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White AM, Eglovitch M, Parlier-Ahmad AB, Dzierzewski JM, James M, Bjork JM, Moeller FG, Martin CE. Insomnia symptoms and neurofunctional correlates among adults receiving buprenorphine for opioid use disorder. PLoS One 2024; 19:e0304461. [PMID: 38870144 PMCID: PMC11175529 DOI: 10.1371/journal.pone.0304461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES Insomnia symptoms are negatively related to opioid use disorder (OUD) treatment outcomes, possibly reflecting the influence of sleep on neurofunctional domains implicated in addiction. Moreover, the intersection between OUD recovery and sleep represents an area well-suited for the development of novel, personalized treatment strategies. This study assessed the prevalence of clinically significant insomnia symptoms and characterized its neurofunctional correlates among a clinical sample of adults with OUD receiving buprenorphine. METHODS Adults (N = 129) receiving buprenorphine for OUD from an outpatient clinic participated in a cross-sectional survey. Participants completed an abbreviated version of NIDA's Phenotyping Assessment Battery, which assessed 6 neurofunctional domains: sleep, negative emotionality, metacognition, interoception, cognition, and reward. Bivariate descriptive statistics compared those with evidence of clinically significant insomnia symptoms (Insomnia Severity Index [ISI] score of ≥11) to those with minimal evidence of clinically significant insomnia symptoms (ISI score of ≤10) across each of the neurofunctional domains. RESULTS Roughly 60% of participants reported clinically significant insomnia symptoms (ISI score of ≥11). Experiencing clinically significant insomnia symptoms was associated with reporting greater levels of depression, anxiety, post-traumatic stress, stress intolerance, unhelpful metacognition, and interoceptive awareness (ps<0.05). Participants with evidence of clinically significant insomnia were more likely to report that poor sleep was interfering with their OUD treatment and that improved sleep would assist with their treatment (ps<0.05). CONCLUSIONS Insomnia was prevalent among adults receiving buprenorphine for OUD. Insomnia was associated with neurofunctional performance, which may impact OUD treatment trajectories. Our findings indicate potential targets in the development of personalized treatment plans for patients with co-morbid insomnia and OUD. To inform the development of novel treatment strategies, more research is needed to understand the potential mechanistic links between sleep disturbances and substance use.
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Affiliation(s)
- Augustus M. White
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Michelle Eglovitch
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Anna Beth Parlier-Ahmad
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | | | - Morgan James
- Department of Psychiatry, Rutgers University, Newark, New Jersey, United States of America
| | - James M. Bjork
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - F. Gerard Moeller
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Caitlin E. Martin
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
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Berle Gabrielsen K, Clausen T, Håvås Haugland S, Vederhus JK. Gradual improvement in functioning and mental distress during long-term outpatient SUD treatment - A prospective pre-post study. Addict Behav Rep 2024; 19:100525. [PMID: 38273991 PMCID: PMC10808902 DOI: 10.1016/j.abrep.2024.100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/18/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024] Open
Abstract
Background Globally, outpatient programs for substance use disorder (SUD) treatment have gained prominence. To assess the broader clinical implications of this trend we investigated shifts in functioning experienced by outpatients undergoing treatment. Methods We describe the clinical characteristics of a cohort of 93 SUD patients in a Norwegian outpatient treatment clinic. Using paired-samples t-tests, we examined changes in perceived functioning, mental distress, and other clinically relevant outcome variables in a 5-month time interval during the treatment course. Results We obtained follow-up data for 67 (72%) of the included patients, with no significant difference in patient-related factors between those who completed the treatment course and those who were not assessed at follow-up. Perceived functioning increased significantly from study inclusion (Time 0) (mean 19.8, standard deviation ± 8.8) to its conclusion (Time 1) (24.3, ±9.3; t (66) = 4.5, (95% CI: 2.5-6.5, p < 0.001). We also identified significant improvement in most other measured variables, including mental distress, self-reported sleep quality, restlessness, and obsessive thinking. Substance use-related variables showed a modest, non-significant improvement at T1. Conclusion During a 5-month course of outpatient treatment, patients' subjective experience of functioning improved significantly. Those with the lowest functioning levels at T0 improved the most. Structured monitoring may be a valuable clinical tool for personalizing intervention, enhancing treatment outcomes, and supporting the clinical decision-making process.
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Affiliation(s)
| | - Thomas Clausen
- Addiction Unit, Sørlandet Hospital, Kristiansand, Norway
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo, Norway
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Yeh YH, Zheng MH, Tegge AN, Athamneh LN, Freitas-Lemos R, Dwyer CL, Bickel WK. The phenotype of recovery XI: associations of sleep quality and perceived stress with discounting and quality of life in substance use recovery. Qual Life Res 2024; 33:1621-1632. [PMID: 38504067 PMCID: PMC11116204 DOI: 10.1007/s11136-024-03625-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Sleep and stress show an interdependent relationship in physiology, and both are known risk factors for relapse in substance use disorder (SUD) recovery. However, sleep and stress are often investigated independently in addiction research. In this exploratory study, the associations of sleep quality and perceived stress with delay discounting (DD), effort discounting (ED), and quality of life (QOL) were examined concomitantly to determine their role in addiction recovery. DD has been proposed as a prognostic indicator of SUD treatment response, ED is hypothesized to be relevant to the effort to overcome addiction, and QOL is an important component in addiction recovery. METHOD An online sample of 118 individuals recovering from SUDs was collected through the International Quit and Recovery Registry. Exhaustive model selection, using the Bayesian Information Criterion to determine the optimal multiple linear model, was conducted to identify variables (i.e., sleep quality, perceived stress, and demographics) contributing to the total variance in DD, ED, and QOL. RESULTS After model selection, sleep was found to be significantly associated with DD. Stress was found to be significantly associated with psychological health, social relationships, and environment QOL. Both sleep and stress were found to be significantly associated with physical health QOL. Neither sleep nor stress was supported as an explanatory variable of ED. CONCLUSION Together, these findings suggest sleep and stress contribute uniquely to the process of addiction recovery. Considering both factors when designing interventions and planning for future research is recommended.
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Affiliation(s)
| | - Michelle H Zheng
- Civil and Environmental Engineering Department, University of California, Los Angeles, CA, USA
| | - Allison N Tegge
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
| | | | - Candice L Dwyer
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA.
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4
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Mumba MN, Sweeney A, Jennings C, Matthews J, Andrabi M, Hall J, Benstead H. Perceived Educational Needs of Substance Use Peer Support Specialists: A Qualitative Study. Community Ment Health J 2024; 60:160-168. [PMID: 37606851 DOI: 10.1007/s10597-023-01176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/26/2023] [Indexed: 08/23/2023]
Abstract
The opioid crisis is an ever-growing issue nationwide. The role of peer support specialists has received widespread acceptance in the substance use and behavioral health spheres. However, there is a lack of standardization on the training required for peer support specialists to function as competent members of integrated behavioral health teams. We conducted qualitative focus groups with 14 practicing certified peer support specialists to determine their perceived educational needs. Inductive thematic analysis was used to analyze the data and six themes emerged: mental health and suicide prevention training, diversity, equity, and inclusion training, counseling skills training, family systems approach to care training, professionalism training, and taking care of self - mind, soul, and body training. To improve peer support specialists' confidence in their ability to competently perform their jobs, important topics need to be incorporated into their educational training and preparation.
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Affiliation(s)
- Mercy Ngosa Mumba
- The Capstone College of Nursing, Center for Substance Use Research and Related Conditions, The University of Alabama, 650 University Blvd East, Tuscaloosa, AL, 35401, USA.
| | - Avaleen Sweeney
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Claudia Jennings
- The Capstone College of Nursing, Center for Substance Use Research and Related Conditions, The University of Alabama, 650 University Blvd East, Tuscaloosa, AL, 35401, USA
| | - Jeremiah Matthews
- College of Engineering, The University of Alabama, Tuscaloosa, AL, USA
| | - Mudasir Andrabi
- The Capstone College of Nursing, Center for Substance Use Research and Related Conditions, The University of Alabama, 650 University Blvd East, Tuscaloosa, AL, 35401, USA
| | - Jordan Hall
- The Capstone College of Nursing, Center for Substance Use Research and Related Conditions, The University of Alabama, 650 University Blvd East, Tuscaloosa, AL, 35401, USA
| | - Heidi Benstead
- The Capstone College of Nursing, Center for Substance Use Research and Related Conditions, The University of Alabama, 650 University Blvd East, Tuscaloosa, AL, 35401, USA
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Keyser-Marcus L, Ramey T, Bjork JM, Martin CE, Sabo R, Moeller FG. Initial Validation of a Behavioral Phenotyping Model for Substance Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:14. [PMID: 38276802 PMCID: PMC10815773 DOI: 10.3390/ijerph21010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024]
Abstract
Standard nosological systems, such as DSM-5 or ICD-10, are relied upon as the diagnostic basis when developing treatments for individuals with substance use disorder (SUD). Unfortunately, the vast heterogeneity of individuals within a given SUD diagnosis results in a variable treatment response and/or difficulties ascertaining the efficacy signal in clinical trials of drug development. Emerging precision medicine methods focusing on targeted treatments based on phenotypic subtypes rather than diagnosis are being explored as alternatives. The goal of the present study was to provide initial validation of emergent subtypes identified by an addiction-focused phenotyping battery. Secondary data collected as part of a feasibility study of the NIDA phenotyping battery were utilized. Participants completed self-report measures and behavioral tasks across six neurofunctional domains. Exploratory and confirmatory factor analysis (EFA/CFA) were conducted. A three-factor model consisting of negative emotionality, attention/concentration, and interoception and mindfulness, as well as a four-factor model adding a second negative emotion domain, emerged from the EFA as candidate models. The CFA of these models did not result in a good fit, possibly resulting from small sample sizes that hindered statistical power.
