Sleep changes in smokers before, during and 3 months after nicotine withdrawal

Exploring the relationship between smoking and poor sleep quality: a cross-sectional study using NHANES

Introduction

Sleeping disorders is a high prevalent disorder, and although previous research has suggested a link between smoking and sleep disorders, there is a lack of large-scale, nationally representative studies examining this association across multiple sleep outcomes and exploring dose-response relationships.

Methods

This study used data from 30,269 participants from the NHANES database (2007-2020). Weighted logistic regression models were used to assess the associations between smoking status (non-smoker, light smoker, moderate smoker, and heavy smoker) and various sleep outcomes, including insufficient sleep duration, reported sleep problems, snoring, snorting, or stopping breathing during sleep, and daytime sleepiness. Dose-response relationships were explored using restricted cubic splines.

Results

Compared to non-smokers, heavy smokers had significantly higher odds of experiencing insufficient sleep duration with OR 1.732 (95% CI 1.528-1.963, P <0.001), reported sleep problems with OR 1.990 (95% CI 1.766-2.243, P <0.001), occasional or frequent snoring with OR 1.908 (95% CI 1.164-3.128, P = 0.03), and occasional or frequent snorting or stopping breathing during sleep with OR 1.863 (95% CI 1.183-2.936, P = 0.022), while results for sometimes, often or almost always being overly sleepy during the day with OR 1.257 (95% CI 0.872-1.810, P = 0.115) are not significant. A trend of positive correlation was observed between smoking and all sleep disorder outcomes (P for trend < 0.05). Dose-response analyses revealed that the odds of these sleep outcomes increased with higher smoking levels.

Conclusion

Smoking is significantly associated with various sleep disorders, and a dose-response relationship exists between smoking levels and the odds of experiencing these sleep problems. These findings underscore the importance of addressing smoking as a modifiable risk factor for poor sleep health and suggest that reducing smoking, even if complete cessation is not achieved, may have positive effects on sleep outcomes.

The positive impact of smoking on poor sleep quality is moderated by IGF1 levels in cerebrospinal fluid: a case-control study among Chinese adults

Objective

Previous research indicates associations between cigarette smoking, insulin-like growth factor-1 (IGF1), and sleep disturbances. This study aimed to examine the association between smoking and sleep quality and investigate the moderating role of IGF1.

Methods

This case-control study involved 146 Chinese adult males (53 active smokers and 93 non-smokers) from September 2014 to January 2016. Sleep quality and disturbances were evaluated using the Pittsburgh Sleep Quality Index (PSQI), which includes seven scales. Pearson correlation analysis and logistic regression analysis were utilized to examine the link between IGF1 levels in cerebrospinal fluid (CSF) and PSQI scores. The effect of IGF1 was assessed using the moderation effect and simple slope analysis, with adjustments made for potential confounders.

Results

Active smokers exhibited significantly higher global PSQI scores and lower IGF1 levels in CSF compared to non-smokers. A significant negative correlation was observed between IGF1 and PSQI scores (â = -0.28, P < 0.001), with a stronger association in non-smokers (Pearson r = -0.30) compared to smokers (Pearson r = -0.01). Smoking was associated with higher global PSQI scores (â = 0.282, P < 0.001), and this association was moderated by IGF1 levels in CSF (â = 0.145, P < 0.05), with a stronger effect at high IGF1 levels (Bsimple = 0.402, p < 0.001) compared to low IGF1 levels (Bsimple = 0.112, p = 0.268). Four subgroup analysis revealed similar results for sleep disturbances (Bsimple = 0.628, P < 0.001), with a marginal moderation effect observed on subjective sleep quality (Bsimple = 0.150, P = 0.070). However, independent associations rather than moderating effects were observed between IGF1 and sleep efficiency and daytime disturbance.

Conclusion

We provided evidence to demonstrate the moderation effect of IGF1 on the relationship between smoking and sleep in CSF among Chinese adult males.

"The worst thing is lying in bed thinking 'I want a cigarette'" a qualitative exploration of smoker's and ex-smoker's perceptions of sleep during a quit attempt and the use of cognitive behavioural therapy for insomnia to aid cessation

