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Kalkanis A, Diamantidou V, Papadopoulos D, Eleftheriou M, Testelmans D, Buyse B. Smoking cessation in the Greek Air Force: associations with shift work and flight status. BMJ Mil Health 2024; 170:93-94. [PMID: 35654471 DOI: 10.1136/bmjmilitary-2022-002144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Alexandros Kalkanis
- Department of Respiratory Diseases, KU Leuven University Hospitals Leuven Campus Gasthuisberg, Leuven, Flanders, Belgium
| | - V Diamantidou
- Intensive Care Unit, 251 Air Force General Hospital, Athens, Attica, Greece
| | - D Papadopoulos
- Department of Respiratory Diseases, KU Leuven University Hospitals Leuven Campus Gasthuisberg, Leuven, Flanders, Belgium
| | - M Eleftheriou
- Department of Mathematics, Hellenic Open University, Patras, Western Greece, Greece
| | - D Testelmans
- Department of Respiratory Diseases, KU Leuven University Hospitals Leuven Campus Gasthuisberg, Leuven, Flanders, Belgium
| | - B Buyse
- Department of Respiratory Diseases, KU Leuven University Hospitals Leuven Campus Gasthuisberg, Leuven, Flanders, Belgium
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2
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Pataka A, Kotoulas SC, Karkala A, Tzinas A, Kalamaras G, Kasnaki N, Sourla E, Stefanidou E. Obstructive Sleep Apnea and Smoking Increase the Risk of Cardiovascular Disease: Smoking Cessation Pharmacotherapy. J Clin Med 2023; 12:7570. [PMID: 38137639 PMCID: PMC10743586 DOI: 10.3390/jcm12247570] [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: 11/12/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Tobacco smoking has been a recognized risk factor for cardiovascular diseases (CVD). Smoking is a chronic relapsing disease and pharmacotherapy is a main component of smoking cessation. Obstructive sleep apnea (OSA) and smoking both increase the risk of CVD and are associated with significant morbidity and mortality. There are few existing data examining how pharmacological treatment, such as nicotine replacement therapy (NRT), bupropion, and varenicline, affect smokers suffering with OSA and especially their cardiovascular effects. The aim of this review was to evaluate the effects of smoking cessation pharmacotherapy on OSA with a special emphasis on the cardiovascular system. Results: Only small studies have assessed the effect of NRTs on OSA. Nicotine gum administration showed an improvement in respiratory events but with no permanent results. No specific studies were found on the effect of bupropion on OSA, and a limited number evaluated varenicline's effects on sleep and specifically OSA. Varenicline administration in smokers suffering from OSA reduced the obstructive respiratory events, especially during REM. Studies on second-line medication (nortriptyline, clonidine, cytisine) are even more limited. There are still no studies evaluating the cardiovascular effects of smoking cessation medications on OSA patients. Conclusions: Sleep disturbances are common withdrawal effects during smoking cessation but could be also attributed to pharmacotherapy. Smokers should receive personalized treatment during their quitting attempts according to their individual needs and problems, including OSA. Future studies are needed in order to evaluate the efficacy and safety of smoking cessation medications in OSA patients.
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Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | | | - Aliki Karkala
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Asterios Tzinas
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - George Kalamaras
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Nectaria Kasnaki
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Evdokia Sourla
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Emiliza Stefanidou
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
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von Ash T, Alikhani A, Sharkey KM, Solano P, Morales Aquino M, Markham Risica P. Associations between Perinatal Sleepiness and Breastfeeding Intentions and Attitudes and Infant Feeding Behaviors and Beliefs. Nutrients 2023; 15:3435. [PMID: 37571371 PMCID: PMC10421484 DOI: 10.3390/nu15153435] [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: 06/02/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.
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Affiliation(s)
- Tayla von Ash
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI 02903, USA;
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI 02903, USA
| | - Anna Alikhani
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI 02903, USA;
| | - Katherine M. Sharkey
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA;
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
| | - Paola Solano
- Brown University, Providence, RI 02912, USA; (P.S.); (M.M.A.)
| | | | - Patricia Markham Risica
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI 02903, USA;
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI 02903, USA
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Truong VTT, Green C, Pedroza C, Hwang LY, Rajan SS, Suchting R, Cinciripini P, Tyndale RF, Lerman C. Bayesian regularization to predict neuropsychiatric adverse events in smoking cessation with pharmacotherapy. BMC Med Res Methodol 2023; 23:107. [PMID: 37118656 PMCID: PMC10148544 DOI: 10.1186/s12874-023-01931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 04/25/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Research on risk factors for neuropsychiatric adverse events (NAEs) in smoking cessation with pharmacotherapy is scarce. We aimed to identify predictors and develop a prediction model for risk of NAEs in smoking cessation with medications using Bayesian regularization. METHODS Bayesian regularization was implemented by applying two shrinkage priors, Horseshoe and Laplace, to generalized linear mixed models on data from 1203 patients treated with nicotine patch, varenicline or placebo. Two predictor models were considered to separate summary scores and item scores in the psychosocial instruments. The summary score model had 19 predictors or 26 dummy variables and the item score model 51 predictors or 58 dummy variables. A total of 18 models were investigated. RESULTS An item score model with Horseshoe prior and 7 degrees of freedom was selected as the final model upon model comparison and assessment. At baseline, smokers reporting more abnormal dreams or nightmares had 16% greater odds of experiencing NAEs during treatment (regularized odds ratio (rOR) = 1.16, 95% credible interval (CrI) = 0.95 - 1.56, posterior probability P(rOR > 1) = 0.90) while those with more severe sleep problems had 9% greater odds (rOR = 1.09, 95% CrI = 0.95 - 1.37, P(rOR > 1) = 0.85). The prouder a person felt one week before baseline resulted in 13% smaller odds of having NAEs (rOR = 0.87, 95% CrI = 0.71 - 1.02, P(rOR < 1) = 0.94). Odds of NAEs were comparable across treatment groups. The final model did not perform well in the test set. CONCLUSIONS Worse sleep-related symptoms reported at baseline resulted in 85%-90% probability of being more likely to experience NAEs during smoking cessation with pharmacotherapy. Treatment for sleep disturbance should be incorporated in smoking cessation program for smokers with sleep disturbance at baseline. Bayesian regularization with Horseshoe prior permits including more predictors in a regression model when there is a low number of events per variable.
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Affiliation(s)
- Van Thi Thanh Truong
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2850, Houston, TX, 77030, USA.
| | - Charles Green
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rachel F Tyndale
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Caryn Lerman
- Keck School of Medicine, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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Ellison-Barnes A, Galiatsatos P. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. Med Clin North Am 2022; 106:1067-1080. [PMID: 36280333 DOI: 10.1016/j.mcna.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a strong evidence base for the use of existing pharmacotherapies to support tobacco cessation, alone or in combination, ideally with concurrent behavioral interventions. Future pharmacotherapies under development may assist in the most refractory cases. Incorporating current and future therapies into a longitudinal chronic care model for tobacco dependence will help a diverse range of patients achieve independence from nicotine addiction.
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Affiliation(s)
- Alejandra Ellison-Barnes
- The Tobacco Treatment and Cancer Screening Clinic, The Johns Hopkins Health System, Baltimore, MD, USA; Division of General Internal Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Panagis Galiatsatos
- The Tobacco Treatment and Cancer Screening Clinic, The Johns Hopkins Health System, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Hussain J, Ling L, Alonzo RT, Rodrigues R, Nicholson K, Stranges S, Anderson KK. Associations between sleep patterns, smoking, and alcohol use among older adults in Canada: Insights from the Canadian Longitudinal Study on Aging (CLSA). Addict Behav 2022; 132:107345. [PMID: 35526407 DOI: 10.1016/j.addbeh.2022.107345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/12/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
Poor sleep is associated with chronic health conditions among older adults. As substance use rates increase in this population, age-related physiological and cognitive declines may exacerbate its detrimental consequences, including sleep problems. We analyzed cross-sectional associations between sleep patterns, smoking, and alcohol use using baseline data from 30,097 community-dwelling Canadian adults aged 45-85 years from the Canadian Longitudinal Study on Aging. Insomnia symptoms (difficulties falling/staying asleep), sleep duration (short:<6h; long:>8h), and sleep satisfaction(dissatisfied/neutral/satisfied) were measured. Smoking and alcohol-use frequency (past 12 months), average daily amount (past 30 days), and binge drinking (past 12 months) were self-reported, and associations were examined using modified Poisson regression. Approximately 23% of participants had insomnia symptoms, and 26% reported sleep dissatisfaction. 91% of participants were current non-smokers, whereas 7% reported smoking daily. Over 50% drank ≤ 2 drinks daily, and 3% reported binge drinking. There was a higher adjusted prevalence of insomnia among daily smokers (PR = 1.10, 95% CI = 1.00-1.21) and binge drinkers (PR = 1.21, 95% CI = 1.02-1.43). Odds of short sleep duration were lower among regular drinkers (COR = 0.71, 95% CI = 0.56-0.90) and higher among daily smokers (COR = 1.19, 95% CI = 1.01-1.40). Heavy and frequent smoking and alcohol use are associated with both insomnia symptoms and sleep dissatisfaction, but not consistently with sleep duration. Further longitudinal investigation of this relationship in aging populations is needed in clinical and public health settings to infer the extent of causality and design effective public health interventions in this vulnerable population.