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Affiliation(s)
- Lori Keyser-Marcus
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Tatiana Ramey
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse (NIDA), Gaithersburg, MD 20877, USA
| | - James M. Bjork
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - Roy Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - F. Gerard Moeller
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
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6
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Miller MB, Cofresí RU, McCarthy DM, Carskadon MA. Sleep and circadian influences on blood alcohol concentration. Sleep 2023; 46:zsad250. [PMID: 37756490 PMCID: PMC10710990 DOI: 10.1093/sleep/zsad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
STUDY OBJECTIVES Anecdotally, adults reach higher levels of subjective intoxication on days they are fatigued or sleep-deprived, but sleep is not typically discussed as a predictor of blood alcohol concentration (BAC) in clinical settings. To inform clinical work and future research, this perspective reviews data examining the impact of sleep (process S) and circadian (process C) factors on indicators of BAC in humans and animal models. METHODS Literature searches of medical and psychological databases were conducted to identify articles that manipulated sleep/circadian factors and reported effects on indicators of alcohol pharmacology (e.g. BAC, alcohol metabolism). RESULTS Of the 86 full-text articles reviewed, 21 met inclusion criteria. Studies included manipulations of time of day, circadian phase (evidence for process C), and time in bed (evidence for process S). Evidence for time-of-day effects on alcohol pharmacology was most compelling. Studies also provided evidence for circadian phase effects, but failed to find support for time-in-bed effects. Although results were not uniform across studies, most evidence from human and animal models indicates that peak BACs occur toward the beginning of the biological day, with some studies indicating slower alcohol elimination rates at this time. CONCLUSIONS Circadian factors likely influence alcohol pharmacokinetics, perhaps due to altered elimination of alcohol from the body. This means that individuals may reach higher BACs if they drink during the morning (when, for most people, circadian alerting is low) versus other times of the day. Alcohol prevention and intervention efforts should highlight sleep/circadian health as a potential contributor to alcohol-related harm.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, USA
| | - Roberto U Cofresí
- Department of Psychological Sciences, University of Missouri College of Arts and Sciences, Columbia, MO, USA
| | - Denis M McCarthy
- Department of Psychological Sciences, University of Missouri College of Arts and Sciences, Columbia, MO, USA
| | - Mary A Carskadon
- Sleep for Science Research Lab, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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7
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Brennan GM, Moffitt TE, Ambler A, Harrington H, Hogan S, Houts RM, Mani R, Poulton R, Ramrakha S, Caspi A. Tracing the origins of midlife despair: association of psychopathology during adolescence with a syndrome of despair-related maladies at midlife. Psychol Med 2023; 53:7569-7580. [PMID: 37161676 PMCID: PMC10636241 DOI: 10.1017/s0033291723001320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Midlife adults are experiencing a crisis of deaths of despair (i.e. deaths from suicide, drug overdose, and alcohol-related liver disease). We tested the hypothesis that a syndrome of despair-related maladies at midlife is preceded by psychopathology during adolescence. METHODS Participants are members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972-73 and followed to age 45 years, with 94% retention. Adolescent mental disorders were assessed in three diagnostic assessments at ages 11, 13, and 15 years. Indicators of despair-related maladies across four domains - suicidality, substance misuse, sleep problems, and pain - were assessed at age 45 using multi-modal measures including self-report, informant-report, and national register data. RESULTS We identified and validated a syndrome of despair-related maladies at midlife involving suicidality, substance misuse, sleep problems, and pain. Adults who exhibited a more severe syndrome of despair-related maladies at midlife tended to have had early-onset emotional and behavioral disorders [β = 0.23, 95% CI (0.16-0.30), p < 0.001], even after adjusting for sex, childhood SES, and childhood IQ. A more pronounced midlife despair syndrome was observed among adults who, as adolescents, were diagnosed with a greater number of mental disorders [β = 0.26, 95% CI (0.19-0.33), p < 0.001]. Tests of diagnostic specificity revealed that associations generalized across different adolescent mental disorders. CONCLUSIONS Midlife adults who exhibited a more severe syndrome of despair-related maladies tended to have had psychopathology as adolescents. Prevention and treatment of adolescent psychopathology may mitigate despair-related maladies at midlife and ultimately reduce deaths of despair.
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Affiliation(s)
- Grace M. Brennan
- Duke Aging Center, Duke University School of Medicine, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Terrie E. Moffitt
- Duke Aging Center, Duke University School of Medicine, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Population Health and Aging, Duke University Population Research Institute, Durham, NC, USA
- Institute of Psychiatry, King's College London, London, UK
- Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Promenta, University of Oslo, Oslo, Norway
| | - Antony Ambler
- Institute of Psychiatry, King's College London, London, UK
| | - HonaLee Harrington
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Sean Hogan
- Department of Psychology and Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Renate M. Houts
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | | | - Richie Poulton
- Department of Psychology and Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Department of Psychology and Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Avshalom Caspi
- Duke Aging Center, Duke University School of Medicine, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Population Health and Aging, Duke University Population Research Institute, Durham, NC, USA
- Institute of Psychiatry, King's College London, London, UK
- Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Promenta, University of Oslo, Oslo, Norway
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8
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Baldassarri SR, Chu JH, Deng A, Xu Z, Blohowiak RF, Byrne S, Kushida C, Yaggi HK, Zinchuk A. Nicotine, alcohol, and caffeine use among individuals with untreated obstructive sleep apnea. Sleep Breath 2023; 27:2479-2490. [PMID: 37058215 PMCID: PMC10576010 DOI: 10.1007/s11325-023-02830-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/22/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Psychoactive substance use (i.e., nicotine, alcohol, and caffeine) has substantial effects on sleep architecture in healthy individuals, but their effects in those with obstructive sleep apnea (OSA) have not been well described. We aimed to describe the association between psychoactive substance use and sleep characteristics and daytime symptoms in individuals with untreated OSA. METHODS We performed a secondary, cross-sectional analysis of The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Exposures included current smoking, alcohol and caffeine use in individuals with untreated OSA. Outcome domains included subjective and objective sleep characteristics, daytime symptoms, and comorbid conditions. Linear or logistic regression assessed the association between substance use and each domain (e.g., self-reported sleep duration, total polysomnographic sleep time, sleepiness, and anxiety). RESULTS Of the 919 individuals with untreated OSA, 116 (12.6%) were current cigarette smokers, 585 (63.7%) were moderate or heavy alcohol users, and 769 (83.7%) were moderate or heavy caffeine users. Participants were on average 52.2±11.9 years old, 65.2% were male with a median BMI of 30.6 (IQR: 27.2, 35.9, kg/m2). Current smokers exhibited lower sleep duration (0.3 h), longer sleep latency (5 min) compared with non-smokers (all p-values < 0.05). People with heavy or moderate alcohol use exhibited more REM sleep (2.5 and 5% of total sleep time respectively), as did those with moderate caffeine use (2%, p-values < 0.05). The combined smoker plus caffeine group exhibited shorter sleep duration (0.4 h, p-value < 0.05) and higher risk for chronic pain [Odds Ratio (95%CI) = 4.83 (1.57, 14.9) compared with non-users. CONCLUSIONS Psychoactive substance use is associated with sleep characteristics and clinically relevant correlates in people with untreated OSA. Further investigation into the effects that various substances have on this population may present opportunities to understand disease mechanisms more fully and increase the effectiveness of treatment in OSA.
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Affiliation(s)
- Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA.
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.
- Program in Sleep Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Jen-Hwa Chu
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
| | - Annan Deng
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
| | - Zhichao Xu
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Reagan F Blohowiak
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
| | - Sean Byrne
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
- Program in Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Clete Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, CA, USA
| | - H Klar Yaggi
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Program in Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrey Zinchuk
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
- Program in Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
- Advanced Apnea Management Program, Yale School of Medicine, New Haven, CT, USA
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9
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Hersey M, Tanda G. Modafinil, an atypical CNS stimulant? ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2023; 99:287-326. [PMID: 38467484 DOI: 10.1016/bs.apha.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Modafinil is a central nervous system stimulant approved for the treatment of narcolepsy and sleep disorders. Due to its wide range of biochemical actions, modafinil has been explored for other potential therapeutic uses. Indeed, it has shown promise as a therapy for cognitive disfunction resulting from neurologic disorders like ADHD, and as a smart drug in non-medical settings. The mechanism(s) of actions underlying the therapeutic efficacy of this agent remains largely elusive. Modafinil is known to inhibit the dopamine transporter, thus decreasing dopamine reuptake following neuronal release, an effect shared by addictive psychostimulants. However, modafinil is unique in that only a few cases of dependence on this drug have been reported, as compared to other psychostimulants. Moreover, modafinil has been tested, with some success, as a potential therapeutic agent to combat psychostimulant and other substance use disorders. Modafinil has additional, but less understood, actions on other neurotransmitter systems (GABA, glutamate, serotonin, norepinephrine, etc.). These interactions, together with its ability to activate selected brain regions, are likely one of the keys to understand its unique pharmacology and therapeutic activity as a CNS stimulant. In this chapter, we outline the pharmacokinetics and pharmacodynamics of modafinil that suggest it has an "atypical" CNS stimulant profile. We also highlight the current approved and off label uses of modafinil, including its beneficial effects as a treatment for sleep disorders, cognitive functions, and substance use disorders.
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Affiliation(s)
- Melinda Hersey
- Medication Development Program, NIDA-IRP, NIH, Baltimore, MD, United States
| | - Gianluigi Tanda
- Medication Development Program, NIDA-IRP, NIH, Baltimore, MD, United States.
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10
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Green YD, Green YS, Yau BN, Ross DA. From Foot-Bread to Flip-Flop Circuits: What History Can Teach Us About Sleep and How to Treat It. Biol Psychiatry 2023; 94:e29-e31. [PMID: 37718032 DOI: 10.1016/j.biopsych.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Yoel D Green
- Department of Psychiatry, Western University, London, Ontario, Canada.
| | - Yaakov S Green
- Department of Psychiatry, Columbia University, New York, New York
| | - Bernice N Yau
- Department of Psychiatry, Columbia University, New York, New York
| | - David A Ross
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
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11
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Eglovitch M, Parlier-Ahmad AB, Legge C, Chithranjan S, Kolli S, Violante S, Dzierzewski JM, Huhn AS, Wilkerson A, Martin CE. Patient reported preferences for sleep interventions among women receiving buprenorphine for opioid use disorder. Front Psychiatry 2023; 14:1244156. [PMID: 37779614 PMCID: PMC10537926 DOI: 10.3389/fpsyt.2023.1244156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Aim Among individuals receiving medication for OUD (MOUD), insomnia is highly prevalent and increases the risk for negative OUD outcomes. However, little is known about MOUD patient-reported preferences for insomnia treatments among women with OUD. This mixed-methods study explored acceptability of and patient preferences for sleep interventions among women in OUD treatment. Methods This is an analysis from an ongoing cross-sectional survey and interview study investigating the relationship between sleep and OUD recovery. The parent study is actively enrolling non-pregnant women between 18-45 years stabilized on buprenorphine from an outpatient program. Participants complete measures including the Insomnia Severity Index (ISI), with scores of ≥10 identifying clinically significant insomnia symptoms. A sub-sample who met this threshold completed semi-structured interviews. Descriptive statistics were generated for survey responses, and applied thematic analysis was used for interview data. Results Participants selected for the qualitative interview (n = 11) highlighted prior positive and negative experiences with sleep treatments, challenges with employing non-pharmacological sleep strategies, and preferences for both medical and behavioral sleep interventions while in recovery. Women emphasized the need for flexibility of sleep therapy sessions to align with ongoing social determinants (e.g., caregiving responsibilities) as well as for sleep medications without sedating effects nor risk of dependency. Conclusions Many women receiving MOUD have concomitant insomnia symptoms, and desire availability of both pharmacologic and behavioral sleep interventions within the OUD treatment setting. Qualitative findings underscore the need for evidence-based sleep interventions that account for the unique socioenvironmental factors that may impact strategy implementation in this population.