Smokers report poorer sleep quality than non-smokers and sleep quality deteriorates further during cessation, increasing risk of smoking relapse. Despite the use of cognitive behavioural therapy for insomnia (CBT-I) to aid quit attempts emerging in the area, little is known about smokers and ex smoker's experiences of sleep during a quit attempt or their perceptions of CBT-I. This study addresses this gap by exploring smoker's and ex-smoker's experiences of the link between smoking and sleep and how this may change as a function of smoking/smoking abstinence. It also explores views of traditional CBT-I components (i.e., perceived feasibility, effectiveness, barriers of use). We conducted semi-structured interviews with current and recently quit smokers (n = 17) between January and September 2022. The framework method was used for analysis. Four themes addressing research questions were described. These included: 1) A viscous cycle; poor sleep quality and negative psychological state during cessation; 2) Perceived engagement and effectiveness; the importance of feasibility, experience, value, identity and psychological state in assessing CBT-I as a cessation tool; 3) Striking a balance; tailoring CBT-I to reduce psychological overload in a time of lifestyle transition; and 4) Personalisation and digital delivery helping overcome psychological barriers during cessation. The analysis suggested during quit attempts smokers experienced a range of sleep problems that could increase risk of relapse due to a negative impact on psychological state. It also revealed participants thought that CBT-I is something they would use during a quit attempt but suggested changes and additions that would improve engagement and be better tailored to quitting smokers. Key additions included the integration of smoking-based cognitive restructuring, starting the intervention prior to a quit attempt, and the need for personalisation and tailoring.

Body weight change during a smoking cessation intervention for individuals with overweight or obesity

INTRODUCTION

A more comprehensive understanding of the factors regarding weight control in individuals with overweight or obesity after quitting smoking is needed. The study aimed to analyze the changes of in-treatment variables during a smoking cessation intervention and examine their impact on weight.

METHODS

A total of 120 individuals who smoke with overweight or obesity (MBMI = 31.75 ± 4.31; 54.16 % female) participated in a cognitive-behavioral therapy for smoking cessation and weight control or the same treatment plus contingency management. Weight, smoking variables (cotinine and continuous abstinence), eating behaviors (appetite, grazing), exercise, and sleep were assessed weekly throughout the treatment.

RESULTS

More participants gained weight over time with reduced nicotine use or abstinence. There was a tendency during treatment to increase appetite and exercise time, while grazing episodes and sleeping hours remained stable. Higher baseline weight (p < .001), greater cotinine reduction (p = .021) and time (p = .009) were associated with greater weight gain, while more hours of exercise (p = .003), no appetite changes (p = .003) and diminished appetite (p < .001) were associated with less gain over the treatment. Both treatment conditions showed similar results in all in-treatment variables.

DISCUSSION

Individuals with overweight and obesity with higher baseline weight and higher baseline cotinine levels during smoking cessation interventions may require special attention to improve weight outcomes. Exercise and appetite regulation may be useful for mitigating weight gain in smoking cessation interventions for individuals with overweight or obesity.

Effects of smoking on sleep architecture and ventilatory parameters including apneas: Results of the Tab-OSA study

Background

The interaction between smoking and sleep seems appears to be bidirectional, but few studies evaluated the impact of smoking and its cessation on objective sleep parameters. In this context, this new study aimed to assess the impact of smoking and its cessation on sleep architecture and on ventilatory sleep parameters, particularly the presence of sleep apnea syndrome (apnea-hypopnea index (AHI)≥15). Methods: Patients hospitalized for polysomnographic sleep exploration were compared according to their smoking status: active smokers (AS), former smokers (FS), non-smokers (NoNi). Psychiatric and non-psychiatric co-morbidities and treatment or substance use were taken into account in the analyses.

Results

A total of 170 participants were included (N = 37 FS, 39 AS, 86 NoNi). A significant decrease in the mean nocturnal O2 saturation was observed for FS and AS compared to NoNi. No differences were found regarding AHI. Regarding sleep architecture, we observed a significant decrease in the slow wave sleep duration for AS compared to NoNi, and interestingly not between FS and NoNi.

Conclusion

This study suggests that current smokers suffer from alterations in both sleep architecture and ventilatory parameters, the later appears to persist even after smoking cessation.

Association between smoking status and subjective quality of sleep in the South Korean population: a cross-sectional study

PURPOSE

This study aimed to investigate the relationship between smoking and subjective sleep quality in the Korean adult population.

METHODS

We designed a cross-sectional survey using data from the 2018 Korean Community Health Service Conditions Survey and selected smoking status as our variable of interest. We divided the participants into people who currently, never, and formerly smoked, those who smoked < 20 cigarettes/day, and those who smoked > 20 cigarettes/day. Subjective sleep quality was analyzed using the Pittsburgh Sleep Quality Index. Multiple logistic regression analysis was performed for statistical analysis.

RESULTS

A total of 174,665 participants were enrolled. People who formerly and currently smoked were found to have poorer subjective sleep quality than those who never smoked. The odds of poor subjective sleep quality in people who smoked > 20 cigarettes/day were 1.15 times (95% confidence interval: 1.09-1.21) for men and 1.51 times (95% confidence interval: 1.22-1.86) for women, compared with men and women who never smoked.