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Affiliation(s)
- Junayd Hussain
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Linda Ling
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rea T Alonzo
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, Western University, London, Ontario, Canada.
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Does Smoking Affect OSA? What about Smoking Cessation? J Clin Med 2022; 11:jcm11175164. [PMID: 36079094 PMCID: PMC9457519 DOI: 10.3390/jcm11175164] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
The connection between smoking and Obstructive sleep apnea (OSA) is not yet clear. There are studies that have confirmed the effect of smoking on sleep disordered breathing, whereas others did not. Nicotine affects sleep, as smokers have prolonged total sleep and REM latency, reduced sleep efficiency, total sleep time, and slow wave sleep. Smoking cessation has been related with impaired sleep. The health consequences of cigarette smoking are well documented, but the effect of smoking cessation on OSA has not been extensively studied. Smoking cessation should improve OSA as upper airway oedema may reduce, but there is limited data to support this hypothesis. The impact of smoking cessation pharmacotherapy on OSA has been studied, especially for nicotine replacement therapy (NRT). However, there are limited data on other smoking cessation medications as bupropion, varenicline, nortriptyline, clonidine, and cytisine. The aim of this review was to explore the current evidence on the association between smoking and OSA, to evaluate if smoking cessation affects OSA, and to investigate the possible effects of different pharmacologic strategies offered for smoking cessation on OSA.
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8
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Zeng X, Ren Y, Wu K, Yang Q, Zhang S, Wang D, Luo Y, Zhang N. Association Between Smoking Behavior and Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2022; 25:364-371. [PMID: 35922388 PMCID: PMC9910143 DOI: 10.1093/ntr/ntac126] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/13/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION To systematically review the association between smoking behavior and obstructive sleep apnea (OSA). AIMS AND METHODS PubMed, Medline, the Cochrane Library, EMBASE, and Scopus databases were used to conduct this review. The two researchers independently screened the literatures, conducted the quality assessment, and data extraction according to the inclusion and exclusion criteria. The RevMan 5.3 was used to analysis the apnea hypopnea index (AHI) index, min saturation of oxyhemoglobin (SaO2), Epworth Sleepiness Scale (ESS) score, and oxygen desaturation index (DOI) and publication bias analysis to assess the effect of smoking on OSA patients. Furthermore, we performed subgroup of the severity of OSA, different countries of sample origin (western countries or eastern countries), and pack-years (PYs < 10 or PYs ≥ 20) to analyze the heterogeneity. RESULTS Thirteen studies were included in this analysis that conformed to inclusion criteria and exclusion criteria. Totally 3654 smokers and 9796 non-smokers have participated. The meta-analysis of 13 studies demonstrated that AHI levels were significantly higher in smoker group compared with non-smoker, ESS scores were also significantly higher in smoker group compared with non-smoker, min SaO2 levels were obviously lower in smoker group compared with non-smoker, however, DOI levels hadn't significantly different between two groups. The subgroup analysis showed that there was an association between severe OSA, eastern countries, pack-years, and smoking. CONCLUSIONS Smoking behavior is a significant association with OSA. Heavy smokers with histories of more than 20 PYs were at a higher risk of OSA. Moreover, patient with severe OSA exhibited a significantly association with smoking compared with patients with mild or moderate OSA. IMPLICATIONS The relationship between smoking and OSA was controversial, especially, whether smoking increase or aggravate the risk of OSA. In our review and meta-analysis, we demonstrated that smoking behavior is a significant association with OSA. Heavy smokers with histories of more than 20 PYs were at a higher risk of OSA. Moreover, patient with severe OSA exhibited a significant association with smoking compared with patients with mild or moderate OSA. More prospective long-term follow-up studies about effect of quit smoking on OSA are recommended to establish the further relationship.
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Affiliation(s)
- Xiangxia Zeng
- Department of Pulmonary and Critical Care, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Yingying Ren
- Medical Record Management Department, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Kang Wu
- Department of Pulmonary and Critical Care, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Qifeng Yang
- Department of Pulmonary and Critical Care, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Sun Zhang
- Department of Pulmonary and Critical Care, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Donghao Wang
- Department of Pulmonary and Critical Care, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Yateng Luo
- Department of Pulmonary and Critical Care, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Nuofu Zhang
- Corresponding Author: Dr. Nuofu Zhang, Professor, Department of Pulmonary and Critical Care, Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China. Telephone: 86-20-83062850; Fax: 86-20-83062850; E-mail:
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Das A, Prithviraj M, Mohanraj PS. Role of Melatonin in the Management of Substance Addiction: A Systematic Review. Cureus 2022; 14:e26764. [PMID: 35967139 PMCID: PMC9366042 DOI: 10.7759/cureus.26764] [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] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Abstract
Recent evidence links melatonin hormone and its receptor to the etiology and behavioral manifestation of addiction. The role of exogenous melatonin in addiction treatment is still inconsistent and unclear. The present study aimed to review the literature on randomized clinical trials that evaluated the role of melatonin supplementation, compared to placebo, in the treatment of various substance addictions. The literature searches of relevant articles published in the English language in MEDLINE and Google Scholar databases were performed from inception up to May 2021. We included only randomized clinical trials investigating the effect of melatonin treatment, compared to placebo, on substance addiction-related parameters. Non-randomized clinical trials, observation studies, and animal studies were excluded. The risk of bias-2 was used to assess the quality of the studies. Of 537 articles, 12 randomized control trials (RCT) met our inclusion criteria. Studies have been conducted on substances of addiction including benzodiazepine (BZD), alcohol, nicotine, and opioids. Our results indicated that melatonin treatment had mixed results in improving sleep quality and was not found beneficial in BDZ cessation/discontinuation rate among patients with BDZ dependence. Sleep quality and mental health had improved by melatonin supplements in opioid addiction. In nicotine addiction, melatonin treatment showed effectiveness only on mood changes but not in performance tests. In patients with alcohol use disorder (AUD), melatonin treatment did not show any improvement in sleep quality. We found that the use of exogenous melatonin in substance addiction has mixed results which do not provide sufficient evidence, relative to randomized clinical trials, to establish its role.
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Dual Orexin Receptor Antagonists (DORAs) as an Adjunct Treatment for Smoking Cessation. CNS Drugs 2022; 36:411-417. [PMID: 35451800 DOI: 10.1007/s40263-022-00918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 12/27/2022]
Abstract
Smoking is recognized as the most avoidable cause for multiplicity of chronic diseases. However, smoking cessation rates remain low, in part due to the limited target engagement of the currently approved medications for smoking cessation. Sleep is a promising focus for increasing smoking cessation rates because smokers' sleep problems are exacerbated during the first week of smoking abstinence and are associated with poor smoking cessation outcomes. Furthermore, the currently approved smoking cessation pharmacological agents varenicline and nicotine replacement treatment exacerbate sleep problems beyond what would be observed as a consequence of natural nicotine withdrawal. Addressing sleep problems with dual orexin receptor antagonists (DORAs) is positioned to remedy the shortcoming of overlooking sleep as a viable smoking cessation intervention target. Based on previous animal literature, DORA agents suvorexant and lemborexant may accomplish this by diminishing withdrawal difficulty and reducing nicotine cravings. The pharmacologic focus is the orexin system, not only because orexin peptides mediate the sleep-wake cycle, but also because DORA agents have a milder adverse event profile over previous treatments for insomnia. A novel adjunct DORA treatment to a currently approved smoking cessation pharmacotherapy holds a potential to reduce morbidity and mortality caused by smoking.