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Affiliation(s)
- Michelle Eglovitch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Catherine Legge
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Sajanee Chithranjan
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Saisriya Kolli
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Stephanie Violante
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | | | | | - Allison Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Caitlin Eileen Martin
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- Department of Obstetrics and Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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12
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Chen RW, Ulsa MC, Li P, Gao C, Zheng X, Xu J, Luo Y, Shen S, Lane J, Scheer FAJL, Hu K, Gao L. Sleep behavior traits and associations with opioid-related adverse events: a cohort study. Sleep 2023; 46:zsad118. [PMID: 37075812 PMCID: PMC10485566 DOI: 10.1093/sleep/zsad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 04/02/2023] [Indexed: 04/21/2023] Open
Abstract
STUDY OBJECTIVES Opioid-related adverse events (OAEs), including opioid use disorders, overdose, and death, are serious public health concerns. OAEs are often associated with disrupted sleep, but the long-term relationship between poor sleep and subsequent OAE risk remains unknown. This study investigates whether sleep behavior traits are associated with incident OAEs in a large population cohort. METHODS 444 039 participants (mean age ± SD 57 ± 8 years) from the UK Biobank reported their sleep behavior traits (sleep duration, daytime sleepiness, insomnia-like complaints, napping, and chronotype) between 2006 and 2010. The frequency/severity of these traits determined a poor sleep behavior impacts score (0-9). Incident OAEs were obtained from hospitalization records during 12-year median follow-up. Cox proportional hazards models examined the association between sleep and OAEs. RESULTS Short and long sleep duration, frequent daytime sleepiness, insomnia symptoms, and napping, but not chronotype, were associated with increased OAE risk in fully adjusted models. Compared to the minimal poor sleep behavior impacts group (scores of 0-1), the moderate (4-5) and significant (6-9) groups had hazard ratios of 1.47 (95% confidence interval [1.27, 1.71]), p < 0.001, and 2.19 ([1.82, 2.64], p < 0.001), respectively. The latter risk magnitude is greater than the risk associated with preexisting psychiatric illness or sedative-hypnotic medication use. In participants with moderate/significant poor sleep impacts (vs. minimal), subgroup analysis revealed that age <65 years was associated with a higher OAE risk than in those ≥65 years. CONCLUSIONS Certain sleep behavior traits and overall poor sleep impacts are associated with an increased risk for opioid-related adverse events.
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Affiliation(s)
- Rudy W Chen
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ma Cherrysse Ulsa
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Peng Li
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Chenlu Gao
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Xi Zheng
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jiawei Xu
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Yong Luo
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Shiqian Shen
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jacqueline Lane
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Frank A J L Scheer
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kun Hu
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lei Gao
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
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13
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Regmi S, Kedia SK, Schmidt M, Mahmood A, Lugemwa T, Dillon PJ. Methamphetamine-Induced Wakefulness and Sleep Management: A Qualitative Analysis of Online Narratives. J Psychoactive Drugs 2023:1-8. [PMID: 37598359 DOI: 10.1080/02791072.2023.2246458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
While much attention has been given to methamphetamine's wake-promoting properties and the concept of using methamphetamine to increase energy, little is known about the ways people who use methamphetamine manage their use to pursue their functional goals or the challenges they encounter doing so. This qualitative study explores the experiences of people who used methamphetamine to manage wakefulness and reduce sleep as a means to achieve functional goals. We conducted a grounded theory analysis of 202 anonymous letters submitted to an online forum. Five themes emerged from this process: (1) Using methamphetamine to extend wakefulness and reduce the need for sleep; (2) Losing control over wakefulness and the need for sleep; (3) Managing wakefulness and the need for sleep while on methamphetamine; (4) Getting caught in a cycle of wakefulness and sleep; and (5) Sleep disruptions even after ceasing methamphetamine use. Participants believed methamphetamine was critical to meeting their functional goals, and they went to great lengths to try to manage the substance's ill effects. Thus, clients in treatment for methamphetamine use disorder may benefit from interventions addressing their underlying motivations and perceived associations between methamphetamine and meeting functional goals.
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Affiliation(s)
- Sanjaya Regmi
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Michael Schmidt
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tony Lugemwa
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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14
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Goodhines PA, Rathod K. Substance use and sleep health in young adults: Implications for integrated treatment and harm reduction. Sleep Med Rev 2023; 70:101811. [PMID: 37423096 DOI: 10.1016/j.smrv.2023.101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
In their systematic review and meta-analysis, Meneo and colleagues document distinct substance-sleep effects reported by young adults (ages 18-30) across multidimensional sleep health and different substances used in the naturalistic environment, including alarming rates of self-medication for sleep aid. Key innovations of Meneo et al.'s review include (a) a multidimensional approach to defining sleep health and (b) robust inclusion of various substances commonly used in young adults. Although future research will be essential to clarifying transdiagnostic risk mechanisms, interplay of co-used substances, and the role of expectancies in risk processes, the developing literature reviewed herein may inform much-needed clinical recommendations. This work by Meneo et al should prompt an emphasis on approaching young adult substance use and self-medication through a harm reduction lens, highlighting recommendations for integrated behavioral sleep treatment tailored to stage of change using motivational interviewing.
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15
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Martin CE, Patel H, Dzierewski JM, Moeller FG, Bierut LJ, Grucza RA, Xu KY. Benzodiazepine, Z-drug, and sleep medication prescriptions in male and female people with opioid use disorder on buprenorphine and comorbid insomnia: an analysis of multistate insurance claims. Sleep 2023; 46:zsad083. [PMID: 36970994 PMCID: PMC10262036 DOI: 10.1093/sleep/zsad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
STUDY OBJECTIVES In adult populations, women are more likely than men to be prescribed benzodiazepines. However, such disparities have not been investigated in people with opioid use disorder (OUD) and insomnia receiving buprenorphine, a population with particularly high sedative/hypnotic receipt. This retrospective cohort study used administrative claims data from Merative MarketScan Commercial and MultiState Medicaid Databases (2006-2016) to investigate sex differences in the receipt of insomnia medication prescriptions among patients in OUD treatment with buprenorphine. METHODS We included people aged 12-64 years with diagnoses of insomnia and OUD-initiating buprenorphine during the study timeframe. The predictor variable was sex (female versus male). The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g. hydroxyzine, trazodone, and mirtazapine). Associations between sex and benzodiazepine, Z-drug, and other insomnia medication prescription receipt were estimated using Poisson regression models. RESULTS Our sample included 9510 individuals (female n = 4637; male n = 4873) initiating buprenorphine for OUD who also had insomnia, of whom 6569 (69.1%) received benzodiazepines, 3891 (40.9%) Z-drugs, and 8441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR = 1.17 [1.11-1.23]), Z-drugs (RR = 1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR = 1.07, [1.02-1.12]). CONCLUSIONS Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment with buprenorphine, with sex-based disparities indicating a higher prescribing impact among female than male OUD treatment patients.
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Affiliation(s)
- Caitlin E Martin
- Department of Obstetrics and Gynecology and VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Hetal Patel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - F. Gerard Moeller
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J Siteman Cancer Center, Barnes Jewish Hospital, St. Louis, MO, USA
| | - Richard A Grucza
- Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, St. Louis, MO, USA
| | - Kevin Y Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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16
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Yen CF, Chou WP, Hsu CY, Wu HC, Wang PW. Effects of heart rate variability biofeedback (HRVBFB) on sleep quality and depression among methamphetamine users. J Psychiatr Res 2023; 162:132-139. [PMID: 37149922 DOI: 10.1016/j.jpsychires.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/29/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
Methamphetamine is garnering concern due to its increasing use worldwide. Depression and sleep quality are major mental health issues in substance users. Heart rate variability biofeedback (HRVBFB) has shown promising results in terms of reducing depression and increasing sleep quality. The present study aimed to explore the effects of HRVBFB on these two issues in methamphetamine users. Sixty-one methamphetamine users were enrolled and allocated randomly into a treatment as usual (TAU) group and a HRVBFB plus TAU group. The levels of depressive symptoms and sleep quality were assessed at intake, end of the intervention, and end of follow-up. Compared with baseline, the levels of depressive symptoms and poor sleep quality were decreased at the end of the intervention and follow-up in the HRVBFB group. The HRVBFB group exhibited a greater decrease in depressive symptoms and a better improvement in sleep quality than the TAU group. The associations of HRV indices with levels of depressive symptoms and poor sleep quality were different in the two groups. Our results showed that HRVBFB is a promising intervention for reducing depressive symptoms and improving sleep quality in methamphetamine users. The benefits with respect to depressive symptoms and poor sleep quality can extend beyond the end of HRVBFB intervention.
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Affiliation(s)
- Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Wei-Po Chou
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Chih-Yao Hsu
- Department of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hung-Chi Wu
- Department of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
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17
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Berro LF, España RA, Mong JA, Gould RW. Editorial: Sleep and circadian rhythm disruptions associated with substance use disorders. Front Neurosci 2023; 17:1165084. [PMID: 37144091 PMCID: PMC10151812 DOI: 10.3389/fnins.2023.1165084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/30/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
- Lais F. Berro
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Rodrigo A. España
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, PA, United States
| | - Jessica A. Mong
- Department of Pharmacology, University of Maryland, Baltimore, MD, United States
| | - Robert W. Gould
- Department of Physiology and Pharmacology, School of Medicine, Wake Forest University, Winston-Salem, NC, United States
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18
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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: 0] [Impact Index Per Article: 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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19
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Jalali N, Khalili P, Jamali Z, Jalali Z, Moghadam-Ahmadi A, Vakilian A, Ayoobi F. Sleep duration, hypnotic drug use, and risk factors: cross- sectional study. Sci Rep 2023; 13:3459. [PMID: 36859460 PMCID: PMC9977908 DOI: 10.1038/s41598-023-30501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Both short sleep duration (SSD) and long sleep duration (LSD) are associated with an increased risk of morbidity and mortality. Here, we aimed to assess the prevalence of sleep duration disturbances among adults in association with demographic, medication use, personal habits, and chronic diseases, while also considering the impact of hypnotic drug use. We performed a cross-sectional study of 9991 adult participants of the Rafsanjan Cohort Study (RCS), as part of the Prospective epidemiological research studies in Iran (PERSIAN). Multivariate logistic regression analyses were conducted to assess the association between short (< 6 h) and long (> 9 h) sleep duration with demographic and lifestyle parameters and common non-communicable diseases. Additionally, we performed stratified analysis to investigate the association of sleep duration with the abovementioned factors and diseases, in groups with and without hypnotic drug use. We found higher odds of SSD significantly associated with age (P < 0.001), BMI (P < 0.001), physical activity (P < 0.001), and depression (P = 0.023). LSD displayed a positive association with the female sex (P < 0.001), opium consumption (P < 0.001), and history of MI (P = 0.045), and a reverse connection with education (P = 0.007), physical activity (P < 0.001) and alcohol consumption (P = 0.027). Stratifying for the hypnotic drug use, our sensitivity analyses indicated that in hypnotic drug users, education (P = 0.034) and physical activity (P < 0.001) were associated with LSD, in this group, significantly increased odds ratio of LSD were associated with opium consumption (P = 0.046) and thyroid dysfunction (P = 0.037). Our findings demonstrated the demographic and lifestyle factors and diseases associated with long and short sleep duration in the population of the RCS. Additionally, after stratifying for hypnotic drug use, our results indicated that some diseases are only associated with abnormal sleep duration upon using hypnotic drugs.