CONCLUSIONS

Smoking was negatively associated with subjective sleep quality. Smoking cessation programs and lifestyle improvement education may be justifiable to improve the quality of sleep in Korean adults.

Substance Use and Sleep Problems in Patients With Psychotic Disorders

Background

Substance use and sleep problems are common in patients with psychotic disorders, but their associations in these patients have not been evaluated. We aimed to investigate associations between substance use and sleep problems in a large nationwide cohort of patients with a psychotic disorder.

Study Design

This study is part of the Finnish SUPER study, which belongs to the Stanley Global Neuropsychiatric Genomics Initiative. In this cross-sectional, multicenter study, participants (N = 8616) were recruited from primary and specialized healthcare. Patients with schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression were included. Information on current alcohol (Alcohol Use Disorders Identification Test-Concise) and cigarette use as well as on lifetime illicit drug use, including cannabis, benzodiazepines, amphetamines, and opioids, was collected using questionnaires. The sleep outcomes in our logistic regression analysis were short (≤6 h) and long sleep (≥10 h) duration, difficulties initiating asleep, early morning awakenings, fatigue, and poor sleep quality (SQ).

Results

Self-reported substance use was associated with a higher prevalence of sleep problems. After adjustments with age, gender, diagnostic group, and living status, hazardous alcohol use (eg, poor SQ odds ratio [OR] = 1.80, 95% CI: 1.49 to 2.16, P < .001), current smoking (short sleep duration OR = 1.28, 95% CI: 1.08 to 1.52, P = .005), and lifetime benzodiazepine misuse (difficulties initiating sleep OR = 2.00, 95% CI: 1.55 to 2.48, P < .001) were associated with sleep problems.

Conclusions

Substance use was associated with sleep problems. Our findings underline the potential benefits of screening substance use when treating sleep problems in patients with psychotic disorders.

Rapid Eye Movement Sleep Engages Melanin-Concentrating Hormone Neurons to Reduce Cocaine Seeking

BACKGROUND

Persistent sleep disruptions following withdrawal from abused drugs may hold keys to battle drug relapse. It is posited that there may be sleep signatures that predict relapse propensity, identifying which may open new avenues for treating substance use disorders.

METHODS

We trained male rats (approximately postnatal day 56) to self-administer cocaine. After long-term drug withdrawal (approximately postnatal day 100), we examined the correlations between the intensity of cocaine seeking and key sleep features. To test for causal relationships, we then used behavioral, chemogenetic, or optogenetic methods to selectively increase rapid eye movement sleep (REMS) and measured behavioral and electrophysiological outcomes to probe for cellular and circuit mechanisms underlying REMS-mediated regulation of cocaine seeking.

RESULTS

A selective set of REMS features was preferentially associated with the intensity of cue-induced cocaine seeking after drug withdrawal. Moreover, selectively increasing REMS time and continuity by environmental warming attenuated a withdrawal time-dependent intensification of cocaine seeking, or incubation of cocaine craving, suggesting that REMS may benefit withdrawal. Warming increased the activity of lateral hypothalamic melanin-concentrating hormone (MCH) neurons selectively during prolonged REMS episodes and counteracted cocaine-induced synaptic accumulation of calcium-permeable AMPA receptors in the nucleus accumbens-a critical substrate for incubation. Finally, the warming effects were partly mimicked by chemogenetic or optogenetic stimulations of MCH neurons during sleep, or intra-accumbens infusions of MCH peptide during the rat's inactive phase.

CONCLUSIONS

REMS may encode individual vulnerability to relapse, and MCH neuron activities can be selectively targeted during REMS to reduce drug relapse.

Dual Orexin Receptor Antagonists (DORAs) as an Adjunct Treatment for Smoking Cessation

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.

Can exercise alleviate sleep disturbances during acute nicotine withdrawal in cigarette smokers?

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).

The impact of cigarette smoking on the quality of sleep in Polish men

Quality of sleep directly impacts quality of life, whilst lifestyle significantly impacts night rest. Cigarette smoking is a serious threat to overall health, including sleep. Nicotine in cigarettes affects the nervous system, whilst the respiratory system is impacted by carcinogenic substances, such as dusts and tarred substances, inhaled with smoke. Cigarettes are assumed to be a risk factor in sleep disorders, including breathing sleep disorders.

This study’s aim was to analyze the impact of cigarette smoking on adult men’s polysomnographic parameters.

Polysomnographic records for 94 adult men were obtained from the polysomnography laboratory in Opolskie Province, Poland. Additionally co-morbidities, height, weight and frequency of smoking were also noted. Three groups of men were categorised according to the frequency with which they smoked: non-smokers, smoking less than a pack a day, smoking more than a pack a day.