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11
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Soreca I, Conklin CA, Vella EJ, Salkeld RP, Joyce CJ, Mumma JM, Jakicic JM, Kupfer DJ. Can exercise alleviate sleep disturbances during acute nicotine withdrawal in cigarette smokers? Exp Clin Psychopharmacol 2022; 30:82-92. [PMID: 33119386 PMCID: PMC8415013 DOI: 10.1037/pha0000390] [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: 02/03/2023]
Abstract
Sleep disturbances, including insomnia (difficulty falling or staying asleep), are common nicotine withdrawal symptoms particularly during the initial stage of nicotine abstinence, and increase the likelihood of relapse within the first 4 weeks of quitting. Although clinically recognized as a key symptom of nicotine withdrawal, sleep disturbances are not addressed in the clinical guidelines for nicotine dependence treatment. Unfortunately, Nicotine Replacement Therapy (NRT) and other pharmacologic interventions do not attenuate withdrawal-provoked sleep disturbances, with several even exacerbating sleep disruption. The present study tested the impact of 30-min of daily moderate exercise, morning versus evening, on key polysomnographic indicators of sleep disturbances during initial 3 days (72 hr) of nicotine withdrawal. Forty-nine daily smokers (53% male) completed 3 separate abstinence periods, during which they completed either morning exercise, evening exercise, or a nonexercising magazine reading control condition. Order of condition was counterbalanced across subjects with a 1-week wash out in between each 3-day abstinence period. Exercise engagement mitigated several changes in sleep architecture associated with acute nicotine deprivation and other time-related effects on sleep, specifically frequency of arousals (B = -2.8, SE = .95; t(1271) = -3.0, p = .003) and reductions in sleep maintenance (B = .58, SE = .21; t(1270) = 2.8, p = .005). Additionally, smokers who reported greater perceived withdrawal severity had the longest latency to fall asleep but experienced the greatest attenuation of this effect following PM exercise. Overall, results suggest a role for exercise as an adjunct smoking cessation treatment to specifically target sleep disturbances during early acute nicotine withdrawal. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Isabella Soreca
- Pittsburgh Veterans Administration Healthcare System, Pittsburgh PA
| | | | | | | | | | - Joel M. Mumma
- University of Pittsburgh, Department of Psychiatry, Pittsburgh PA
| | - John M. Jakicic
- University of Pittsburgh, Department of Health and Physical Activity, Pittsburgh PA
| | - David J. Kupfer
- University of Pittsburgh, Department of Psychiatry, Pittsburgh PA
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12
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Danilov M, Issany A, Mercado P, Haghdel A, Muzayad JK, Wen X. Sleep quality and health among pregnant smokers. J Clin Sleep Med 2022; 18:1343-1353. [PMID: 34978278 PMCID: PMC9059582 DOI: 10.5664/jcsm.9868] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES We aimed to examine 1) sleep quality trends of pregnant smokers and 2) their associations with health outcomes. METHODS A secondary analysis of 88 participants from the University at Buffalo Pregnancy and Smoking Cessation Study (non-randomized clinical study) was performed. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) (higher scores, worse quality) and sleep duration was self-reported repeatedly during pregnancy at pre-intervention, post-intervention, and end-of-pregnancy visits. Participants were divided into 3 groups (until pre-intervention, until post-intervention, until end-of-pregnancy). Maternal outcomes included gestational weight gain (GWG) and smoking cessation. Infant outcomes included birth weight, gestational age, and APGAR score. RESULTS There was a significant increase (P= 0.046) in PSQI score from post-intervention (mean, 5.5 [SD, 2.6]) to end-of-pregnancy (6.6 [SD, 2.8]). Mean GWG was significantly lower for participants with poor sleep quality than those with good sleep quality (19.0 kg [SD, 21.3] vs. 36.1 kg [SD, 22.8]; P=0.008). Newborns with poor maternal sleep quality had a significantly lower mean 5-minute APGAR score (8.1 [SD, 1.3] vs. 9.0 [SD, 0.0]; P=0.021) than newborns with good maternal sleep quality. Pre-intervention sleep quality was not associated with smoking cessation, birth weight, or gestational age. Smoking cessation was almost half as prevalent in participants with insufficient sleep (<7 hours/night) vs. sufficient sleep duration (47.4% vs. 92.3%, P=0.011). CONCLUSIONS Sleep quality worsened towards the end-of-pregnancy among smokers. Poor sleep might negatively influence GWG and APGAR score. Insufficient pre-intervention sleep might negatively influence smoking cessation.
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Affiliation(s)
- Michael Danilov
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Arsh Issany
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Paul Mercado
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Arsalan Haghdel
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Jamila Khlid Muzayad
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
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Hattatoğlu DG, Aydin Ş, Yildiz BP. Does smoking impair sleep hygiene? ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:1123-1128. [PMID: 34852074 DOI: 10.1590/0004-282x-anp-2020-0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sleep architecture and sleep hygiene might be disrupted by several pathogenetic mechanisms, and the effect of smoking has not been evaluated. OBJECTIVE To investigate the effect of smoking on sleep hygiene behaviors that might be associated with the deterioration of quality-of-life (QoL) parameters. METHODS In a prospective cross-sectional study, smokers (n=114) and nonsmokers (n=119) were included. The Pittsburgh Sleep Quality İndex (PSQI), the Epworth Daytime Sleepiness Scale (ESS), the Sleep Hygiene Index (SHI), and the Short Form-36 quality of life scale (SF-36) were applied. RESULTS We found that none of the components, as well as the PSQI total score were affected in smokers compared with the nonsmoker controls (65.5% of smokers had poor sleep compared to 62.5% of nonsmokers). Although smokers tend to get out of bed at different times from day to day and do important work before bedtime (components of the SHI) more often than non-smokers, no significant differences were detected between groups in any component and SHI total score (27.91±6.72 for smokers and 29.23±8.0 for non-smokers). ESS, depression and anxiety symptoms, and SHI scores in smokers with poor sleep quality were significantly different compared with smokers that had normal sleep quality. Both PSQI and SHI scores were inversely associated with QoL parameters. CONCLUSIONS Our results suggest that smoking by itself is not associated with poor sleep hygiene or sleep quality. It can be concluded that worse SHI and quality of sleep negatively affect QoL, depression, and anxiety in smokers.
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Affiliation(s)
- Didem Görgün Hattatoğlu
- University of Health Sciences, Yedikule Chest Disease and Surgery Training and Research Hospital, Pulmonology, Istanbul, Turkey
| | - Şenay Aydin
- University of Health Sciences, Yedikule Chest Disease and Surgery Training and Research Hospital, Neurology, Istanbul, Turkey
| | - Birsen Pınar Yildiz
- University of Health Sciences, Yedikule Chest Disease and Surgery Training and Research Hospital, Pulmonology, Istanbul, Turkey
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Catoire S, Nourredine M, Lefebvre S, Couraud S, Gronfier C, Rey R, Peter-Derex L, Geoffroy PA, Rolland B. Tobacco-induced sleep disturbances: A systematic review and meta-analysis. Sleep Med Rev 2021; 60:101544. [PMID: 34597890 DOI: 10.1016/j.smrv.2021.101544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/26/2022]
Abstract
Even though tobacco-induced sleep disturbances (TISDs) have been reported in previous studies, the present article is the first meta-analysis quantitatively assessing the impact of tobacco on sleep parameters. We conducted a systematic review and meta-analysis of the studies comparing objective (i.e. polysomnography and actigraphy) and/or subjective sleep parameters in chronic tobacco smokers without comorbidities versus healthy controls. Studies were retrieved using PubMed, PsycINFO, and Web of Science. Differences are expressed as standardized mean deviations (SMD) and their 95% confidence intervals (95%CI). Fourteen studies were finally included into the review, among which ten were suitable for meta-analysis. Compared to healthy controls, chronic tobacco users displayed increased N1 percentage (SMD = 0.65, 95%CI: 0.22 to 1.07), N2 percentage (SMD = 1.45, 95%CI: 0.26 to 2.63), wake time after sleep onset (SMD = 6.37, 95%CI: 2.48 to 10.26), and decreased slow-wave sleep (SMD = -2.00, 95%CI: -3.30 to -0.70). Objective TISDs preferentially occurred during the first part of the night. Regarding subjective parameters, only the Pittsburgh Sleep Quality Index (PSQI) total score could be analyzed, with no significant between-groups difference (SMD = 0.53, 95%CI: -0.18 to 1.23). Smoking status should be carefully assessed in sleep medicine, while TISDs should be regularly explored in chronic tobacco users.
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Affiliation(s)
- Sébastien Catoire
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le Vinatier, 69500, Bron, France; Unité Michel Jouvet, 69Z19, Pôle Est, CH Le Vinatier, 69500, Bron, France; Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Hôpital Lyon-Sud, CHU Lyon, 69310 Pierre Bénite, France.
| | - Mikail Nourredine
- Service Hospitalo-Universitaire de pharmacotoxicologie, Service de recherche et épidémiologie clinique Hospices Civils de Lyon, 69424, Lyon, France; Faculté de Médecine Lyon-Sud, 69921, Oullins, France
| | - Stéphanie Lefebvre
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le Vinatier, 69500, Bron, France; Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Sébastien Couraud
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Hôpital Lyon-Sud, CHU Lyon, 69310 Pierre Bénite, France; EMR 3738 Ciblage thérapeutique en Oncologie, Faculté de médecine et de maïeutique Lyon Sud Charles - Mérieux, Université Lyon 1, France
| | - Claude Gronfier
- Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Romain Rey
- Unité Michel Jouvet, 69Z19, Pôle Est, CH Le Vinatier, 69500, Bron, France; Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Laure Peter-Derex
- Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France; Centre de Médecine du Sommeil et des Maladies Respiratoires, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Pierre A Geoffroy
- Service de Psychiatrie et d'Addictologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Bichat, Paris, France; Université de Paris, NeuroDiderot, Inserm, Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014, Paris, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le Vinatier, 69500, Bron, France; Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France; Service d'Addictologie, Hôpital Édouard Herriot, CHU Lyon, 69003, Lyon, France
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Doornenbal B, Spisak B. The asymmetric relationship between smoking and sleep: Longitudinal findings from Dutch panel data. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/142891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Liu J, Wu T, Liu Q, Wu S, Chen JC. Air pollution exposure and adverse sleep health across the life course: A systematic review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 262:114263. [PMID: 32443219 PMCID: PMC7877449 DOI: 10.1016/j.envpol.2020.114263] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 05/07/2023]
Abstract
An increasing number of epidemiological studies have examined air pollution as a possible contributor to adverse sleep health, but results are mixed. The aims of this systematic review are to investigate and summarize the associations between exposures to air pollutants and various sleep measures across the lifespan. PubMed, CINAHL, Cochrane, Scopus, Web of Science, and PsycInfo were searched through October 2019 to identify original data-based research examining direct epidemiological associations between ambient and indoor air pollution exposures and various sleep health measures, including sleep quality, sleep duration, sleep disturbances, and daytime sleepiness. Twenty-two articles from 2010 to 2019 were selected for inclusion in this review, including a wide range of study populations (from early childhood to elderly) and locations (10 Asian, 4 North American, 3 European, 5 other). Due to variation in both exposure and outcome assessments, conducting a meta-analysis was not plausible. Twenty-one studies reported a generally positive association between exposure and poor sleep quality. While most studies focused on ambient air pollutants, five assessed the specific effect of indoor exposure. In children and adolescents, increased exposure to both ambient and indoor pollutants is associated with increased respiratory sleep problems and a variety of additional adverse sleep outcomes. In adults, air pollution exposure was most notably related to sleep disordered breathing. Existing literature generally shows a negative relationship between exposures to air pollution and sleep health in populations across different age groups, countries, and measures. While many associations between air pollution and sleep outcomes have been investigated, the mixed study methods and use of subjective air pollution and sleep measures result in a wide range of specific associations. Plausible toxicological mechanisms remain inconclusive. Future studies utilizing objective sleep measures and controlling for all air pollution exposures and individual encounters may help ameliorate variability in the results reported by current published literature.