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Affiliation(s)
- Nazanin Jalali
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Neurology Department, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Parvin Khalili
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Epidemiology, School of Public Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zahra Jamali
- Clinical Research Development Unit (CRDU), Niknafs Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zahra Jalali
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Clinical Biochemistry, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Amir Moghadam-Ahmadi
- Neurology Department, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Neuro-Immunology Research Scholar, Neurological Research Laboratory, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alireza Vakilian
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Neurology Department, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fatemeh Ayoobi
- Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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20
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Holter KM, Pierce BE, Gould RW. Metabotropic glutamate receptor function and regulation of sleep-wake cycles. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 168:93-175. [PMID: 36868636 DOI: 10.1016/bs.irn.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Metabotropic glutamate (mGlu) receptors are the most abundant family of G-protein coupled receptors and are widely expressed throughout the central nervous system (CNS). Alterations in glutamate homeostasis, including dysregulations in mGlu receptor function, have been indicated as key contributors to multiple CNS disorders. Fluctuations in mGlu receptor expression and function also occur across diurnal sleep-wake cycles. Sleep disturbances including insomnia are frequently comorbid with neuropsychiatric, neurodevelopmental, and neurodegenerative conditions. These often precede behavioral symptoms and/or correlate with symptom severity and relapse. Chronic sleep disturbances may also be a consequence of primary symptom progression and can exacerbate neurodegeneration in disorders including Alzheimer's disease (AD). Thus, there is a bidirectional relationship between sleep disturbances and CNS disorders; disrupted sleep may serve as both a cause and a consequence of the disorder. Importantly, comorbid sleep disturbances are rarely a direct target of primary pharmacological treatments for neuropsychiatric disorders even though improving sleep can positively impact other symptom clusters. This chapter details known roles of mGlu receptor subtypes in both sleep-wake regulation and CNS disorders focusing on schizophrenia, major depressive disorder, post-traumatic stress disorder, AD, and substance use disorder (cocaine and opioid). In this chapter, preclinical electrophysiological, genetic, and pharmacological studies are described, and, when possible, human genetic, imaging, and post-mortem studies are also discussed. In addition to reviewing the important relationships between sleep, mGlu receptors, and CNS disorders, this chapter highlights the development of selective mGlu receptor ligands that hold promise for improving both primary symptoms and sleep disturbances.
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Affiliation(s)
- Kimberly M Holter
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Bethany E Pierce
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Robert W Gould
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States.
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21
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Sun C, Wang X, Huang X, Shao Y, Ling A, Qi H, Zhang Z. Sleep disorders as a prospective intervention target to prevent drug relapse. Front Public Health 2023; 10:1102115. [PMID: 36684873 PMCID: PMC9846318 DOI: 10.3389/fpubh.2022.1102115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Objective The high rate of relapse has become the primary obstacle of drug rehabilitation. In this study, we explored the relationship between sleep disorders and relapse inclination in substance users, as well as the potential mediating mechanisms and corresponding interventions. Methods A total of 392 male substance users were recruited to complete the questionnaires on sleep disorders, quality of life and relapse inclination. On account of this, 60 participants with sleep disorders were randomly screened and allocated to the intervention and control groups. The former received 12 weeks of Health Qigong aimed at treating sleep disorders, whereas the latter performed their regular production work. Results Sleep disorders had a positive effect on relapse inclination, quality of life was a potential mediator of this relationship, and 12-week Health Qigong designed to treat sleep disorders improved not only their sleep quality but also their overall quality of life, which in turn reduce the tendency to relapse. Conclusion Current research not only explores the high-risk factors influencing relapse, but also develops customized intervention strategies, which have theoretical and practical implications for decreasing relapse and increasing abstinence.
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Affiliation(s)
- Chao Sun
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xiaojun Wang
- China Wushu School, Beijing Sport University, Beijing, China,*Correspondence: Xiaojun Wang ✉
| | - Xuetong Huang
- China Wushu School, Beijing Sport University, Beijing, China
| | - Yongcong Shao
- School of Psychology, Beijing Sport University, Beijing, China
| | - Anna Ling
- Beihu Road Primary School, Liuzhou, Guangxi, China
| | - Huanhuan Qi
- China Wushu School, Beijing Sport University, Beijing, China
| | - Zhuolin Zhang
- China Wushu School, Beijing Sport University, Beijing, China
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22
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Kavaliotis E, Boardman JM, Clark JW, Ogeil RP, Verdejo-García A, Drummond SPA. The relationship between sleep and appetitive conditioning: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 144:105001. [PMID: 36529310 DOI: 10.1016/j.neubiorev.2022.105001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/24/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
This systematic review and meta-analysis (PROSPERO registration animal/human studies: CRD42021234793/CRD42021234790) examined the relationship between sleep and appetitive conditioning. Inclusion criteria included: a) appetitive conditioning paradigm; b) measure of conditioning; c) sleep measurement and/or sleep loss; d) human and/etor non-human animal samples; and e) written in English. Searches of seven databases returned 3777 publications. The final sample consisted of 42 studies using primarily animal samples and involving food- and drug-related conditioning tasks. We found sleep loss disrupted appetitive conditioning of food rewards (p < 0.001) but potentiated appetitive conditioning of drug rewards (p < 0.001). Furthermore, sleep loss negatively impacted extinction learning irrespective of the reward type. Post-learning sleep was associated with increases in REM sleep (p = 0.02). Findings suggest sleep loss potentiates the impact of psychoactive substances in a manner likely to produce an increased risk of problematic substance use. In obese/overweight populations, sleep loss may be associated with deficits in the conditioning and extinction of reward-related behaviours. Further research should assess the relationship between sleep and appetitive conditioning in humans.
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Affiliation(s)
- Eleni Kavaliotis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria 3800, Australia
| | - Johanna M Boardman
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria 3800, Australia
| | - Jacob W Clark
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria 3800, Australia
| | - Rowan P Ogeil
- Eastern Health Clinical School and Monash Addiction Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria 3800, Australia; Turning Point, Eastern Health, Victoria 3121, Australia
| | - Antonio Verdejo-García
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria 3800, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria 3800, Australia.
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23
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Guo R, Vaughan DT, Rojo ALA, Huang YH. Sleep-mediated regulation of reward circuits: implications in substance use disorders. Neuropsychopharmacology 2023; 48:61-78. [PMID: 35710601 PMCID: PMC9700806 DOI: 10.1038/s41386-022-01356-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 12/11/2022]
Abstract
Our modern society suffers from both pervasive sleep loss and substance abuse-what may be the indications for sleep on substance use disorders (SUDs), and could sleep contribute to the individual variations in SUDs? Decades of research in sleep as well as in motivated behaviors have laid the foundation for us to begin to answer these questions. This review is intended to critically summarize the circuit, cellular, and molecular mechanisms by which sleep influences reward function, and to reveal critical challenges for future studies. The review also suggests that improving sleep quality may serve as complementary therapeutics for treating SUDs, and that formulating sleep metrics may be useful for predicting individual susceptibility to SUDs and other reward-associated psychiatric diseases.
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Affiliation(s)
- Rong Guo
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA
- Allen Institute, Seattle, WA, 98109, USA
| | - Dylan Thomas Vaughan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA
- The Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA, USA
| | - Ana Lourdes Almeida Rojo
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA
- The Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA, USA
| | - Yanhua H Huang
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA.
- The Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA, USA.
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24
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The Effect of Zao Ren An Shen Capsule on Insomnia among Patients with Anxiety: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022. [DOI: 10.1155/2022/6520849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background. Zao Ren An Shen capsule (ZRASC) is one of the most widely used Chinese herbal medicine (CHM) in treating insomnia, but its effect on insomnia patients with anxiety remains unclear. We aimed to examine the effect of ZRASC combined with alprazolam in anxiety patients compared with those only with alprazolam prescription. Methods. We conducted a single-blind, parallel-group, randomized trial involving persons from 2 hospitals in China. Participants were randomly assigned in a 1 : 1 ratio to the intervention group, in which the participants were provided with ZRASC and alprazolam, or to the control group, in which the participants were provided with alprazolam. The primary outcomes were insomnia symptoms measured by the insomnia severity index (ISI). The secondary outcomes were anxiety symptoms measured with the Hamilton anxiety rating scale (HAMA). All participants were followed up at 2-week and 4-week after the treatment. The effect was estimated using the mixed-effect models. Results. A total of 334 patients were enrolled in the trial. 167 of them (mean (SD) age, 44.4 (12.8) years; 43.1% female) were assigned to the usual treatment group, while 167 (mean (SD) age, 46.0 (13.4) years; 43.7% female) were assigned to the ZRASC group. From baseline to the 4-weekfollow-up, the mean differences in ISI and HAMA scores between the ZRASC group and the usual care group were −2.542 and −2.563, respectively (both
). Patients in the ZRASC group were more likely to have remission of insomnia and anxiety than those in the control group at the 4-weekfollow-up, with incidence rate ratios of 265% and 213%, respectively (both
). Proportions of remission were 74.93% (
) for insomnia and 85.80% (
) for anxiety at 4-weekfollow-up. Conclusions. This randomized study showed that adjunctive treatment with ZRASC was able to reduce insomnia and anxiety symptoms at the 4-weekfollow-up. Trial Registration. This study was registered in the Chinese Clinical Trial Registry (ChiCTR1800019913).
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25
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Dunn KE, Finan PH, Huhn AS, Gamaldo C, Bergeria CL, Strain EC. Wireless electroencephalography (EEG) to monitor sleep among patients being withdrawn from opioids: Evidence of feasibility and utility. Exp Clin Psychopharmacol 2022; 30:1016-1023. [PMID: 34096756 PMCID: PMC8648854 DOI: 10.1037/pha0000483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sleep impairment is a common comorbid and debilitating symptom for persons with opioid use disorder (OUD). Research into underlying mechanisms and efficacious treatment interventions for OUD-related sleep problems requires both precise and physiologic measurements of sleep-related outcomes and impairment. This pilot examined the feasibility of a wireless sleep electroencephalography (EEG) monitor (Sleep Profiler™) to measure sleep outcomes and architecture among participants undergoing supervised opioid withdrawal. Sleep outcomes were compared to a self-reported sleep diary and opioid withdrawal ratings. Participants (n = 8, 100% male) wore the wireless EEG 85.6% of scheduled nights. Wireless EEG detected measures of sleep architecture including changes in total, NREM and REM sleep time during study phases, whereas the diary detected changes in wakefulness only. Direct comparisons of five overlapping outcomes revealed lower sleep efficiency and sleep onset latency and higher awakenings and time spent awake from the wireless EEG versus sleep diary. Associations were evident between wireless EEG and increased withdrawal severity, lower sleep efficiency, less time in REM and non-REM stages 1 and 2, and more hydroxyzine treatment; sleep diary was associated with total sleep time and withdrawal only. Data provide initial evidence that a wireless EEG is a feasible and useful tool for objective monitoring of sleep in persons experiencing acute opioid withdrawal. Data are limited by the small and exclusively male sample, but provide a foundation for using wireless EEG sleep monitors for objective evaluation of sleep-related impairment in persons with OUD in support of mechanistic and treatment intervention research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Charlene Gamaldo
- Department of Neurology, Johns Hopkins University School of Medicine
| | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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26
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Belloir JA, Kidd JD, Dworkin JD, Bockting WO. Examining the role of problematic drug use in the relationship between discrimination and sleep disturbance in transgender and nonbinary individuals. Addict Behav 2022; 135:107459. [PMID: 35986953 DOI: 10.1016/j.addbeh.2022.107459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Transgender and nonbinary (TGNB) individuals are a health disparity population at high risk for sleep disturbance (e.g., insomnia). Recent evidence suggests minority stress (e.g., discrimination) is associated with sleep disturbance in TGNB adults. However, investigators have yet to identify factors that might explain this relationship. In this study, we investigated the role of problematic drug use (PDU) in the relationship between discrimination and sleep disturbance in TGNB individuals. METHODS The study sample included 194 TGNB participants from Wave 5 (2021) of Project AFFIRM, a multi-site longitudinal study of transgender health. Discrimination, PDU, and sleep disturbance were measured using the Everyday Discrimination Scale, Drug Use Disorders Identification Test (DUDIT), and PROMIS Sleep Disturbance measures, respectively. Individuals were classified as having PDU using established DUDIT criteria that were applied based on sex assigned at birth. Regression analyses were used to estimate the associations of study variables, and subsequently, mediation analysis was used to determine whether PDU partially mediated the association between discrimination and sleep disturbance. RESULTS Nearly half of participants reported PDU, of which 83.2% reported cannabis use. Higher levels of discrimination were associated with worse self-reported sleep disturbance scores. Additionally, participants with greater discrimination were more likely to have PDU. Surprisingly, participants with PDU had lower sleep disturbance scores. CONCLUSIONS Our cross-sectional findings suggest that PDU partially suppressed the association between discrimination and sleep disturbance in TGNB people. Efforts to address PDU in TGNB adults may consider assessing sleep disturbance as a motivating factor for drug use and the potential role of discrimination in perpetuating PDU.
