain reaction (PCR)-genotyping. RESULTS Of the 148 subjects, 77 (52.0%) were carriers of CYP2B6*6 allele. CYP2B6*6 allele carriers had shorter cold pain threshold and pain tolerance times than non-carriers of CYP2B6*6 allele (21.05s vs 33.69s, p=0.036 and 27.15s vs 44.51s, p=0.020, respectively). Pain intensity scores of the CYP2B6*6 allele carriers was 67.55, whereas that of the CYP2B6*6 allele non-carriers was 64.86 (p=0.352). CONCLUSION Our study indicates that the CYP2B6*6 allele is associated with a lower pain threshold and lower pain tolerance among males with opioid dependence on MMT. The CYP2B6*6 allele may provide a mechanistic explanation for clinical observations of heightened pain sensitivity among opioid dependent patients receiving MMT.
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Affiliation(s)
- Zalina Zahari
- Department of Pharmacy, Hospital Universiti Sains Malaysia, Kelantan, Malaysia; Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia.
| | - Chee Siong Lee
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Muslih Abdulkarim Ibrahim
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia; Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Hawler, Iraq
| | - Nurfadhlina Musa
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Mohd Azhar Mohd Yasin
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia; Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Soo Choon Tan
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Nasir Mohamad
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia; Faculty of Medicine & Health Sciences, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Rusli Ismail
- Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia; Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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