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Affiliation(s)
- Jianghong Liu
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Tina Wu
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Qisijing Liu
- Peking University School of Public Health, Beijing, China
| | - Shaowei Wu
- Peking University School of Public Health, Beijing, China
| | - Jiu-Chiuan Chen
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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17
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Włodarska A, Doboszyńska A. Tobacco smoke exposure as a risk factor for obstructive sleep apnea in children. Pediatr Int 2020; 62:840-847. [PMID: 32034991 DOI: 10.1111/ped.14191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 01/09/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The most common respiratory disturbance in sleeping children is obstructive sleep apnea syndrome (OSAS). Passive smoking is one of factors predisposing to OSAS. The aim of this study was to determine the correlations between exposure to tobacco smoke (passive smoking) and development of respiratory disorders in children during sleep. METHODS One hundred and sixty school-aged children (6-18 years) were included in the study. The inclusion criterion was exposure to tobacco smoke at home (n = 90). The control group were school-aged children who had had no contact with tobacco smoke at home (n = 70). Exclusion criteria were obesity and children with impaired patency of the nose. Each child had a polygraphic examination performed at home. The children and their parents completed a questionnaire to assess the level of child's exposure to tobacco smoke. The study ran from December 15, 2012 to February 26, 2016. RESULTS OSAS was observed in 12% of children with an apnea-hypopnea index >1.5 (<13 years of age) and an apnea-hypopnea index >5 (for children >13 years), and with diurnal and nocturnal symptoms. Children exposed to tobacco smoke presented more apnea-hypopnea events (n = 17) than the control group (n = 3; P < 0.001). In the group exposed to tobacco smoke the following issues were noted: concentration problems (38.9%), tiredness/lethargy (46.7%), and irritability/hyperactivity (36.7%). No statistically significant differences were found in waking up, snoring, or sleep apnea. CONCLUSIONS OSAS occurs more often in children exposed to tobacco smoke and these children demonstrate concentration problems, tiredness, and irritability/hyperactivity to a greater extent than control group.
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Affiliation(s)
| | - Anna Doboszyńska
- Department of Pulmonology, Faculty of Health Sciences, University of Warmia and Mazury, Olsztyn, Poland
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18
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Hägg SA, Ljunggren M, Janson C, Holm M, Franklin KA, Gislason T, Johannessen A, Jõgi R, Olin AC, Schlünssen V, Lindberg E. Smokers with insomnia symptoms are less likely to stop smoking. Respir Med 2020; 170:106069. [PMID: 32843184 DOI: 10.1016/j.rmed.2020.106069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Smoking is associated with sleep disturbances. The aim of this study was to analyze whether sleep disturbances are predictors of smoking cessation and whether continued smoking is associated with the development of sleep disturbances. METHODS A questionnaire was sent to randomly selected men and women in Northern Europe in 1999-2001 (RHINE II) and was followed up by a questionnaire in 2010-2012 (RHINE III). The study population consisted of 2568 participants who were smokers at baseline and provided data on smoking at follow-up. Insomnia symptoms were defined as having difficulty initiating and/or maintaining sleep and/or early morning awakening ≥3 nights/week. Multiple logistic regression analyses were performed to calculate odds ratios (OR). RESULTS Subjects with difficulty initiating sleep (adjusted odds ratio; 95% confidence interval: 0.6; 0.4-0.8), difficulty maintaining sleep (0.7; 0.5-0.9), early morning awakening (0.6; 0.4-0.8), any insomnia symptom (0.6; 0.5-0.8) or excessive daytime sleepiness (0.7; 0.5-0.8) were less likely to achieve long-term smoking cessation after adjustment for age, BMI, pack-years, hypertension, diabetes, chronic bronchitis, rhinitis, asthma, gender and BMI difference. There was no significant association between snoring and smoking cessation. In subjects without sleep disturbance at baseline, continued smoking increased the risk of developing difficulty initiating sleep during the follow-up period compared with those that had quit smoking (adj. OR 1.7, 95% CI 1.2-2.3). CONCLUSIONS Insomnia symptoms and excessive daytime sleepiness negatively predict smoking cessation. Smoking is a risk factor for the development of difficulty initiating sleep. Treatment for sleep disturbances should be included in smoking-cessation programs.
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Affiliation(s)
- Shadi Amid Hägg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Karl A Franklin
- Department of Surgery and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Anna-Carin Olin
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus University, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Cohen A, Ben Abu N, Haimov I. The Interplay Between Tobacco Dependence and Sleep Quality Among Young Adults. Behav Sleep Med 2020; 18:163-176. [PMID: 30463440 DOI: 10.1080/15402002.2018.1546707] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective/Background: Sleep disturbances are considered among the negative consequences of smoking. However, the relationship between sleep quality and smoking among young adults, a population in which the prevalence of smoking is highest, has scarcely been examined. The current study aimed at examining differences in sleep indices, assessed by both subjective and objective (actigraphy) measures, between smokers and nonsmokers, and whether such differences are associated with levels of nicotine dependence. Participants: Eighty-six young (19-28 years old) volunteers, of them 46 nonsmokers (69.6% women) and 40 regular smokers (70.0% women) smoking at least 10 cigarettes a day. Methods: The participants completed the State-Trait Anxiety Inventory, Beck Depression Inventory, Brief Questionnaire on Smoking Urges, the Fagerstrom Test for Nicotine Dependence, and the Pittsburgh Sleep Quality Index. Their sleep was monitored objectively for one week using an actigraph. Results: Smokers' self-reported sleep quality was similar to that of nonsmokers. However, actigraphy data pointed to lower sleep continuity in smokers compared to nonsmokers as reflected by increased wake time after sleep onset (Mean ± SD: 18.56 ± 15.29 vs. 11.21 ± 11.19, p < .01) and decreased sleep efficiency (Mean ± SD: 95.63 ± 3.53 vs. 97.23 ± 2.62, p < .012). Total sleep time and sleep onset latency did not differ between the groups. Notably, severity of nicotine dependence was negatively associated with sleep efficiency (β = -.32; p < .05). Conclusion: Young adult smokers have lower sleep continuity without necessarily subjectively experiencing their sleep as poor. Nevertheless, their lower sleep continuity is related to their level of nicotine dependence.
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Affiliation(s)
- Ami Cohen
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Natali Ben Abu
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Iris Haimov
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
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20
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Bender AM, Van Dongen HPA, Roll JM, Layton ME. Sleep disturbance and daytime sleepiness in cigarette smokers attempting to quit without treatment. Sleep Biol Rhythms 2019. [DOI: 10.1007/s41105-019-00235-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Mathews HL, Stitzel JA. The effects of oral nicotine administration and abstinence on sleep in male C57BL/6J mice. Psychopharmacology (Berl) 2019; 236:1335-1347. [PMID: 30564868 PMCID: PMC7372999 DOI: 10.1007/s00213-018-5139-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 11/29/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sleep disturbances are common in smoking cessation attempts and are predictive of relapse. Despite this knowledge, there is no established animal model to study the effect of nicotine abstinence on sleep and EEG parameters. OBJECTIVES The present study was conducted to characterize sleep and wakefulness in male C57BL/6J mice during periods of oral nicotine administration and abstinence. METHODS Male C57BL/6J mice were implanted with EEG/EMG recording devices. EEG/EMG data were recorded continuously for a period of 4 weeks. At the beginning of week 2, 200 μg/ml of nicotine was added to the 0.2% saccharin vehicle drinking solution. Following a 2-week period of oral nicotine administration, abstinence was initiated by excluding the nicotine from the 0.2% saccharin vehicle drinking solution. EEG/EMG were analyzed at pre-nicotine baseline, during nicotine administration, and on days 1, 2, and 5 of abstinence from nicotine. RESULTS Oral nicotine administration decreased total sleep time during the active phase, consistent with the stimulant actions of nicotine. In contrast, NREM sleep quantity was increased during the active phase on nicotine abstinence day 1 and REM sleep was decreased during days 2 and 5 of abstinence. Further, sleep fragmentation was increased during the inactive phase on all days of abstinence. Oral nicotine administration and abstinence from nicotine also altered EEG relative power frequencies during the inactive and active phase. CONCLUSIONS Both oral nicotine administration and abstinence lead to sleep disturbances in mice. Similarities between this model and human reports on the effect of nicotine/nicotine withdrawal on sleep support its utility in examining the molecular mechanisms that modulate the relationship between sleep, nicotine, and nicotine abstinence/withdrawal.