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Affiliation(s)
- Joseph A Belloir
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, USA.
| | - Jeremy D Kidd
- Columbia University and the New York State Psychiatric Institute, USA.
| | - Jordan D Dworkin
- Columbia University and the New York State Psychiatric Institute, USA.
| | - Walter O Bockting
- Columbia University and the New York State Psychiatric Institute, USA.
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27
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Vujanovic AA, Kauffman BY, Zegel M, Zvolensky MJ. COVID-related stress and substance use: examining the role of sleep disturbance. Cogn Behav Ther 2022; 51:486-502. [PMID: 35762877 PMCID: PMC9764365 DOI: 10.1080/16506073.2022.2079557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
The current investigation employed a cross-sectional design to evaluate the associations of COVID-19 stress, sleep disturbance, and substance use among a national sample of 143 adults (57.3% male, Mage = 38.5 years, SD = 11.28), surveyed at a single time-point using Amazon's MTurk platform. We hypothesized that COVID-19-related stress would be indirectly related to substance use outcomes (i.e. number of substance classes used daily, number of alcoholic drinks per occasion, substance use coping motives; but not substance use enhancement motives) through sleep disturbance severity. As expected, results indicated that the models examining indirect effects were statistically significant for number of substance classes used daily and substance use coping motives. However, there was no evidence that sleep disturbance explained the relation between COVID-19-related stress and number of alcoholic drinks per occasion or substance use enhancement motives. These findings underscore the importance of sleep disturbance in efforts to better understand how COVID-19-related stress is associated with certain types of substance use behavior.
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Affiliation(s)
| | | | | | - Michael J. Zvolensky
- University of Houston
- HEALTH Institute
- The University of Texas MD Anderson Cancer Center
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28
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Taufique SKT, Ehichioya DE, Pendergast JS, Yamazaki S. Genetics and functional significance of the understudied methamphetamine sensitive circadian oscillator (MASCO). F1000Res 2022; 11:1018. [PMID: 36226037 PMCID: PMC9539084 DOI: 10.12688/f1000research.125432.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 01/13/2023] Open
Abstract
The last 50 years have witnessed extraordinary discoveries in the field of circadian rhythms. However, there are still several mysteries that remain. One of these chronobiological mysteries is the circadian rhythm that is revealed by administration of stimulant drugs to rodents. Herein we describe the discovery of this circadian rhythm and its underlying oscillator, which is frequently called the methamphetamine-sensitive circadian oscillator, or MASCO. This oscillator is distinct from canonical circadian oscillators because it controls robust activity rhythms independently of the suprachiasmatic nucleus and circadian genes are not essential for its timekeeping. We discuss these fundamental properties of MASCO and integrate studies of strain, sex, and circadian gene mutations on MASCO. The anatomical loci of MASCO are not known, so it has not been possible thus far to discover its novel molecular timekeeping mechanism or its functional significance. However, studies in mutant mice suggest that genetic approaches can be used to identify the neural network involved in the rhythm generation of MASCO. We also discuss parallels between human and rodent studies that support our working hypothesis that a function of MASCO may be to regulate sleep-wake cycles.
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Affiliation(s)
- S K Tahajjul Taufique
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, Texas, 75390-9111, USA
| | - David E Ehichioya
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, Texas, 75390-9111, USA
| | - Julie S Pendergast
- Department of Biology, University of Kentucky, Lexington, Kentucky, 40506-0225, USA
| | - Shin Yamazaki
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, Texas, 75390-9111, USA,Peter O’Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, 75390-8823, USA,
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29
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Gray E, Wilson M, Landis TT, Little-Gott A. "It's Like Your Whole Body Hates You": Experiences of Withdrawal, Distress, and Barriers to Relief Among Adults Receiving Methadone for Opioid Use Disorder. J Addict Nurs 2022; 33:309-316. [PMID: 37140418 DOI: 10.1097/jan.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT A qualitative descriptive study was conducted concurrent with a larger study investigating the effects of hyperbaric oxygen treatment on withdrawal symptoms for adults receiving daily methadone for opioid use disorder. The aims of this study were to (a) evaluate the perceptions of withdrawal symptoms and sleep characteristics of study participants and (b) explore the experiences of participation in the parent trial of hyperbaric oxygen treatment.Adults with opioid use disorder can experience distressing symptoms related to withdrawal as well as co-occurring symptoms; sleep impairment is frequently reported. Few studies have examined how adults who receive medication for opioid use disorder experience sleep. A preliminary study of adults receiving daily methadone found that withdrawal symptoms were improved after hyperbaric oxygen treatment. This study explores the narrative of opioid users who report their overall experiences with withdrawal and sleep as well as their experiences of hyperbaric therapy.A convenience sample of six participants was recruited, who represented a small subgroup of participants who completed the larger hyperbaric treatment study. Data were collected via semistructured interviews. Data were analyzed using the qualitative content analysis guidelines proposed by Schreier (2012). All participants described poor overall sleep hygiene and disturbed sleep. More than half of the respondents reported improved or eliminated withdrawal symptoms, and all reported improvement in sleep quality after participation in the sleep study.This companion study confirms that subjective sleep disturbance may be prevalent for adults with opioid use disorder. Participants felt the experience of hyperbaric oxygen treatment produced a positive effect on sleep.
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30
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Jones MR, Brandner AJ, Vendruscolo LF, Vendruscolo JCM, Koob GF, Schmeichel BE. Effects of Alcohol Withdrawal on Sleep Macroarchitecture and Microarchitecture in Female and Male Rats. Front Neurosci 2022; 16:838486. [PMID: 35757544 PMCID: PMC9226367 DOI: 10.3389/fnins.2022.838486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
The prevalence of sleep disruptions is higher among people with alcohol use disorder (AUD), particularly during alcohol withdrawal, compared to non-AUD individuals. Although women generally have a higher risk of developing sleep disorders, few studies have investigated sex differences in sleep disruptions following chronic alcohol exposure. The present study examined sleep macroarchitecture (time spent asleep or awake and sleep onset latency) and microarchitecture (bout rate and duration and sleep spindle characterization) prior to alcohol vapor exposure (baseline), during acute withdrawal, and through protracted abstinence in female and male rats. Females and males showed reduced time in rapid eye movement (REM) sleep during acute withdrawal, which returned to baseline levels during protracted abstinence. REM sleep onset latency was decreased during protracted abstinence in females only. Furthermore, there was a sex difference observed in overall REM sleep bout rate. Although there were no changes in non-REM sleep time, or to non-REM sleep bout rate or duration, there was an increase in non-REM sleep intra-spindle frequency during acute withdrawal in both females and males. Finally, there was increased wakefulness time and bout duration during acute withdrawal in both females and males. The results demonstrate both macroarchitectural and microarchitectural changes in sleep following chronic alcohol exposure, particularly during acute withdrawal, suggesting the need for therapeutic interventions for sleep disturbances during withdrawal in individuals with AUD. Furthermore, sex differences were observed in REM sleep, highlighting the importance of including both sexes in future alcohol-related sleep studies.
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Affiliation(s)
- Marissa R Jones
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Adam J Brandner
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States
| | - Leandro F Vendruscolo
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States
| | - Janaina C M Vendruscolo
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States
| | - George F Koob
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States
| | - Brooke E Schmeichel
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States.,Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States
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31
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Berro LF, Roehrs T. Catching up on sleep: Recent evidence on the role of sleep in substance use disorders. Pharmacol Biochem Behav 2022; 213:173330. [PMID: 34995638 DOI: 10.1016/j.pbb.2022.173330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this editorial is to summarize the findings published in the special issue on "Sleep and Drug Abuse". The manuscripts in this issue include review articles as well as original investigations, and cover topics ranging from pre-clinical investigation to epidemiological-based clinical studies. Together, these papers provide evidence that sleep and drug abuse share a bidirectional relationship, with sleep playing a prominent role in substance use disorders. The knowledge included here can inform treatment development and future research endeavors, clearly pointing to the need for attention that focuses on sleep quality in the treatment of substance use disorders.
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Affiliation(s)
- Laís F Berro
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS 39216, USA.
| | - Timothy Roehrs
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA; Sleep Disorders Center, Henry Ford Health System, Detroit, MI, USA
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32
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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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33
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Martin CE, Dzierzewski JM, Keyser-Marcus L, Donovan EK, Ramey T, Svikis DS, Moeller FG. Sex Specific Sleep Parameters Among People With Substance Use Disorder. Front Psychiatry 2022; 13:905332. [PMID: 35722562 PMCID: PMC9199851 DOI: 10.3389/fpsyt.2022.905332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Sleep can have substantial impacts in substance use disorder (SUD) pathogenesis, treatment, and recovery. Sex differences exist in both sleep and SUD, but how sleep is uniquely associated with SUD by sex is not known. The study objective was to compare, within sex, sleep parameters between individuals with SUD and non-substance misusing controls. METHODS Secondary analyses of a parent cross-sectional study examining the feasibility and acceptability of a novel neurocognitive phenotyping assessment battery were completed. SUD and control subjects were recruited through local advertising and an established research registry. Subjects with SUD were also recruited through a university-based outpatient SUD treatment clinic. Self-reported sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Sex-stratified t-tests compared sleep between SUD and control subjects while Crosstab analyses explored group differences in the proportion of individuals reporting poor sleep (defined as PSQI ≥ 5). RESULTS Data from 162 males (44 controls, 118 SUD) and 146 females (64 controls, 82 SUD) were included in the present study. For females only, a significantly lower proportion of controls reported PSQI-defined poor sleep than individuals with any SUD or specifically with opioid use disorder. Male, but not female, controls reported shorter sleep latency, longer sleep duration, and less sleep disturbance than males with each SUD type. DISCUSSION/IMPLICATIONS Sleep holds promise as an avenue to address SUD within a biopsychosocial model. Future work at the intersection of SUD and sleep should prioritize investigations of their interplay with sex to identify targets for tailored SUD interventions.