Compared to non-smokers and mild smokers, men who were heavy smokers also exhibited the longest sleepless time (H=8.11; p=0.017), the maximum waking time following the onset of sleep (H=7.99; p= 0.018), the lowest sleep efficiency across the three groups (H=7.96; p=0.019), the greatest number of apnea events per hour of sleep (H=6.23; p= 0.045), the lowest Oxygen Level Nadir (H=11.44; p= 0.003) and the highest rate of limb movements per hour of sleep (H=9.81; p=0.007).

The dose effect was identified, which correlated more cigarettes men smoked per day with lower sleep quality.

Varenicline administration for smoking cessation may reduce apnea hypopnea index in sleep apnea patients

OBJECTIVE/BACKGROUND

Varenicline (VAR) is used for smoking cessation as it inhibits nicotine for binding on its receptors reducing nicotine dependence. VAR administration has been reported to affect sleep. The aim of this study was to evaluate possible changes in polysomnography (PSG) during VAR treatment (SmokeFreeBrain) in healthy smokers and smokers with obstructive sleep apnea (OSA).

PATIENTS/METHODS

Thirty smokers (21 men) with 15.3 ± 10.2 PY, aged 32.8 ± 4.5 years, with BMI 28.6 ± 4 kg/m², 16 without and 14 with OSA (92% males) were studied with PSG (Embletta MPR-Master) before treatment with VAR while smoking and 20-30 days during VAR administration and smoking cessation for at least 5 days.

RESULTS

No significant differences were observed in sleep macro architecture (N1, N2, N3, REM, Sleep Efficiency, Total Sleep Time) during VAR treatment apart from prolongation of sleep latency, N2 and N3 latency in both smokers with and without OSA. Apnea hypopnea index (AHI) was reduced in OSA smokers and especially during REM with a borderline increase of arousal index (ArI) and reduction of sleep efficiency (SE).

CONCLUSION

VAR treatment worsened sleep quality as a prolongation of sleep latency, N2 and N3 latency was observed. A marginal reduction of AHI was found in OSA patients, more significantly during REM. Due to the small sample size, further studies are needed to distinguish between the adverse reactions of VAR treatment and smoking cessation effects and to evaluate whether VAR may play a role in OSA treatment.

Cocaine-induced neural adaptations in the lateral hypothalamic melanin-concentrating hormone neurons and the role in regulating rapid eye movement sleep after withdrawal

Sleep abnormalities are often a prominent contributor to withdrawal symptoms following chronic drug use. Notably, rapid eye movement (REM) sleep regulates emotional memory, and persistent REM sleep impairment after cocaine withdrawal negatively impacts relapse-like behaviors in rats. However, it is not understood how cocaine experience may alter REM sleep regulatory machinery, and what may serve to improve REM sleep after withdrawal. Here, we focus on the melanin-concentrating hormone (MCH) neurons in the lateral hypothalamus (LH), which regulate REM sleep initiation and maintenance. Using adult male Sprague-Dawley rats trained to self-administer intravenous cocaine, we did transcriptome profiling of LH MCH neurons after long-term withdrawal using RNA-sequencing, and performed functional assessment using slice electrophysiology. We found that 3 weeks after withdrawal from cocaine, LH MCH neurons exhibit a wide range of gene expression changes tapping into cell membrane signaling, intracellular signaling, and transcriptional regulations. Functionally, they show reduced membrane excitability and decreased glutamatergic receptor activity, consistent with increased expression of voltage-gated potassium channel gene Kcna1 and decreased expression of metabotropic glutamate receptor gene Grm5. Finally, chemogenetic or optogenetic stimulations of LH MCH neural activity increase REM sleep after long-term withdrawal with important differences. Whereas chemogenetic stimulation promotes both wakefulness and REM sleep, optogenetic stimulation of these neurons in sleep selectively promotes REM sleep. In summary, cocaine exposure persistently alters gene expression profiles and electrophysiological properties of LH MCH neurons. Counteracting cocaine-induced hypoactivity of these neurons selectively in sleep enhances REM sleep quality and quantity after long-term withdrawal.

Tobacco smoke exposure and sleep: estimating the association of urinary cotinine with sleep quality

INTRODUCTION

A majority of studies on tobacco smoke exposure and sleep quality have relied on self-reported smoking, resulting in potential exposure misclassification and biases related to self-report. The objective of this study was to investigate associations between urinary cotinine, a biological marker of tobacco smoke exposure, and sleep quality measures, including sleep duration, sleep continuity or efficiency, sleep satisfaction and alertness during normal waking hours.