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Affiliation(s)
- Hunter L Mathews
- Department of Psychology and Neuroscience, The University of Colorado Boulder, Institute for Behavioral Genetics, 1480 30th Street, Boulder, CO, 80309, USA.
| | - Jerry A Stitzel
- Department of Integrative Physiology, The University of Colorado Boulder, Institute for Behavioral Genetics, 1480 30th Street, Boulder, CO, 80309, USA
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Cohen A, Colodner R, Masalha R, Haimov I. The Relationship Between Tobacco Smoking, Cortisol Secretion, and Sleep Continuity. Subst Use Misuse 2019; 54:1705-1714. [PMID: 31081433 DOI: 10.1080/10826084.2019.1608250] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Existing theories hold that chronic tobacco smoking leads to the development of adverse psychological symptoms, thus producing a compulsive urge to smoke in order to alleviate these sensations. Sleep disturbances are often considered among the negative consequences of chronic smoking. Objectives: The current study aimed at examining whether dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis may be involved in this disruption of sleep quality among smokers. Methods: Smokers and non-smokers provided saliva samples following awakening for assessment of cortisol concentrations as a measure of HPA activity. Subsequently the participants completed the State-Trait Anxiety Inventory, Brief Questionnaire on Smoking Urges, the Fagerstrom Test for Nicotine Dependence, and the Pittsburgh Sleep Quality Index. Next, their sleep was monitored objectively for one week using an actigraph. Results: While smokers' self-reported sleep quality was similar to that of non-smokers, their sleep recording data pointed to diminished sleep continuity (increased wake time after sleep onset; WASO), while total sleep time and sleep onset latency were similar to that of non-smokers. Cortisol secretion was higher among smokers. However, among smokers only, cortisol was negatively correlated with WASO, suggesting that the direct enhancing effect of smoking on WASO is somewhat balanced by an indirect process related to higher cortisol levels. Possible interpretations for this inconsistent mediation are discussed. Conclusions/Importance: Smoking is associated with reduced sleep continuity and the relationship between smoking and sleep continuity may involve the HPA axis.
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Affiliation(s)
- Ami Cohen
- a Department of Psychology, The Center for Psychobiological Research , The Max Stern Academic College of Emek Yezreel , Yezreel Valley , Israel
| | - Raul Colodner
- b Endocrinology Laboratory , Emek Medical Center , Afula , Israel
| | - Rifat Masalha
- b Endocrinology Laboratory , Emek Medical Center , Afula , Israel
| | - Iris Haimov
- a Department of Psychology, The Center for Psychobiological Research , The Max Stern Academic College of Emek Yezreel , Yezreel Valley , Israel
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Oshri A, Kogan S, Liu S, Sweet L, Mackillop J. Pathways Linking Adverse Childhood Experiences to Cigarette Smoking Among Young Black Men: a Prospective Analysis of the Role of Sleep Problems and Delayed Reward Discounting. Ann Behav Med 2018; 51:890-898. [PMID: 28500481 DOI: 10.1007/s12160-017-9914-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND African American men experience increases in smoking during the young adult transition. Exposure to childhood adversity, a risk factor which disproportionately affects African American men, has been identified as a robust precursor to health risk behavior in general and cigarette smoking in particular. The intermediate mechanisms that transmit the influence of early adversity to smoking behavior are not well understood. PURPOSE We tested a model of the escalation of smoking behaviors among young adult African American men, investigating sleep disturbance and delayed reward discounting as intermediate factors linking adverse childhood experiences with smoking. METHODS Hypotheses were tested with three waves of data (M age-T1 = 20.34, M age-T2 = 21.92, M age-T3 = 23.02) from 505 African American men living in rural counties in South Georgia. Men provided self-report data on their adverse childhood experiences, sleep problems, and smoking behavior using audio-assisted computer self-interviews. Men also completed a computer-based delayed reward discounting task. RESULTS Structural equation modeling analyses supported our hypotheses: Adverse childhood experiences predicted poor sleep adequacy, which forecast increases in delayed reward discounting; discounting, in turn, predicted increased smoking. Significant indirect pathways were detected linking adversity to discounting via sleep adequacy and linking sleep adequacy to smoking via discounting. CONCLUSIONS Prevention and intervention researchers can draw on these findings to develop programs that focus on sleep adequacy to reduce smoking in African American men exposed to childhood adversity.
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Affiliation(s)
- Assaf Oshri
- Department of Human Development and Family Science, The Youth Development Institute, The University of Georgia, Athens, GA, 30602, USA.
| | - Steven Kogan
- Department of Human Development and Family Science, The Youth Development Institute, The University of Georgia, Athens, GA, 30602, USA
| | - Sihong Liu
- Department of Human Development and Family Science, The Youth Development Institute, The University of Georgia, Athens, GA, 30602, USA
| | - Lawrence Sweet
- Department of Psychology, Behavioral and Brain Sciences Program, The University of Georgia, Athens, GA, 30602, USA
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Onaolapo OJ, Onaolapo AY. Melatonin in drug addiction and addiction management: Exploring an evolving multidimensional relationship. World J Psychiatry 2018; 8:64-74. [PMID: 29988891 PMCID: PMC6033744 DOI: 10.5498/wjp.v8.i2.64] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/06/2018] [Accepted: 05/10/2018] [Indexed: 02/05/2023] Open
Abstract
Melatonin is a pleiotropic signalling molecule that regulates several physiological functions, and synchronises biological rhythms. Recent evidences are beginning to reveal that a dysregulation of endogenous melatonin rhythm or action may play a larger role in the aetiology and behavioural expression of drug addiction, than was previously considered. Also, the findings from a number of animal studies suggest that exogenous melatonin supplementation and therapeutic manipulation of melatonin/melatonin receptor interactions may be beneficial in the management of behavioural manifestations of drug addiction. However, repeated exogenous melatonin administration may cause a disruption of its endogenous rhythm and be associated with potential drawbacks that might limit its usefulness. In this review, we examine the roles of melatonin and its receptors in addictive behaviours; discussing how our understanding of melatonin’s modulatory effects on the brain rewards system and crucial neurotransmitters such as dopamine has evolved over the years. Possible indications(s) for melatonergic agents in addiction management, and how manipulations of the endogenous melatonin system may be of benefit are also discussed. Finally, the potential impediments to application of melatonin in the management of addictive behaviours are considered.
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Affiliation(s)
- Olakunle J Onaolapo
- Behavioural Neuroscience/Neuropharmacology Unit, Department of Pharmacology and Therapeutics, Ladoke Akintola University of Technology, Osogbo 230263, Osun State, Nigeria
| | - Adejoke Y Onaolapo
- Behavioural Neuroscience/Neurobiology Unit, Department of Anatomy, Ladoke Akintola University of Technology, Ogbomosho 210211, Oyo State, Nigeria
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Chang LY, Chang HY, Wu WC, Lin LN, Wu CC, Yen LL. Dual Trajectories of Sleep Duration and Cigarette Smoking during Adolescence: Relation to Subsequent Internalizing Problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018. [DOI: 10.1007/s10802-018-0414-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Predictors of Smoking Cessation and Relapse in Cancer Patients and Effect on Psychological Variables: an 18-Month Observational Study. Ann Behav Med 2018; 51:117-127. [PMID: 27670773 DOI: 10.1007/s12160-016-9834-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Although cancer patients are generally strongly advised to quit smoking in order to improve treatment efficacy and survival, up to 68 % of patients who were smokers at the time of cancer diagnosis continue smoking. Psychological factors such as depression and anxiety are likely to be associated with smoking behavior following a cancer diagnosis, but the empirical evidence is scarce. PURPOSE This observational study aimed at estimating smoking cessation rates and assessing the effect of smoking cessation on psychological symptoms, as well as the predictive role of the same psychological variables on smoking cessation and smoking relapse following cancer surgery. METHODS As part of a larger prospective, epidemiological study, smokers (n = 175) with a first diagnosis of nonmetastatic cancer completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, and the Fear of Cancer Recurrence Inventory. Quitters (n = 55) and pair-matched nonquitters (n = 55) were compared on each symptom at pre-quitting, post-quitting, and at a 4-month follow-up. Predictors of smoking cessation and smoking relapse, including psychological variables, were also investigated. RESULTS Fifty-five patients (31.4 %) stopped smoking at least on one occasion during the study. Of the 55 quitters, 27 (49.1 %) experienced a relapse. At pre-quitting, quitters had significantly higher levels of anxiety (p = .03) and fear of cancer recurrence (p = .01) than nonquitters, symptoms that significantly diminished at post-quitting and 4 months later in this subgroup of patients. Having breast cancer significantly predicted smoking cessation (relative risk [RR] = 3.08), while depressive symptoms were a significant predictor of smoking relapse (RR = 1.07). CONCLUSIONS This study highlights the importance of psychological symptoms in predicting tobacco cessation and relapse among individuals with cancer. Our findings suggest that breast cancer patients are more inclined to stop smoking than patients with other cancers, but future studies should attempt to delineate the effect on smoking cessation of gender and other demographics that characterize this subgroup. This study also suggests that a particular attention should be paid to the early management of depressive symptoms in order to prevent smoking relapse.
