The association between sleep disturbances and alcohol relapse: A 12-month observational cohort study

Background Sleep disturbances are extremely common in alcohol recovery. Systematic research into the relationship between alcohol relapse and sleep disturbances using validated scales and accounting for potential confounders is lacking. Methods: Patients admitted to a 1-month residential addiction treatment program were administered the Pittsburg Sleep Quality Index (PSQI) at admission/discharge. In addition, the Alcohol Use Disorders Identification Test (AUDIT), Patient Health Questionnaire-9 (PHQ-9), and Pennsylvania Alcohol Craving Scale (PACS) were administered. Patients were contacted every 3 months over 1 year following discharge. Associations of clinical factors with time until relapse were examined using univariate Cox proportional hazard models. Results: One-hundred and nineteen patients with alcohol use disorders met inclusion criteria (mean age 50.6±13.2 years, 57% male), relapse data were available for 81 patients. Eighty percent of subjects had other psychiatric diagnoses, 66.3% had sleep disturbances at the time of admission, and 57.1% were using hypnotics; 49.1% of patients had sleep disturbances at discharge. Sleep disturbances at admission and discharge were not associated with alcohol relapse at 12 months (OR=1.00, 95%CI=0.89-1.13; p=0.95 and OR=0.97, 95%CI=0.86-1.09; p=0.61). The PSQI sub-scale scores were also not associated with relapse at 12 months. The use of alcohol to help fall asleep (OR=3.26, 95% CI=1.33-7.95; p=0.008), hypnotic use at admission(OR=4.03, 95%CI=1.63-9.97; p=0.002) and age (OR=1.03, 95%CI=1.00-1.06; p=0.035) were associated with relapse over 12 months. Conclusion In patients completing a residential treatment program, sleep disturbances as measured by the PSQI were not associated with alcohol relapse at 12 months. Alcohol use as a hypnotic and hypnotic use at admission were associated with subsequent relapse.