METHODS

Using data on a national sample of 10 806 adults (aged 18-79 years) from the Canadian Health Measures Survey (2007-2013), we performed binary logistic regression analyses to estimate associations between urinary cotinine concentrations and sleep quality measures, while controlling for potential confounders. Additionally, we performed ordinal logistic regression to assess the association between urinary cotinine concentrations and increased number of sleep problems.

RESULTS

Overall, 28.7% of adult Canadian survey respondents had urinary cotinine concentrations above the limit of detection (LOD), nd the prevalence of each sleep problem ranged from 5.5% to 35.6%. Elevated urinary cotinine concentrations (quartile 4 vs. <LOD) were associated with significantly higher odds of short or long sleep duration (OR = 1.41; 95% CI: 1.02-1.95; p-trend = .021), trouble falling or staying asleep (OR = 1.71; 95% CI: 1.28-2.27; p-trend = .003), sleep dissatisfaction (OR = 1.87; 95% CI: 1.21-2.89; p-trend = .011), and increased number of sleep problems (OR = 1.64; 95% CI: 1.19-2.26; p-trend = .001). Stronger associations were observed among females compared to males.

CONCLUSION

Using a biological marker of tobacco smoke exposure, our study contributes to the body of literature of toxic environmental exposures on sleep quality by supporting an association between tobacco smoke exposure and poorer sleep quality. To address the limitations of a cross-sectional study design and to better assess the temporality of tobacco smoke exposure and sleep quality, longitudinal studies are recommended.

Smoking and risk of sleep-related issues: a systematic review and meta-analysis of prospective studies

OBJECTIVES

Smoking has many deleterious consequences on health, one of which can be sleep-related issues. Therefore, a meta-analysis was performed with the aim of pooling results from studies on the relationship between smoking and sleep-related issues.

METHODS

The present study follows PRISMA guidelines. Databases were searched by both researchers to find the articles. The review was done up to December 2018. In order to analyze the results of the screened articles, statistical indexes were converted to logarithms and the studies were combined with each other. Finally, several analyses were conducted with respect to various subgroups. In the subgroup analysis, the pool index of the studies was determined and the degree of heterogeneity in each subgroup was presented. Meta-regression was also used.

RESULTS

Smoking is associated with a risk of developing sleep-related issues. Risk ratio (1.47; 1.20-1.79) for smokers was higher than for non-smokers. Egger's test and Begg's test indicated publication bias.

CONCLUSIONS

Smoking is associated with sleep-related issues. Informing smokers about the effects of smoking on sleep issues can be effective in reducing and preventing its consequences.

Smokers with insomnia symptoms are less likely to stop smoking

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.

Efficacy of a sleep health intervention to optimize standard smoking cessation treatment response: results from a pilot randomized controlled trial

Background

We tested if an adjunctive sleep health (SH) intervention improved smoking cessation treatment response by increasing quit rates. We also examined if baseline sleep, and improvements in sleep in the first weeks of quitting, were associated with quitting at the end of treatment.

Methods

Treatment-seeking smokers (N = 29) aged 21–65 years were randomized to a SH intervention (n = 16), or general health (GH) control (n = 13) condition. Participants received six counseling sessions across 15-weeks: SH received smoking cessation + SH counseling; GH received smoking cessation + GH counseling. Counseling began 4-weeks before the target quit date (TQD), and varenicline treatment began 1-week prior to TQD. Smoking status and SH were assessed at baseline (week 1), TQD (week 4), 3 weeks after cessation (week 7), week 12, and at the end of treatment (EOT; week 15).

Results

SH versus GH participants had higher Carbon Monoxide (CO) -verified, 7-day point prevalence abstinence at EOT (69% vs. 54%, respectively; adjusted odds ratio (aOR) = 2.10, 95% confidence interval (CI) = 0.40–10.69, P = 0.77). Higher baseline sleep efficiency (aOR = 1.42, 95% CI = 1.03–1.96, P = 0.03), predicted higher EOT cessation. Models were adjusted for age, sex, education, and baseline nicotine dependence.

Conclusions

Improving SH in treatment-seeking smokers prior to cessation warrants further examination as a viable strategy to promote cessation.

The Association of Sleep Duration and the Use of Electronic Cigarettes, NHANES, 2015-2016

Introduction. The unknown effects of electronic cigarettes are public health concerns. One potential effect of electronic cigarette fluid constituents, such as nicotine, may influence sleep. The purpose of this study is to determine if there is an association between sleep duration and electronic cigarette use.

Methods

A retrospective, cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2015-2016. Variables of interest included responses to questions concerning electronic cigarette use, hours of sleep, and other variables associated with sleep. Data analyses were conducted with the Rao-Scott chi square test and logistic regression.