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Abstract
The present systematic review examines whether very low nicotine content (VLNC) cigarettes ameliorate withdrawal-induced impairments in behavioral/cognitive performance. PubMed, PsycInfo, and Web of Science were searched for performance effects of VLNC cigarettes. For inclusion, reports had to be in English, published in a peer-reviewed journal through June 2017, examine VLNC cigarettes (<0.2mg nicotine yield), include ≥2hour smoking abstinence or reduced nicotine exposure, and examine performance. 19 of 1243 articles reviewed met inclusion criteria. Poorer performance after smoking VLNC versus normal nicotine content (NNC) cigarettes was observed across 7 of 10 domains, including reaction time (8/11), short-term memory (3/10), sustained attention (4/6), inhibitory control (1/4), long-term memory (3/3 studies), and response variability (2/2). In two studies, combining VLNC smoking with nicotine replacement therapy (NRT) resulted in performance that was comparable to performance after NNC smoking. VLNC versus NNC differences were not discerned in motor control/functioning (0/2), visuospatial processing (0/2), learning (0/1), or verbal fluency (0/1). Eleven of nineteen (58%) studies were rated of Good or Excellent quality. Overall, VLNC cigarettes may not fully ameliorate withdrawal-induced disruptions in performance, although this varies by domain, with the strongest evidence for reaction time. Importantly, combining VLNC cigarettes with NRT appears to ameliorate withdrawal that is not reduced by VLNC cigarettes alone. As only 19 studies were identified, many domains are under-investigated. A more thorough evaluation of the extent to which VLNC cigarettes affect withdrawal-impaired performance may be warranted.
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Peltier MR, Lee J, Ma P, Businelle MS, Kendzor DE. The influence of sleep quality on smoking cessation in socioeconomically disadvantaged adults. Addict Behav 2017; 66:7-12. [PMID: 27855299 DOI: 10.1016/j.addbeh.2016.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022]
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Short NA, Mathes BM, Gibby B, Oglesby ME, Zvolensky MJ, Schmidt NB. Insomnia symptoms as a risk factor for cessation failure following smoking treatment. ADDICTION RESEARCH & THEORY 2016; 25:17-23. [PMID: 29104521 PMCID: PMC5665381 DOI: 10.1080/16066359.2016.1190342] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Insomnia symptoms are associated with smoking, and may interfere with smoking cessation. Specifically, studies have shown that smoking-related sleep problems are associated with long-term smoking relapse, and longer sleep duration is associated with successful smoking cessation. However, it is currently unclear whether pre- or post-quit insomnia symptoms are associated with smoking cessation outcomes. As such, the current study aimed to extend previous findings by using a measure of insomnia symptoms as a predictor of smoking cessation failure by month 3 following smoking cessation treatment. Additionally, we examined whether post-quit insomnia symptoms predicted cessation outcomes. Results indicated that pre-, but not post-quit insomnia, predicted smoking cessation failure by 3 months post-cessation, after covarying for depressive symptoms, anxiety sensitivity, alcohol use disorder severity, treatment condition, and number of cigarettes per day. These findings add to the literature on insomnia symptoms as a risk factor for difficulties with smoking cessation, and suggest it may be a worthy clinical target for smoking populations who are interested in quitting smoking.
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Sleep Disturbance During Smoking Cessation: Withdrawal or Side Effect of Treatment? J Smok Cessat 2016; 12:63-70. [PMID: 28553407 DOI: 10.1017/jsc.2016.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The nicotine-metabolite ratio (NMR) predicts treatment response and is related to treatment side effect severity. Sleep disturbance may be one important side effect, but understanding sleep disturbance effects on smoking cessation is complicated by the fact that nicotine withdrawal also produces sleep disturbance. AIMS To evaluate the effects of withdrawal and treatment side effects on sleep disturbance. METHODS This is a secondary analysis of data from a clinical trial (Lerman et al., 2015) of 1,136 smokers randomised to placebo (n = 363), transdermal nicotine (TN; n = 381), or varenicline (n = 392) and stratified based on NMR (559 slow metabolisers; 577 normal metabolisers). Sleep disturbance was assessed at baseline and at 1-week following the target quit date (TQD). We also examined whether sleep disturbance predicted 7-day point-prevalence abstinence at end-of-treatment (EOT). RESULTS The varenicline and TN groups exhibited greater increases in sleep disturbance (vs. placebo; treatment × time interaction; p = 0.005), particularly among those who quit smoking at 1-week post-TQD. There was a main effect of NMR (p = 0.04), but no interactions with treatment. TN and varenicline attenuated withdrawal symptoms unrelated to sleep (vs. placebo). Greater baseline sleep disturbance predicted relapse at EOT (p = 0.004). CONCLUSIONS Existing treatments may not mitigate withdrawal-related sleep disturbance and adjunctive treatments that target sleep disturbance may improve abstinence rates.
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Obstructive Sleep Apnea and Smoking as a Risk Factor for Venous Thromboembolism Events: Review of the Literature on the Common Pathophysiological Mechanisms. Obes Surg 2015; 26:640-8. [DOI: 10.1007/s11695-015-2012-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
The aim of Addiction Biology is to advance our understanding of the action of drugs of abuse and addictive processes via the publication of high-impact clinical and pre-clinical findings resulting from behavioral, molecular, genetic, biochemical, neurobiological and pharmacological research. As of 2013, Addiction Biology is ranked number 1 in the category of Substance Abuse journals (SCI). Occasionally, Addiction Biology likes to highlight via review important findings focused on a particular topic and recently published in the journal. The current review summarizes a number of key publications from Addiction Biology that have contributed to the current knowledge of nicotine research, comprising a wide spectrum of approaches, both clinical and pre-clinical, at the cellular, molecular, systems and behavioral levels. A number of findings from human studies have identified, using imaging techniques, alterations in common brain circuits, as well as morphological and network activity changes, associated with tobacco use. Furthermore, both clinical and pre-clinical studies have characterized a number of mechanistic targets critical to understanding the effects of nicotine and tobacco addiction. Together, these findings will undoubtedly drive future studies examining the dramatic impact of tobacco use and the development of treatments to counter nicotine dependence.
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Affiliation(s)
- Rick E. Bernardi
- Institute of Psychopharmacology; Central Institute of Mental Health; Medical Faculty Mannheim/Heidelberg University; Germany
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Jaehne A, Unbehaun T, Feige B, Cohrs S, Rodenbeck A, Schütz AL, Uhl V, Zober A, Riemann D. Sleep changes in smokers before, during and 3 months after nicotine withdrawal. Addict Biol 2015; 20:747-55. [PMID: 24797355 DOI: 10.1111/adb.12151] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nicotine may affect sleep by influencing sleep-regulating neurotransmitters. Sleep disorders can increase the risk for depression and substance dependency. To detect the influence of sleep disturbances on the effect of smoking cessation, we investigated polysomnographically (PSG) the sleep of smoking subjects during a period of smoking, during withdrawal and after a period of abstinence from nicotine. Thirty-three smokers (23 male, 10 female, median age 29 years, Fagerström Test for Nicotine Dependence score 6.3) were examined during smoking, 24-36 hours after smoking and 3 months after cessation. All subjects had an adaptation night followed by the PSG night. Compared with the smoking state, we found increased arousal index and wake time during nicotine withdrawal. Smokers who later relapsed (11) presented a higher degree of nicotine dependence and more withdrawal symptoms than those who abstained (22) and were characterized by less rapid eye movement (REM) sleep, a longer REM latency as well as by more intense sleep impairments in the subjective sleep rating during the withdrawal. Impairments of sleep during the withdrawal phase may reflect more severe nicotine dependence and may contribute to earlier relapse into smoking behaviours.
