Sleep behavior traits and associations with opioid-related adverse events: a cohort study

• Published in: Sleep (New York, N.Y.) Vol. 46; no. 9; p. 1
• Main Authors: Chen, Rudy W, Ulsa, Ma Cherrysse, Li, Peng, Gao, Chenlu, Zheng, Xi, Xu, Jiawei, Luo, Yong, Shen, Shiqian, Lane, Jacqueline, Scheer, Frank A J L, Hu, Kun, Gao, Lei
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 08-09-2023
• Subjects: Aged; Analgesics, Opioid - adverse effects; Behavior; Cohort analysis; Cohort Studies; Disorders of Excessive Somnolence - chemically induced; Disorders of Excessive Somnolence - epidemiology; Humans; Insomnia; Narcotics; Risk Factors; Sleep; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - drug therapy; Sleep Initiation and Maintenance Disorders - epidemiology; Sleep, Health, and Disease; opioid use disorder; opioid crisis; sleep health; chronotype; napping; Opioid-related adverse events; insomnia
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsad118

Abstract
Study Objectives
Opioid-related adverse events (OAEs), including opioid use disorders, overdose, and death, are serious public health concerns. OAEs are often associated with disrupted sleep, but the long-term relationship between poor sleep and subsequent OAE risk remains unknown. This study investigates whether sleep behavior traits are associated with incident OAEs in a large population cohort.
Methods
444 039 participants (mean age ± SD 57 ± 8 years) from the UK Biobank reported their sleep behavior traits (sleep duration, daytime sleepiness, insomnia-like complaints, napping, and chronotype) between 2006 and 2010. The frequency/severity of these traits determined a poor sleep behavior impacts score (0–9). Incident OAEs were obtained from hospitalization records during 12-year median follow-up. Cox proportional hazards models examined the association between sleep and OAEs.
Results
Short and long sleep duration, frequent daytime sleepiness, insomnia symptoms, and napping, but not chronotype, were associated with increased OAE risk in fully adjusted models. Compared to the minimal poor sleep behavior impacts group (scores of 0–1), the moderate (4–5) and significant (6–9) groups had hazard ratios of 1.47 (95% confidence interval [1.27, 1.71]), p < 0.001, and 2.19 ([1.82, 2.64], p < 0.001), respectively. The latter risk magnitude is greater than the risk associated with preexisting psychiatric illness or sedative-hypnotic medication use. In participants with moderate/significant poor sleep impacts (vs. minimal), subgroup analysis revealed that age <65 years was associated with a higher OAE risk than in those ≥65 years.
Conclusions
Certain sleep behavior traits and overall poor sleep impacts are associated with an increased risk for opioid-related adverse events.
Graphical Abstract