Results

This study was conducted on 2889 participants, aged 18-65 years, of whom 50.7% were female. Using a bivariate analyses of electronic cigarette usage and sleep duration, participants who never used an electronic cigarette were more likely to have appropriate sleep durations as compared with participants who were currently using electronic cigarettes (P < 0.0001). After adjusting for sociodemographic variables and cigarette smoking, current electronic cigarette use was associated with higher odds of less sleep duration (adjusted odds ratio = 1.82; 95% CI: 1.18, 2.79; P < 0.0001). After adjusting for sociodemographic variables and cigarette smoking, current electronic cigarette use was associated with higher odds of less sleep duration (adjusted odds ratio = 1.82; 95% CI: 1.18, 2.79.

Conclusions

Participants currently using electronic cigarettes are more likely to have less sleep as compared to participants who have never used electronic cigarettes. Implications. With sleep time duration being a major factor for proper body function and repair, this study can serve as confirmation that the use of electronic cigarettes is not a harmless health behavior.

Sleep as a Target for Optimized Response to Smoking Cessation Treatment

Declining national rates of current tobacco use to an all-time low of 15.1% represents a public health victory. Undermining this progress, however, are smoking rates of up to 50% among high-risk, low-income populations. Current FDA-approved treatments for nicotine dependence are ineffective with between 70-95% of treatment-seekers relapsing within the first year of attempted abstinence. Thus, identification of novel intervention targets to optimize response to currently available treatments for nicotine dependence is a critical next step. One such target may be sleep insomnia. Insomnia is a clinically verified nicotine withdrawal symptom but, to date, addressing insomnia or other sleep disturbance symptoms as an adjunctive smoking cessation therapy has yet to be fully considered. To this end, this manuscript presents a narrative review of: (1) sleep continuity and architecture in smokers versus nonsmokers; (2) effects of nicotine abstinence on sleep; (3) possible mechanisms linking sleep with smoking cessation outcomes; (4) plausible adjunctive sleep therapies to promote smoking cessation; (5) possible treatments for unhealthy sleep in smokers; and (6) directions for future research. Taken together, this will provide conceptual support for sleep therapy as an adjunctive treatment for smoking cessation.

Implications

This narrative literature review presents a comprehensive discussion of the relationship between habitual sleep and cigarette smoking. The extent to which unhealthy sleep in smokers may be a viable intervention target for promoting response to smoking cessation treatment is considered. Ultimately, this review provides conceptual support for sleep therapy as an adjunctive treatment for smoking cessation.

Differential Effects of Addictive Drugs on Sleep and Sleep Stages

Addictive drugs affect sleep both in individuals currently using drugs and in individuals who have withdrawn from drugs. In fact, sleep disturbances are reported by individuals for some drugs long after they have quit taking them and after other withdrawal symptoms have subsided. This suggests that addictive drugs and sleep share some of the same neurobiological mechanisms. Sleep researchers may be studying the neurobiology of addictive drugs without knowing it. The purpose of this survey is to summarize the effects that addictive drugs have on sleep and stages of sleep. We demonstrate that different addictive drugs have differential effects on disturbance of sleep, in general, and on specific stages of sleep either while the drug is on board or after withdrawal. Accordingly, these results are intended to encourage sleep researchers to use their knowledge of sleep mechanisms to offer researchers of addictive drugs new insights of how addictive drugs might affect brain mechanisms. Also, these results should alert researchers of addiction that treatment for drug effects needs to consider treatment for sleep disturbances as well. Treatment for addiction is rarely accompanied by treatment for sleep disturbances even though this survey demonstrates they are clearly related.

HIV status and sleep disturbance in college students and relationship with smoking

OBJECTIVE

Adults with HIV have greater sleep difficulties and are more likely to smoke cigarettes. We tested whether current smoking plays a role in sleep difficulties experienced by young adults with HIV.

DESIGN

Cross-sectional.

SETTING

Data were from the 2011-2014 waves of the National College Health Assessment, an annual survey conducted by the American College Health Association.

PARTICIPANTS

108,159 (including N = 224 HIV positive) college students provided data for this study.

MEASUREMENTS

Health conditions (including HIV positive status) were self-reported. Participants were also asked whether "sleep difficulties" were "traumatic or difficult for you to handle" over the past 12 months. Smoking was self-reported (smokers reported smoking on at least 20 of the last 30 days). Logistic regression models were adjusted for age, sex, survey year, current alcohol use or current marijuana use, diagnosis and/or treatment of anxiety or depression in last year.