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Affiliation(s)
- Andreas Jaehne
- Department of Psychiatry and Psychotherapy; Freiburg University Medical Center; Freiburg Germany
| | - Thomas Unbehaun
- Department of Psychiatry and Psychotherapy; Freiburg University Medical Center; Freiburg Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy; Freiburg University Medical Center; Freiburg Germany
| | - Stefan Cohrs
- Department of Sleep Medicine; St. Hedwig Clinic; Berlin Germany
- Department of Physiology, Sleep Medicine and Chronobiology; Charité; Berlin Germany
- Department of Psychiatry and Psychotherapy; Georg-August University; Göttingen Germany
| | - Andrea Rodenbeck
- Department of Physiology, Sleep Medicine and Chronobiology; Charité; Berlin Germany
- Department of Psychiatry and Psychotherapy; Georg-August University; Göttingen Germany
| | - Anna-Lisa Schütz
- Department of Psychiatry and Psychotherapy; Freiburg University Medical Center; Freiburg Germany
| | - Verena Uhl
- Department of Psychiatry and Psychotherapy; Freiburg University Medical Center; Freiburg Germany
| | - Alexander Zober
- Department of Psychiatry and Psychotherapy; Freiburg University Medical Center; Freiburg Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy; Freiburg University Medical Center; Freiburg Germany
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An association between the use of hypnotics and quit status in the treatment of nicotine dependence with varenicline in bipolar disorder. J Clin Psychopharmacol 2015; 35:199-200. [PMID: 25627075 PMCID: PMC4344405 DOI: 10.1097/jcp.0000000000000272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krishnan V, Dixon-Williams S, Thornton JD. Where there is smoke…there is sleep apnea: exploring the relationship between smoking and sleep apnea. Chest 2015; 146:1673-1680. [PMID: 25451354 DOI: 10.1378/chest.14-0772] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Smoking and OSA are widely prevalent and are associated with significant morbidity and mortality. It has been hypothesized that each of these conditions adversely affects the other, leading to increased comorbidity while altering the efficacy of existing therapies. However, while the association between smoking and OSA is plausible, the evidence is less than conclusive. Cigarette smoking may increase the severity of OSA through alterations in sleep architecture, upper airway neuromuscular function, arousal mechanisms, and upper airway inflammation. Conversely, some evidence links untreated OSA with smoking addiction. Smoking cessation should improve OSA, but the evidence to support this is also limited. This article reviews the current evidence linking both conditions and the efficacy of various treatments. Limitations of the current evidence and areas in need of future investigation are also addressed.
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Affiliation(s)
- Vidya Krishnan
- Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, OH.
| | - Sherrie Dixon-Williams
- Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - J Daryl Thornton
- Division of Pulmonary, Critical Care, and Sleep Medicine, Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, OH
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The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Med Rev 2014; 22:23-36. [PMID: 25454674 DOI: 10.1016/j.smrv.2014.10.001] [Citation(s) in RCA: 424] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 08/01/2014] [Accepted: 10/03/2014] [Indexed: 02/03/2023]
Abstract
The ineffectiveness of sleep hygiene as a treatment in clinical sleep medicine has raised some interesting questions. If it is known that, individually, each specific component of sleep hygiene is related to sleep, why wouldn't addressing multiple individual components (i.e., sleep hygiene education) improve sleep? Is there still a use for sleep hygiene? Global public health concern over sleep has increased demand for sleep promotion strategies accessible to the population. However, the extent to which sleep hygiene strategies apply outside clinical settings is not well known. The present review sought to evaluate the empirical evidence for sleep hygiene recommendations regarding exercise, stress management, noise, sleep timing, and avoidance of caffeine, nicotine, alcohol, and daytime napping, with a particular emphasis on their public health utility. Thus, our review is not intended to be exhaustive regarding the clinical application of these techniques, but rather to focus on broader applications. Overall, though epidemiologic and experimental research generally supported an association between individual sleep hygiene recommendations and nocturnal sleep, the direct effects of individual recommendations on sleep remains largely untested in the general population. Suggestions for clarification of sleep hygiene recommendations and considerations for the use of sleep hygiene in nonclinical populations are discussed.
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Abstract
Substance use disorders (SUD) are common and individuals who suffer from them are prone to relapse. One of the most common consequences of the use of and withdrawal from substances of abuse is sleep disturbance. Substances of abuse affect sleep physiology, including the neurotransmitter systems that regulate the sleep-wake system. Emerging research now highlights an interactive effect between sleep disorders and substance use. New findings in alcohol and sleep research have utilized sophisticated research designs and expanded the scope of EEG and circadian rhythm analyses. Research on marijuana and sleep has progressed with findings on the effects of marijuana withdrawal on objective and subjective measures of sleep. Treatment studies have focused primarily on sleep in alcohol use disorders. Therapies for insomnia in cannabis disorders are needed. Future research is poised to further address mechanisms of sleep disturbance in alcoholics and the effect of medical marijuana on sleep and daytime functioning.
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Cohrs S, Rodenbeck A, Riemann D, Szagun B, Jaehne A, Brinkmeyer J, Gründer G, Wienker T, Diaz-Lacava A, Mobascher A, Dahmen N, Thuerauf N, Kornhuber J, Kiefer F, Gallinat J, Wagner M, Kunz D, Grittner U, Winterer G. Impaired sleep quality and sleep duration in smokers-results from the German Multicenter Study on Nicotine Dependence. Addict Biol 2014; 19:486-96. [PMID: 22913370 DOI: 10.1111/j.1369-1600.2012.00487.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cigarette smoking is a severe health burden being related to a number of chronic diseases. Frequently, smokers report about sleep problems. Sleep disturbance, in turn, has been demonstrated to be involved in the pathophysiology of several disorders related to smoking and may be relevant for the pathophysiology of nicotine dependence. Therefore, determining the frequency of sleep disturbance in otherwise healthy smokers and its association with degree of nicotine dependence is highly relevant. In a population-based case-control study, 1071 smokers and 1243 non-smokers without lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorder were investigated. Sleep quality (SQ) of participants was determined by the Pittsburgh Sleep Quality Index. As possible confounders, age, sex and level of education and income, as well as depressiveness, anxiety, attention deficit hyperactivity, alcohol drinking behaviour and perceived stress, were included into multiple regression analyses. Significantly more smokers than non-smokers (28.1% versus 19.1%; P < 0.0001) demonstrated a disturbed global SQ. After controlling for the confounders, impaired scores in the component scores of sleep latency, sleep duration and global SQ were found significantly more often in smokers than non-smokers. Consistently, higher degrees of nicotine dependence and intensity of smoking were associated with shorter sleep duration. This study demonstrates for the first time an elevated prevalence of sleep disturbance in smokers compared with non-smokers in a population without lifetime history of psychiatric disorders even after controlling for potentially relevant risk factors. It appears likely that smoking is a behaviourally modifiable risk factor for the occurrence of impaired SQ and short sleep duration.
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Affiliation(s)
- Stefan Cohrs
- Department of Sleep Medicine; St. Hedwig Clinic Berlin; Berlin Germany
- Institute of Physiology, Sleepresearch & Clinical Chronobiology, Charité; Berlin Germany
- Department of Psychiatry and Psychotherapy; Georg-August University Göttingen; Göttingen Germany
| | - Andrea Rodenbeck
- Institute of Physiology, Sleepresearch & Clinical Chronobiology, Charité; Berlin Germany
- Department of Psychiatry and Psychotherapy; Georg-August University Göttingen; Göttingen Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy; University of Freiburg; Freiburg Germany
| | - Bertram Szagun
- University of Applied Sciences; Ravensburg-Weingarten Germany
| | - Andreas Jaehne
- Department of Psychiatry and Psychotherapy; University of Freiburg; Freiburg Germany
| | - Jürgen Brinkmeyer
- Department of Psychiatry; Heinrich-Heine University Düsseldorf; Düsseldorf Germany
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy, and Psychosomatics; RWTH Aachen University; Aachen Germany
| | - Thomas Wienker
- Institute of Medical Biometry, Informatics and Epidemiology; University of Bonn; Bonn Germany
| | - Amalia Diaz-Lacava
- Institute of Medical Biometry, Informatics and Epidemiology; University of Bonn; Bonn Germany
- Cologne Center for Genomics (CCG); Cologne University; Cologne Germany
| | - Arian Mobascher
- Department of Psychiatry; Johannes Gutenberg University; Mainz Germany
| | - Norbert Dahmen
- Department of Psychiatry; Johannes Gutenberg University; Mainz Germany
| | - Norbert Thuerauf
- Department of Psychiatry; Friedrich-Alexander University; Erlangen-Nuernberg Germany
| | - Johannes Kornhuber
- Department of Psychiatry; Friedrich-Alexander University; Erlangen-Nuernberg Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addictive Medicine; Central Institute of Mental Health; Mannheim Germany
| | - Jürgen Gallinat
- Department of Psychiatry; Charité University Hospital; Berlin Germany
| | - Michael Wagner
- Department of Psychiatry; University of Bonn; Bonn Germany
| | - Dieter Kunz
- Department of Sleep Medicine; St. Hedwig Clinic Berlin; Berlin Germany
- German Heart Institute; Berlin Germany
| | - Ulrike Grittner
- Department of Biostatistics and Clinical Epidemiology; Charité- University Medicine; Berlin Germany
| | - Georg Winterer
- Cologne Center for Genomics (CCG); Cologne University; Cologne Germany
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Vandrey R, Babson KA, Herrmann ES, Bonn-Miller MO. Interactions between disordered sleep, post-traumatic stress disorder, and substance use disorders. Int Rev Psychiatry 2014; 26:237-47. [PMID: 24892898 PMCID: PMC4052373 DOI: 10.3109/09540261.2014.901300] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Disordered sleep is associated with a number of adverse health consequences and is an integral component of many psychiatric disorders. Rates of substance use disorders (SUDs) are markedly higher among individuals with post-traumatic stress disorder (PTSD), and this relationship may be partly mediated by disturbed sleep. Sleep disturbances (e.g. insomnia, daytime sleepiness, vivid nightmares) are hallmark features of PTSD and there is evidence that individuals with PTSD engage in substance use as a means of coping with these symptoms. However, prolonged substance use can lead to more severe sleep disturbances due to the development of tolerance and withdrawal. Behavioural or pharmacological treatment of disordered sleep is associated with improved daytime symptoms and psychosocial functioning among individuals who have developed PTSD. Initial research also suggests that improving sleep could be similarly beneficial in reducing coping oriented substance use and preventing relapse among those seeking treatment for SUDs. Together, these findings suggest that ameliorating sleep disturbance among at-risk individuals would be a viable target for the prevention and treatment of PTSD and associated SUDs, but prospective research is needed to examine this hypothesis. Enhanced understanding of the interrelation between sleep, PTSD, and SUDs may yield novel prevention and intervention approaches for these costly, prevalent and frequently co-occurring disorders.