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Affiliation(s)
- Caitlin E Martin
- Department of Obstetrics and Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.,Division of Therapeutics and Medical Consequences, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
| | - Joseph M Dzierzewski
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Lori Keyser-Marcus
- Division of Therapeutics and Medical Consequences, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
| | - Emily K Donovan
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Tatiana Ramey
- Department of Psychiatry, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Dace S Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - F Gerard Moeller
- Division of Therapeutics and Medical Consequences, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
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34
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Raymond JS, Rehn S, Hoyos CM, Bowen MT. The influence of oxytocin-based interventions on sleep-wake and sleep-related behaviour and neurobiology: A systematic review of preclinical and clinical studies. Neurosci Biobehav Rev 2021; 131:1005-1026. [PMID: 34673110 DOI: 10.1016/j.neubiorev.2021.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/26/2022]
Abstract
The oxytocin (OXT) system has garnered considerable interest due to its influence on diverse behaviours. However, scant research has considered the influence of oxytocin on sleep-wake and sleep-related behaviour and neurobiology. Consequently, the objective of this systematic review was to assess the extant preclinical and clinical evidence for the influence of oxytocin-based interventions on sleep-wake outcomes. The primary search was conducted on 22/7/2020 using six electronic databases; 30 studies (19 preclinical, 11 clinical) were included based on inclusion criteria. Studies were evaluated for risk of bias using the SYRCLE tool and the Cochrane risk of bias tools for preclinical and clinical studies, respectively. Results indicated manipulation of the OXT system can influence sleep-wake outcomes. Preclinical evidence suggests a wake-promoting influence of OXT system activation whereas the clinical evidence suggests little or no sleep-promoting influence of OXT. OXT dose was identified as a likely modulatory factor of OXT-induced effects on sleep-wake behaviour. Future studies are necessary to validate and strengthen these tentative conclusions about the influence of OXT on sleep-wake behaviour.
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Affiliation(s)
- Joel S Raymond
- The University of Sydney, Faculty of Science, School of Psychology, Camperdown, NSW, Australia; The University of Sydney, Brain and Mind Centre, Camperdown, NSW, Australia
| | - Simone Rehn
- The University of Sydney, Faculty of Science, School of Psychology, Camperdown, NSW, Australia
| | - Camilla M Hoyos
- The University of Sydney, Faculty of Science, School of Psychology, Camperdown, NSW, Australia; The University of Sydney, Brain and Mind Centre, Camperdown, NSW, Australia; The University of Sydney, Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Camperdown, NSW, Australia
| | - Michael T Bowen
- The University of Sydney, Faculty of Science, School of Psychology, Camperdown, NSW, Australia; The University of Sydney, Brain and Mind Centre, Camperdown, NSW, Australia.
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35
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O'Brien CB, Locklear CE, Glovak ZT, Zebadúa Unzaga D, Baghdoyan HA, Lydic R. Opioids cause dissociated states of consciousness in C57BL/6J mice. J Neurophysiol 2021; 126:1265-1275. [PMID: 34469699 DOI: 10.1152/jn.00266.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The electroencephalogram (EEG) provides an objective, neural correlate of consciousness. Opioid receptors modulate mammalian neuronal excitability, and this fact was used to characterize how opioids administered to mice alter EEG power and states of consciousness. The present study tested the hypothesis that antinociceptive doses of fentanyl, morphine, or buprenorphine differentially alter the EEG and states of sleep and wakefulness in adult, male C57BL/6J mice. Mice were anesthetized and implanted with telemeters that enabled wireless recordings of cortical EEG and electromyogram (EMG). After surgical recovery, EEG and EMG were used to objectively score states of consciousness as wakefulness, rapid eye movement (REM) sleep, or non-REM (NREM) sleep. Measures of EEG power (dB) were quantified as δ (0.5-4 Hz), θ (4-8 Hz), α (8-13 Hz), σ (12-15 Hz), β (13-30 Hz), and γ (30-60 Hz). Compared with saline (control), fentanyl and morphine decreased NREM sleep, morphine eliminated REM sleep, and buprenorphine eliminated NREM sleep and REM sleep. Opioids significantly and differentially disrupted the temporal organization of sleep/wake states, altered specific EEG frequency bands, and caused dissociated states of consciousness. The results are discussed relative to the fact that opioids, pain, and sleep modulate interacting states of consciousness.NEW & NOTEWORTHY This study discovered that antinociceptive doses of fentanyl, morphine, and buprenorphine significantly and differentially disrupt EEG-defined states of consciousness in C57BL/6J mice. These data are noteworthy because: 1) buprenorphine is commonly used in medication-assisted therapy for opioid addiction, and 2) there is evidence that disordered sleep can promote addiction relapse. The results contribute to community phenotyping efforts by making publicly available all descriptive and inferential statistics from this study (Supplemental Tables S1-S8).
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Affiliation(s)
| | | | - Zachary T Glovak
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee
| | | | - Helen A Baghdoyan
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee.,Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | - Ralph Lydic
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee.,Oak Ridge National Laboratory, Oak Ridge, Tennessee
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Bauer LO. Temporal instability in brain activation: a novel paradigm for evaluating the maintenance of attention among substance dependent patients. Psychopharmacology (Berl) 2021; 238:2937-2946. [PMID: 34196741 PMCID: PMC10127227 DOI: 10.1007/s00213-021-05909-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Prior studies have demonstrated statistically significant but subtle differences in brain function between patients with a history of substance dependence (SD) and control groups. OBJECTIVES The goal of the present study was to show that variability in brain activation over the trials of a cognitive task is more useful for revealing the putative impact of SD than analyses focusing on the amplitude of activation averaged over trials. The study also tested the additional contribution of antisocial personality disorder (ASPD)-a prevalent comorbidity that promotes both an early onset and more severe course of SD. METHODS Two hundred eleven adults performed two selective attention tasks while P300 event-related electroencephalographic potentials were recorded. They were assigned to one of 3 mutually exclusive groups: no lifetime history of SD or ASPD (n = 67), a SD history but no ASPD (n = 68), or both SD and ASPD (n = 76). RESULTS The major finding was a statistically significant elevation of P300 amplitude inter-trial variability (ITV) in the SD plus ASPD group in comparison to the group with neither attribute. The elevation was detected during both selective attention tasks and most prominent at electrodes sites located over the frontal brain. There were no group differences in P300 amplitude averaged over trials. CONCLUSIONS We conclude from these findings that the ITV of P300 amplitude is an efficient and sensitive biomarker of the maintenance of attention. It is valuable for revealing group differences associated with substance dependence and ASPD. It may ultimately be valuable for detecting improvements resulting from psychostimulant treatment or other interventions, including cognitive remediation.
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Affiliation(s)
- Lance O Bauer
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
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Dokkedal-Silva V, Fernandes GL, Morelhão PK, Pires GN, Rowlett JK, Galduróz JCF, Berro LF, Tufik S, Andersen ML. Sleep, psychiatric and socioeconomic factors associated with substance use in a large population sample: A cross-sectional study. Pharmacol Biochem Behav 2021; 210:173274. [PMID: 34547353 DOI: 10.1016/j.pbb.2021.173274] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 08/16/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022]
Abstract
Multiple elements modulate drug use, including sleep, which is increasingly being considered as an important contributor to substance use and abuse. The present study aimed to evaluate the association between sleep, psychiatric and socioeconomic/demographic factors and substance use in a large-scale representative sample from the city of São Paulo, Brazil. Data from the 2007 São Paulo Epidemiological Sleep Study (EPISONO) database were used. In the EPISONO study, volunteers underwent a polysomnographic exam and completed a series of questionnaires to assess objective and subjective sleep quality and associated comorbidities. Drug use was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Linear (univariate and multivariate) and logistic regressions were performed to identify factors associated with the use of the 4 most commonly used substances in the sample (tobacco, alcohol, cannabis and cocaine/crack). Structural equation models were used to establish theoretical networks to explain the relationship between sleep, psychiatric and socioeconomic factors and use of these substances. The logistic regression results showed that psychiatric symptoms, lower income, and poorer subjective sleep were the main factors associated with tobacco consumption; gender and occupational status with alcohol intake; age and occupation with cannabis use; and education with cocaine/crack use. The structural equation models partially supported these findings and identified significant effects of psychiatric symptoms on tobacco consumption, both directly and mediated by sleep. Our results reinforce previous findings concerning factors associated with generally misused substances and suggest that sleep should be considered as an important element in future substance use disorder studies.
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Affiliation(s)
- Vinícius Dokkedal-Silva
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo 04024-002, Brazil
| | - Guilherme L Fernandes
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo 04024-002, Brazil
| | - Priscila K Morelhão
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo 04024-002, Brazil
| | - Gabriel N Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo 04024-002, Brazil
| | - James K Rowlett
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 N State St, Jackson, 39216 Jackson, United States
| | - José Carlos F Galduróz
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo 04024-002, Brazil
| | - Laís F Berro
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 N State St, Jackson, 39216 Jackson, United States.
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo 04024-002, Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo 04024-002, Brazil
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Kumar P, Sharma A, Kumar D, Sharma L. Use of Spectroscopic Methods and Their Clinical Applications in Drug Abuse: A Review. Crit Rev Anal Chem 2021; 53:360-373. [PMID: 34376090 DOI: 10.1080/10408347.2021.1958196] [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: 02/08/2023]
Abstract
Assurance of substance abuse in plasma and different parts of the body is vital in clinical and legal toxicology. Detection techniques are evaluated for their appropriateness in scientific and clinical sciences, where extraordinary prerequisites must be met. Recognition and affirmation are for the most part done by gas chromatography-Mass spectrometry (GC-MS) or liquid chromatography (LC-MS), Surface-enhanced Raman spectroscopy (SERS), Magnetic resonance imaging, Positron Emission Tomography, Infrared Spectroscopy, and UV Spectroscopy. Progressed spectroscopic techniques provided helpful quantitative or qualitative data about the natural chemistry and science of exploited substances. These spectroscopic techniques are assumed as quick, precise, and some of them are non-damaging investigation apparatus that may be assumed as a substitution for previously used compound investigation. Spectroscopy with its advances in technology is centralized to novel applications in the detection of abused drug substances and clinical toxicology. These techniques have attracted growing interest as forensic tools for the early detection and monitoring of exploited drugs. This review describes the principle, role, and clinical application of various spectroscopic techniques which are utilized for the identification of drug abuse like morphine, cocaine, codeine, alcohol, amphetamines, and their metabolites in whole blood, plasma, hair, and nails.