RESULTS

HIV positive students were more likely to be smokers (OR = 2.0, SE = 0.43, 95% CI [1.31, 3.05], P = .001) and were more likely to experience sleep difficulties (OR = 2.02, SE = 0.29, 95% CI [1.52, 2.68], P < .0001). While a significant HIV-x-smoking interaction was not found, when models were stratified by smoking, the relationship between HIV status and sleep difficulties was seen among non-smokers (OR = 1.97), and this relationship was stronger among smokers (OR = 2.64).

CONCLUSIONS

Among college students, HIV positive status is associated with increased sleep difficulties. These problems are worse among smokers. Sleep interventions are warranted in this vulnerable group, and could potentially enhance smoking cessation efforts.

Anxiety sensitivity and daily cigarette smoking in relation to sleep disturbances in treatment-seeking smokers

Although the association between anxiety and sleep disturbance is well-documented, the underlying mechanisms are less clear. Anxiety sensitivity (AS), the fear of physiological arousal and bodily sensations, is a risk factor for anxiety and poor sleep. Smoking also contributes to poor sleep and may compound the effects of AS on sleep quality. This study evaluated the main and interactive effects of AS and cigarettes/day on sleep quality among smokers. Participants (n = 190) were adult treatment-seeking daily smokers who completed a baseline assessment as part of a larger smoking cessation trial. Sleep quality was self-reported. Results indicated that AS was significantly correlated with greater disturbance in sleep duration, subjective sleep quality, sleep onset latency, sleep disturbance, daytime dysfunction, and sleep medication use. There was a significant interaction between AS and cigarettes/day in terms of sleep onset latency, but not other sleep quality indices. AS was associated with significantly longer sleep onset latency minutes among heavier smokers, but not lighter smokers. Specifically, the association between AS and sleep onset latency was significant for those who smoked ≥ 33 cigarettes/day. AS is a psychological factor that may contribute to poor sleep quality, especially in heavy smokers, and thus may be a promising intervention target.

Rapid eye movement fragmentation, not slow-wave sleep, predicts neutral declarative memory consolidation in posttraumatic stress disorder

Individuals diagnosed with posttraumatic stress disorder (PTSD) experience disruption at both slow-wave sleep (SWS) and rapid-eye movement (REM) sleep stages and demonstrate marked memory impairment. A small group of studies suggests that, within the disorder, there is a mechanistic relation between these sleep and memory impairments. This study sought to extend that literature by examining whether, in PTSD-diagnosed individuals, memory-retention deficits are present after a sleep-filled (but not after a wake-filled) delay (i.e., whether memory deficits can be traced to interruptions of sleep-dependent memory consolidation). Moreover, we investigated whether SWS- or REM-based disturbances, or both, contribute to retention deficits. We recruited participants into three groups: PTSD (n = 21), trauma-exposed non-PTSD (TE; n = 19) and healthy control (HC; n = 20). Using a crossover design, we assessed memory recall before and after an 8-hr period of polysomnography-monitored sleep and an 8-hr period of regular waking activity. PTSD-diagnosed participants retained less information than controls over the sleep-filled (but not wake-filled) delay. Furthermore, increased REM fragmentation predicted postsleep memory retention in PTSD-diagnosed individuals only. No SWS parameter was associated with or predictive of the amount of information retained postsleep. We conclude that specific REM-related changes in PTSD-diagnosed individuals affected sleep-dependent neutral declarative memory consolidation. Generally, these findings extend the literature suggesting that the co-occurrence of sleep and memory difficulties in PTSD is not accidental, but that these two symptom clusters are meaningfully related. Specifically, the study illustrates that subtle REM-related disruptions contribute most strongly to memory impairment in PTSD.

The effects of oral nicotine administration and abstinence on sleep in male C57BL/6J mice

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.

Triple comorbid trajectories of alcohol, cigarette, and marijuana use from adolescence to adulthood predict insomnia in adulthood

Approximately 9% of adults report the symptoms of insomnia, and there are a number of adverse consequences of insomnia. This could be a public health concern. The current study seeks plausible longitudinal predictors of insomnia for prevention purposes. A community sample of 674 participants (53% African Americans and 47% Puerto Ricans; 60% were females) were recruited from the Harlem Longitudinal Development Study. We applied a growth mixture model to obtain the triple trajectories of alcohol, cigarette, and marijuana use. Logistic regression analyses were then conducted to examine the associations between the triple trajectory groups from mean age 14 to 36 and insomnia at age 36. The estimated prevalence of insomnia is 7.1%. A five-group triple trajectory model was selected: A) Increasing use of all three substances (18%); B) Moderate use of alcohol and marijuana, and high use of cigarette (11%); C) Moderate use of alcohol and cigarette, and experimental use of marijuana (3%); D) Moderate use of all three substances (5%); and E) No or low use of all three substances (63%). Among the five trajectory groups, the increasing use of all three substances group (AOR = 2.71, p-value = .011) was associated with an increased likelihood of having insomnia as compared to the no or low use of all three substances group. Treatment programs to quit or reduce the use of alcohol, cigarette, and marijuana may help decrease the prevalence of insomnia. This could lead to improvements in individualized treatments for patients who have symptoms of insomnia and who also use substances.