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Affiliation(s)
- Ryan Vandrey
- Johns Hopkins University School of Medicine, University of Pennsylvania
| | - Kimberly A. Babson
- Center for Innovation to Implementation, VA Palo Alto Health Care System, University of Pennsylvania
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, University of Pennsylvania
| | - Evan S. Herrmann
- Johns Hopkins University School of Medicine, University of Pennsylvania
| | - Marcel O. Bonn-Miller
- Center for Innovation to Implementation, VA Palo Alto Health Care System, University of Pennsylvania
- Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VAMC; Department of Psychiatry, University of Pennsylvania
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Abstract
Despite its pervasiveness in primary care, deficient sleep often is underappreciated as a cue to other health risks. Accordingly, this review discusses contemporary evidence-based perspectives on impaired sleep and its associations with other lifestyle medicine concerns, including obesity, cardiovascular conditions, psychological problems, and health-compromising habits. The potential clinical benefits of promoting sleep health also will be considered.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
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McNamara JP, Wang J, Holiday DB, Warren JY, Paradoa M, Balkhi AM, Fernandez-Baca J, McCrae CS. Sleep disturbances associated with cigarette smoking. PSYCHOL HEALTH MED 2013; 19:410-9. [DOI: 10.1080/13548506.2013.832782] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Alt JA, Smith TL, Mace JC, Soler ZM. Sleep quality and disease severity in patients with chronic rhinosinusitis. Laryngoscope 2013; 123:2364-70. [PMID: 23918740 DOI: 10.1002/lary.24040] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/07/2013] [Accepted: 01/15/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate sleep quality in patients with chronic rhinosinusitis (CRS) using a validated outcome measure and to compare measures of CRS disease severity with sleep dysfunction. STUDY DESIGN Cross-sectional evaluation of a multi-center cohort. METHODS According to the 2007 Adult Sinusitis Guidelines, patients with CRS were prospectively enrolled from four academic, tertiary care centers across North America. Each subject completed the Pittsburgh Sleep Quality Index (PSQI) instrument, in addition to CRS-specific measures of quality-of-life (QOL), endoscopy, computed tomography (CT), and olfaction. Patient demographics, comorbid conditions, and clinical measures of disease severity were compared between patients with "good" (PSQI; ≤5) and "poor" (PSQI; > 5) sleep quality. RESULTS Patients (n = 268) reported a mean PSQI score of 9.4 (range: 0-21). Seventy-five percent of patients reported PSQI scores above the traditional cutoff, indicating poor sleep quality. Patients with poor sleep quality were found to have significantly worse QOL scores on both the Rhinosinusitis Disability Index (P < 0.001) and 22-item Sinonasal Outcome Test (P < 0.001). No significant differences in average endoscopy, CT, or olfactory function scores were found between patients with good or poor sleep quality. Tobacco smokers reported worse average PSQI total scores compared to nonsmokers (P = 0.030). Patients reporting poor sleep were more likely to have a history of depression, even after controlling for gender (P = 0.020). CONCLUSION The majority of patients with CRS have a poor quality of sleep, as measured by the PSQI survey. Poor sleep quality is significantly associated with CRS-specific QOL, gender, comorbid depression, and tobacco use, but not CT score or endoscopy grade. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health and Science University, Portland, Oregon
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How smoking affects sleep: A polysomnographical analysis. Sleep Med 2012; 13:1286-92. [DOI: 10.1016/j.sleep.2012.06.026] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/19/2012] [Accepted: 06/27/2012] [Indexed: 11/15/2022]
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Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters. J Occup Environ Med 2011; 53:928-33. [PMID: 21785370 DOI: 10.1097/jom.0b013e318225898f] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Little attention has been given to factors contributing to firefighters' psychosomatic well-being. The purpose of this descriptive study was to examine such contributing factors in a sample of professional firefighters. METHODS Measures assessing sleep, depression, substance use, social bonding, and quality of life were examined in 112 firefighters. RESULTS Overall, many firefighters reported sleep deprivation (59%), binge drinking behavior (58%), poor mental well-being (21%), current nicotine use (20%), hazardous drinking behavior (14%), depression (11%), poor physical well-being (8%), caffeine overuse (5%), or poor social bonding (4%). CONCLUSIONS Small-to-medium correlations were identified between sleep deprivation, depression, physical/mental well-being, and drinking behaviors. High-risk behaviors that impact psychosomatic well-being are prevalent in professional firefighters, which require environmental and individual-based health promotion interventions. The inter-correlation relationships between such behaviors, therefore, need to be explored in further details.
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van de Water AT, Eadie J, Hurley DA. Investigation of sleep disturbance in chronic low back pain: An age- and gender-matched case-control study over a 7-night period. ACTA ACUST UNITED AC 2011; 16:550-6. [DOI: 10.1016/j.math.2011.05.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 04/26/2011] [Accepted: 05/09/2011] [Indexed: 11/17/2022]
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Lopez-Campos JL, Alvarez-Gutiérrez FJ, Vellisco A, Medina JF, Barrot E. Factors predicting the initiation of a tobacco cessation program in Spain. Am J Addict 2011; 20:575-80. [PMID: 21999505 DOI: 10.1111/j.1521-0391.2011.00175.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
There have been limited studies regarding the characteristics of subjects who have decided to initiate a cessation program to quit tobacco smoking. Identifying such characteristics is important because it provides information regarding recruiting and tailoring strategies, as well as intervention methods. This observational trial with cross-sectional data analysis sought to identify the characteristics of subjects who have decided to initiate a smoking cessation program compared with those who did not. All subjects who asked for information about our cessation program between January 2000 and December 2005 were eligible for participation. All subjects were interviewed regarding their tobacco consumption practices. We also collected information on medical history and psychological conditions. Multivariate analysis was used to identify variables associated with the decision to initiate the cessation program. A total of 1,681 subjects asked for information about smoking cessation at our center, and 1,132 (67.3%) decided to enter our program. Independent factors associated with the decision to initiate the cessation program included female gender (OR: 1.54; 95% CI:1.23-1.93), having a university degree (OR: 1.46; 95% CI: 1.12-1.88), bronchial asthma (OR: 0.41; 95% CI: 0.24-0.71), nonpsychotic psychiatric disorders (OR: 0.52; 95% CI: 0.40-0.66), psychotic disorders (OR: 6.00; 95% CI: 2.74-13.14), and a history of insomnia (OR: 6.22; 95% CI: 1.85-20.87). Although all smokers should be counseled to quit smoking, our data may help to concentrate efforts on some subjects in order to increase the participation in smoking cessation programs.
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Affiliation(s)
- Jose Luis Lopez-Campos
- Centro de Especialidades Dr. Fleming, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Seville, Spain.
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Subjective sleep disturbance during a smoking cessation program: associations with relapse. Addict Behav 2011; 36:861-4. [PMID: 21482029 DOI: 10.1016/j.addbeh.2011.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 01/18/2011] [Accepted: 03/02/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sleep disturbance may affect smoking cessation efforts. We describe sleep changes across three months among women in a smoking cessation program and tested whether sleep disturbances at baseline and 1 month post-quit attempt predicted smoking status at three months. METHODS Participants (N=322) were women in a randomized, clinical trial for smoking cessation. Sleep disturbances, as well as, insomnia, drowsiness, and sleep quality were evaluated prior to and during three months of cessation treatment. Repeated measures mixed models evaluated change in sleep over time by smoking outcome status. Logistic regression analyses determined whether sleep disturbances at baseline and 1 month post-quit were associated with smoking status at 3 months. RESULTS Sleep disturbances were reported by more than 25% of women. Drowsiness, insomnia, and sleep quality changed over time. However, contrary to our hypotheses, none of the sleep variables at either baseline or 1 month post-quit attempt was associated with relapse (p's>.05). CONCLUSIONS Although mild to severe drowsiness was reported by more women who relapsed than those who remained abstinent, none of the sleep disturbance symptoms predicted smoking relapse. Given high rates of sleep disturbances among women smokers, better prospective evaluations of the relationship of sleep disturbances to smoking cessation treatment outcome are needed.
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L-DOPA attenuates nicotine withdrawal-induced behaviors in rats. Pharmacol Biochem Behav 2011; 98:552-8. [DOI: 10.1016/j.pbb.2011.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/27/2011] [Accepted: 02/07/2011] [Indexed: 11/19/2022]
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