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Affiliation(s)
- Pardeep Kumar
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Aditi Sharma
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Deepak Kumar
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Lalit Sharma
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
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At the intersection of sleep deficiency and opioid use: mechanisms and therapeutic opportunities. Transl Res 2021; 234:58-73. [PMID: 33711513 PMCID: PMC8217216 DOI: 10.1016/j.trsl.2021.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/17/2021] [Accepted: 03/06/2021] [Indexed: 12/18/2022]
Abstract
Due to the ongoing opioid epidemic, innovative scientific perspectives and approaches are urgently needed to reduce the unprecedented personal and societal burdens of nonmedical and recreational opioid use. One promising opportunity is to focus on the relationship between sleep deficiency and opioid use. In this review, we examine empirical evidence: (1) at the interface of sleep deficiency and opioid use, including hypothesized bidirectional associations between sleep efficiency and opioid abstinence; (2) as to whether normalization of sleep deficiency might directly or indirectly improve opioid abstinence (and vice versa); and (3) regarding mechanisms that could link improvements in sleep to opioid abstinence. Based on available data, we identify candidate sleep-restorative therapeutic approaches that should be examined in rigorous clinical trials.
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40
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Gu Y, Sainburg LE, Kuang S, Han F, Williams JW, Liu Y, Zhang N, Zhang X, Leopold DA, Liu X. Brain Activity Fluctuations Propagate as Waves Traversing the Cortical Hierarchy. Cereb Cortex 2021; 31:3986-4005. [PMID: 33822908 PMCID: PMC8485153 DOI: 10.1093/cercor/bhab064] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The brain exhibits highly organized patterns of spontaneous activity as measured by resting-state functional magnetic resonance imaging (fMRI) fluctuations that are being widely used to assess the brain's functional connectivity. Some evidence suggests that spatiotemporally coherent waves are a core feature of spontaneous activity that shapes functional connectivity, although this has been difficult to establish using fMRI given the temporal constraints of the hemodynamic signal. Here, we investigated the structure of spontaneous waves in human fMRI and monkey electrocorticography. In both species, we found clear, repeatable, and directionally constrained activity waves coursed along a spatial axis approximately representing cortical hierarchical organization. These cortical propagations were closely associated with activity changes in distinct subcortical structures, particularly those related to arousal regulation, and modulated across different states of vigilance. The findings demonstrate a neural origin of spatiotemporal fMRI wave propagation at rest and link it to the principal gradient of resting-state fMRI connectivity.
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Affiliation(s)
- Yameng Gu
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Lucas E Sainburg
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Sizhe Kuang
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Feng Han
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Jack W Williams
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Yikang Liu
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Nanyin Zhang
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
- The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Xiang Zhang
- College of Information Sciences and Technology, The Pennsylvania State University, University Park, PA, 16802, USA
| | - David A Leopold
- Neurophysiology Imaging Facility, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, and National Eye Institute, National Institutes of Health, Bethesda, MD, 20892, USA
- Section on Cognitive Neurophysiology and Imaging, Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Xiao Liu
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
- Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
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McGee-Vincent P, Juhasz K, Jamison AL, Avery TJ, Owen JE, Jaworski BK, Blonigen DM. Mobile Mental Health Apps from the National Center for PTSD: Digital Self-Management Tools for Co-Occurring Disorders. J Dual Diagn 2021; 17:181-192. [PMID: 34152258 DOI: 10.1080/15504263.2021.1939919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mobile mental health apps can help bridge gaps in access to care for those with substance use disorders and dual diagnoses. The authors describe a portfolio of free, publicly available mobile mental health apps developed by the National Center for PTSD. The authors also demonstrate how this suite of primarily non-substance use disorder-specific mobile mental health apps may support the active ingredients of substance use disorder treatment or be used for self-management of substance use disorder and related issues. The potential advantages of these apps, as well as limitations and considerations for future app development, are discussed.
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Affiliation(s)
- Pearl McGee-Vincent
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Katherine Juhasz
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Andrea L Jamison
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Timothy J Avery
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Jason E Owen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Beth K Jaworski
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Daniel M Blonigen
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Menlo Park, California, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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Zlebnik NE, Holtz NA, Lepak VC, Saykao AT, Zhang Y, Carroll ME. Age-specific treatment effects of orexin/hypocretin-receptor antagonism on methamphetamine-seeking behavior. Drug Alcohol Depend 2021; 224:108719. [PMID: 33940327 PMCID: PMC8180489 DOI: 10.1016/j.drugalcdep.2021.108719] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Worldwide methamphetamine (METH) use has increased significantly over the last 10 years, and in the US, METH dependence has sky-rocketed among individuals with opioid use disorder. Of significant concern, METH use is gaining popularity among groups with susceptibility to developing severe substance use disorders, such as women and adolescents. Nevertheless, there is no established pharmacotherapy for METH addiction. Emerging evidence has identified the orexin/hypocretin system as an important modulator of reward-driven behavior and a potential target for the treatment of drug addiction and relapse. However, to date, there have been no investigations into the therapeutic efficacy of orexin/hypocretin receptor antagonists for METH-motivated behavior in adolescents or adults. In the present study, we examined the effects of selective antagonists of the orexin-1 (SB-334867, 20 mg/kg) and orexin-2 (TCS-OX2-29, 20 mg/kg) receptors on the reinstatement of METH seeking in both adolescent and adult male and female rats. METHODS Rats were trained to self-administer METH (0.05 mg/kg/inf, iv) during two 2-h sessions/day for 5 days. Following 20 sessions of extinction over 10 days, a within-subjects design was used to test for METH seeking precipitated by METH (1 mg/kg, ip) or METH cues after systemic pretreatment with SB-334867 or TCS-OX2-29. RESULTS SB-334867 reduced cue-induced reinstatement in males and females, regardless of age. Additionally, METH-induced METH seeking was attenuated by SB-334867 in adolescents and by TCS-OX2-29 in adults. CONCLUSION Selective orexin/hypocretin receptor antagonists have significant therapeutic potential for diminishing METH-seeking behavior, although their treatment efficacy may be influenced by age.
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Affiliation(s)
- Natalie E. Zlebnik
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA,Present address: Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA,Natalie E. Zlebnik, PhD, Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 20 Penn Street, Baltimore, MD 21201, , Tel: +1-410-706-2440
| | - Nathan A. Holtz
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA,Present address: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
| | - Victoria C. Lepak
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Amy T. Saykao
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Yanan Zhang
- Research Triangle Institute, Research Triangle Park, NC 27709, USA
| | - Marilyn E. Carroll
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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43
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Vrajová M, Šlamberová R, Hoschl C, Ovsepian SV. Methamphetamine and sleep impairments: neurobehavioral correlates and molecular mechanisms. Sleep 2021; 44:6066541. [PMID: 33406259 DOI: 10.1093/sleep/zsab001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 11/01/2020] [Indexed: 12/12/2022] Open
Abstract
Methamphetamine is a potent and highly addictive psychostimulant, and one of the most widely used illicit drugs. Over recent years, its global usage and seizure have been on a rapid rise, with growing detrimental effects on mental and physical health, and devastating psychosocial impact pressing for intervention. Among the unwanted effects of methamphetamine, acute and long-term sleep impairments are of major concern, posing a significant therapeutic challenge, and a cause of addiction relapse. Unraveling mechanisms and functional correlates of methamphetamine-related sleep and circadian disruption are, therefore, of key relevance to translational and clinical psychiatry. In this article, we review the mounting evidence for the acute and long-term impairements of sleep-wake behavior and circadian activity caused by single or recurring methamphetamine usage and withdrawal. Factors contributing to the severity of sleep loss and related cognitive deficit, with risks of relapse are discussed. Key molecular players mediating methamphetamine-induced dopamine release and neuromodulation are considered, with wake-promoting effects in mesolimbic circuits. The effects on various sleep phases and related changes in dopamine levels in selected subcortical structures are reviewed and compared to other psychostimulants with similar action mechanisms. A critical appraisal is presented of the therapeutic use of modafinil, countering sleep, and circadian rhythm impairments. Finally, emerging knowledge gaps and methodical limitations are highlighted along with the areas for future research and therapeutic translation.
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Affiliation(s)
- Monika Vrajová
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic
| | - Romana Šlamberová
- Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Cyril Hoschl
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Klecany, Czech Republic
| | - Saak V Ovsepian
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Klecany, Czech Republic
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Fragale JE, James MH, Avila JA, Spaeth AM, Aurora RN, Langleben D, Aston-Jones G. The Insomnia-Addiction Positive Feedback Loop: Role of the Orexin System. FRONTIERS OF NEUROLOGY AND NEUROSCIENCE 2021; 45:117-127. [PMID: 34052815 PMCID: PMC8324012 DOI: 10.1159/000514965] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/02/2021] [Indexed: 01/06/2023]
Abstract
Significant sleep impairments often accompany substance use disorders (SUDs). Sleep disturbances in SUD patients are associated with poor clinical outcomes and treatment adherence, emphasizing the importance of normalizing sleep when treating SUDs. Orexins (hypocretins) are neuropeptides exclusively produced by neurons in the posterior hypothalamus that regulate various behavioral and physiological processes, including sleep-wakefulness and motivated drug taking. Given its dual role in sleep and addiction, the orexin system represents a promising therapeutic target for treating SUDs and their comorbid sleep deficits. Here, we review the literature on the role of the orexin system in sleep and drug addiction and discuss the therapeutic potential of orexin receptor antagonists for SUDs. We argue that orexin receptor antagonists may be effective therapeutics for treating addiction because they target orexin's regulation of sleep (top-down) and motivation (bottom-up) pathways.
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Affiliation(s)
- Jennifer E Fragale
- Brain Health Institute, Rutgers Biomedical Health Sciences, Rutgers University, Piscataway, New Jersey, USA
| | - Morgan H James
- Brain Health Institute, Rutgers Biomedical Health Sciences, Rutgers University, Piscataway, New Jersey, USA
| | - Jorge A Avila
- Brain Health Institute, Rutgers Biomedical Health Sciences, Rutgers University, Piscataway, New Jersey, USA
| | - Andrea M Spaeth
- Department of Kinesiology and Health, Rutgers University, New Brunswick, New Jersey, USA
| | - R Nisha Aurora
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Daniel Langleben
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary Aston-Jones
- Brain Health Institute, Rutgers Biomedical Health Sciences, Rutgers University, Piscataway, New Jersey, USA
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Hersey M, Bacon AK, Bailey LG, Coggiano MA, Newman AH, Leggio L, Tanda G. Psychostimulant Use Disorder, an Unmet Therapeutic Goal: Can Modafinil Narrow the Gap? Front Neurosci 2021; 15:656475. [PMID: 34121988 PMCID: PMC8187604 DOI: 10.3389/fnins.2021.656475] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022] Open
Abstract
The number of individuals affected by psychostimulant use disorder (PSUD) has increased rapidly over the last few decades resulting in economic, emotional, and physical burdens on our society. Further compounding this issue is the current lack of clinically approved medications to treat this disorder. The dopamine transporter (DAT) is a common target of psychostimulant actions related to their use and dependence, and the recent availability of atypical DAT inhibitors as a potential therapeutic option has garnered popularity in this research field. Modafinil (MOD), which is approved for clinical use for the treatment of narcolepsy and sleep disorders, blocks DAT just like commonly abused psychostimulants. However, preclinical and clinical studies have shown that it lacks the addictive properties (in both behavioral and neurochemical studies) associated with other abused DAT inhibitors. Clinical availability of MOD has facilitated its off-label use for several psychiatric disorders related to alteration of brain dopamine (DA) systems, including PSUD. In this review, we highlight clinical and preclinical research on MOD and its R-enantiomer, R-MOD, as potential medications for PSUD. Given the complexity of PSUD, we have also reported the effects of MOD on psychostimulant-induced appearance of several symptoms that could intensify the severity of the disease (i.e., sleep disorders and impairment of cognitive functions), besides the potential therapeutic effects of MOD on PSUD.