Evaluation of Patients in a Smoking Cessation Support Group Using the Nursing Outcomes Classification

PURPOSE

To evaluate patients in a smoking cessation support group using the Nursing Outcomes Classification (NOC).

METHODS

Prospective observational cohort study conducted with 21 patients participating in a smoking cessation support group. Data were collected using an instrument consisting of 2 NOC outcomes and 20 indicators, applied during each of the six support group meetings.

FINDINGS

The two NOC outcomes, Smoking Cessation Behavior (1625) and Substance Withdrawal Severity (2108), showed statistically significant differences over time in many of their indicators.

CONCLUSIONS

The NOC outcomes demonstrated the clinical evolution and behavioral improvement of patients during the smoking cessation process.

IMPLICATIONS FOR NURSING PRACTICE

The findings highlight important elements of the evaluation of behavioral change and severity of withdrawal symptoms.

Predictors of Smoking Cessation and Relapse in Cancer Patients and Effect on Psychological Variables: an 18-Month Observational Study

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.

Better Sleep in a Strange Bed? Sleep Quality in South African Women with Posttraumatic Stress Disorder

Although individuals diagnosed with posttraumatic stress disorder (PTSD) regularly report subjective sleep disruption, many studies using objective measures (e.g., polysomnography) report no PTSD-related sleep disruption. To account for these inconsistencies, some authors hypothesize that PTSD-diagnosed individuals have sleep-state misperception; that is, they self-report experiencing poor sleep quality, but objectively sleep relatively normally. We tested this sleep-state misperception hypothesis, collecting data on subjectively-reported sleep quality (in the home, and in the laboratory) and on objectively-measured, laboratory-based, sleep quality in PTSD-diagnosed participants from low socioeconomic status South African communities. Women with PTSD (n = 21), with trauma exposure but no PTSD (TE; n = 19), and healthy controls (HC; n = 20) completed questionnaires on their average sleep quality in the past 30 days, and on their sleep quality after a night (8 h) of polysomnographic-monitored sleep in the laboratory. PTSD-diagnosed individuals reported poorer everyday subjective sleep quality than TE and HC individuals. In the laboratory, however, there were no between-group differences in subjective sleep quality, and few between-group differences in objective sleep quality (PTSD-diagnosed individuals only had decreased sleep depth). Furthermore, whereas measures of laboratory-based objective and subjective sleep quality correlated significantly, especially in PTSD-diagnosed individuals, there were few significant associations between objective sleep measures and everyday subjective sleep quality. Taken together, these findings suggest that PTSD-diagnosed individuals likely experienced better sleep quality in the laboratory than at home. Descriptive observations corroborated this interpretation, with almost half the sample rating their laboratory sleep (which they described as “safe” and “quiet”) as better than their home sleep (which was experienced in an atmosphere marked by high levels of violence and nighttime noise). These findings disconfirm the sleep-state misperception hypothesis as related to PTSD, and suggest that the laboratory environment may influence sleep quality positively in these individuals. Many investigations of sleep in PTSD do not consider the influence of the laboratory environment. Our findings suggest that future studies in this field should consider that sleep-state misperception may be an artifact of the laboratory setting, especially when samples are drawn from communities where violence and crime are an everyday reality.

Sleep Problems in Relation to Smoking and Alcohol Use in Chinese Adolescents

This study examined sleep patterns and sleep problems in relation to smoking and alcohol use in Chinese adolescents. A questionnaire survey of 2090 adolescent students was conducted in Lijin County, Shandong, China. A self-administered questionnaire was used to collect the data. After adjustment for demographics and internalizing and externalizing problems, poor sleep quality was associated with increased risk of smoking (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.24-5.40), alcohol use (OR, 2.65; 95% CI, 2.81-3.89), and getting drunk (OR, 2.81; 95% CI, 1.72-4.57); sleeping 7 hours (OR, 1.64; 95% CI, 1.20-2.43) and sleeping 6 hours or less per night on weekdays (OR, 1.97; 95% CI, 1.25-3.10) were significantly associated with increased risk for alcohol use, and sleeping 6 hours or less per night on weekends (OR, 2.09; 95% CI, 1.18-3.70) were significantly associated with increased risk for getting drunk; and hypnotic medication use was significantly associated with ever smoking (OR, 1.80; 95% CI, 1.08-2.99). These findings highlight the potential role of sleep intervention in the prevention of adolescent substance use.