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Affiliation(s)
- Melinda Hersey
- Medication Development Program, Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Amanda K. Bacon
- Medication Development Program, Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Lydia G. Bailey
- Medication Development Program, Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Mark A. Coggiano
- Medication Development Program, Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Amy H. Newman
- Medication Development Program, Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Lorenzo Leggio
- Medication Development Program, Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
- Clinical Psychoneuroendo- crinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
- National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Biological Research, National Institutes of Health, Bethesda, MD, United States
| | - Gianluigi Tanda
- Medication Development Program, Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
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Abstract
INTRODUCTION Insomnia is a complex sleep disorder that compromises quality of life and affects approximately 10% of the general population. Insomnia, defined as trouble initiating or maintaining sleep associated with impaired daytime function or distress, is treated using a comprehensive approach comprised of cognitive behavioral therapy and pharmacotherapy. Lemborexant, a dual orexin receptor antagonist, is a new pharmacotherapeutic option recently approved for the treatment of insomnia. AREAS COVERED Here, the authors describe lemborexant, assess its efficacy and safety profile in clinical trials, and evaluate its role in the current insomnia treatment landscape. EXPERT OPINION Lemborexant may offer an improved treatment option compared with other pharmacotherapies for insomnia because it is effective both over the long term and over a wide range of outcome measures. Importantly, lemborexant improves latency to sleep onset and sleep maintenance and is able to help people who experience early morning awakenings. Safety data reveal that lemborexant has minimal residual effects on morning alertness or next day function, and that patients are able to respond to an external auditory stimulus in the middle of the night. In conclusion, lemborexant represents a new, effective, and well-tolerated medication for patients with insomnia.
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Affiliation(s)
- Gary Zammit
- Clinilabs Drug Development Corporation, New York, NY, USA
| | - Andrew Krystal
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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Roehrs T, Sibai M, Roth T. Sleep and alertness disturbance and substance use disorders: A bi-directional relation. Pharmacol Biochem Behav 2021; 203:173153. [PMID: 33582097 PMCID: PMC7996967 DOI: 10.1016/j.pbb.2021.173153] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/18/2021] [Accepted: 02/09/2021] [Indexed: 02/04/2023]
Abstract
The majority of the literature describing the relation of sleep/alertness disturbance and substance use disorders (SUD) has focused on the disruptive effects of substances with abuse liability on sleep and alertness. Rarely have studies or literature reviews assessed or discussed how sleep/alertness disturbance affects substance use. This paper focuses on the sleep/alertness disturbance side of the relation. We argue that the relation is bi-directional and review evidence showing that sleep/alertness disturbance affects all phases of the addiction cycle, including the initiation, maintenance and relapse of SUD. We review a variety of substances across all phases of the addiction cycle and conclude sleep/alertness disturbance is a critical factor in both understanding and treating SUD.
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Affiliation(s)
- Timothy Roehrs
- Sleep Medicine, Henry Ford Health System, Detroit, MI, United States of America; Dept of Psychiatry & Behavioral Neuroscience, Wayne State University, SOM, Detroit, MI, United States of America; Dept of Psychology, University of Detroit Mercy, Detroit, MI, United States of America
| | - Mohammad Sibai
- Sleep Medicine, Henry Ford Health System, Detroit, MI, United States of America; Dept of Psychology, University of Detroit Mercy, Detroit, MI, United States of America
| | - Thomas Roth
- Sleep Medicine, Henry Ford Health System, Detroit, MI, United States of America; Dept of Psychiatry & Behavioral Neuroscience, Wayne State University, SOM, Detroit, MI, United States of America.
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Jenkins DD, Khodaparast N, O'Leary GH, Washburn SN, Covalin A, Badran BW. Transcutaneous Auricular Neurostimulation (tAN): A Novel Adjuvant Treatment in Neonatal Opioid Withdrawal Syndrome. Front Hum Neurosci 2021; 15:648556. [PMID: 33762918 PMCID: PMC7982745 DOI: 10.3389/fnhum.2021.648556] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/15/2021] [Indexed: 12/26/2022] Open
Abstract
Maternal opioid use during pregnancy is a growing national problem and can lead to newborns developing neonatal opioid withdrawal syndrome (NOWS) soon after birth. Recent data demonstrates that nearly every 15 min a baby is born in the United States suffering from NOWS. The primary treatment for NOWS is opioid replacement therapy, commonly oral morphine, which has neurotoxic effects on the developing brain. There is an urgent need for non-opioid treatments for NOWS. Transcutaneous auricular neurostimulation (tAN), a novel and non-invasive form of electrostimulation, may serve as a promising alternative to morphine. tAN is delivered via a multichannel earpiece electrode worn on and around the left ear, targeting two cranial nerves—the vagus and trigeminal nerves. Prior research suggests that auricular neurostimulation exerts an anxiolytic effect on the body by releasing endogenous opioids and reduces withdrawal symptoms in adults actively withdrawing from opioids. In this first-in-human prospective, open-label trial, we investigated tAN as an adjuvant to morphine therapy in eight infants >33 weeks gestational age suffering from NOWS and receiving oral morphine treatment. Infants received tAN for 30 min 1 h before receiving a morphine dose. tAN was delivered at 0.1 mA below perception intensity at two different nerve targets on the ear: Region 1, the auricular branch of the vagus nerve; and Region 2, the auriculotemporal nerve. tAN was delivered up to four times daily for a maximum of 12 days. The primary outcome measures were safety [heart rate monitoring, Neonatal Infant Pain Scale (NIPS), and skin irritation] and morphine length of treatment (LOT). tAN was well-tolerated and resulted in no unanticipated adverse events. Comparing to the national average of 23 days, the average oral morphine LOT was 13.3 days (median 9 days) and the average LOT after tAN initiation was 7 days (median 6 days). These preliminary data suggest that tAN is safe and may serve as a promising alternative adjuvant for treating NOWS and reducing the amount of time an infant receives oral morphine.
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Affiliation(s)
- Dorothea D Jenkins
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | | | - Georgia H O'Leary
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States.,Department of Psychiatry & Behavioral Sciences, Brain Stimulation Division, Medical University of South Carolina, Charleston, SC, United States
| | | | | | - Bashar W Badran
- Department of Psychiatry & Behavioral Sciences, Brain Stimulation Division, Medical University of South Carolina, Charleston, SC, United States
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Beydoun MA, Ng AE, Fanelli-Kuczmarski MT, Hossain S, Beydoun HA, Evans MK, Zonderman AB. Vitamin D status and its longitudinal association with changes in patterns of sleep among middle-aged urban adults. J Affect Disord 2021; 282:858-868. [PMID: 33601729 PMCID: PMC10103179 DOI: 10.1016/j.jad.2020.12.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/28/2020] [Accepted: 12/23/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We examined relationships of vitamin D status with over time changes in patterns of sleep in a longitudinal study of Whites and African-American urban middle-aged adults, while further testing effect modification by age group, sex and race and the potential roles of dietary and supplemental vitamin D. METHODS Data on 1,760 middle-aged participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS study: Age range at v2: 33-71y, mean±SD:53.0±8.8, % women: 58.4%, % African-American:60.3%) were used, with complete baseline 25-hydroxyvitamin D [25(OH)D] serum concentration data, initial selected covariates and mediators, and initial and/or follow-up data on five sub-scales (sleep duration, daytime dysfunction, sleep disturbance, sleep latency and sleep quality) of the Pittsburgh Sleep Quality Index. Mean±SD time between initial and follow-up visits: 4.1±1.5 years. Time-interval multiple mixed-effects linear regression models were used. RESULTS Upon multiple testing adjustment, among Whites, initial 25(OH)D was associated with better sleep duration [25(OH)D × TIME γ±SE: -0.027±0.011, P=0.017] and sleep quality [25(OH)D × TIME γ±SE: -0.026±0.010, P=0.008] over time, with heterogeneity by race found for both relationships (P<0.05 for 25(OH)D × TIME × Race in the un-stratified model). These relationships remained unaltered after further adjustment for dietary and supplemental vitamin D, indicating that this association may be largely explained by sunlight exposure. LIMITATIONS Limitations included small sample size, selection bias, residual confounding and lack of objective sleep measures. Conclusions Vitamin D status, possibly through mechanisms involving sunlight exposure, was linked to a potential improvement in sleep duration and quality among White urban adults.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD.
| | - Amanda E Ng
- Department of Epidemiology & Biostatistics, University of Maryland, College Park
| | | | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD
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50
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Liang F, Xu Q, Jiang M, Feng R, Jiang S, Yuan B, Xu S, Wu T, Wang F, Huang JH. Emotion Induced Monoamine Neuromodulator Release Affects Functional Neurological Disorders. Front Cell Dev Biol 2021; 9:633048. [PMID: 33659255 PMCID: PMC7917220 DOI: 10.3389/fcell.2021.633048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/15/2021] [Indexed: 01/11/2023] Open
Abstract
Functional neurologic disorders (FNDs), also called conversion disorder (previously called hysteria), can show almost all the symptoms of other neurological diseases, including both physical (for example, seizure, weakness, fatigue) and psychological (for instance, depression, anxiety) symptoms. In spite of our general knowledge about emotional processes and developmental defects in the formation of these somatic symptoms, there is still no systemic and comprehensive research on the effects of emotional developmental variables in FND. Recently, both experimental and theoretical emotion studies have been greatly increased, such as prediction error, conceptual act model, basic emotional theory, and monoamine neuromodulator based three primary emotions. In addition, a large amount of evidence has confirmed the role of psychosocial adversity (such as stressful life events, interpersonal difficulties) as an important risk factor for FND. Here, we review recent advances about emotional stress on FND, and pay special attention to the effects of monoamine neuromodulators, such as how norepinephrine and serotonin affect behaviors. Then, we discuss the significance of these changes for FND, which may contribute to clarifying the pathogenesis of FND, and thus provide potential therapeutic drug targets or psychological intervention methods in the future.
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Affiliation(s)
- Fei Liang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Qiuyue Xu
- School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mingchen Jiang
- School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Key Laboratory of Pediatric Respiratory Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Rou Feng
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Shan Jiang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Bin Yuan
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shijun Xu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ting Wu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fushun Wang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, United States.,Department of Surgery, College of Medicine, Texas A&M University, Temple, TX, United States
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