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Sleeping Problems in Chinese Illicit Drug Dependent Subjects

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Sleeping Problems in Chinese Illicit Drug Dependent Subjects Tang et al. BMC Psychiatry (2015) 15:28 DOI 10.1186/s12888-015-0409-x RESEARCH ARTICLE Open Access Sleeping problems in Chinese illicit drug dependent subjects Jinsong Tang1, Yanhui Liao1*, Haoyu He1, Qijian Deng1, Guanbai Zhang1,2, Chang Qi1, Hangtao Cui1,3, Bin Jiao1,4, Mei Yang1,5, Zhijuan Feng1, Xiaogang Chen1, Wei Hao1 and Tieqiao Liu1,6,7* Abstract Background: Illicit drug use/dependence has been recognized as a major problem. Clinical studies demonstrate that poor sleep quality is associated with increased frequency of drug use and relapse. However, few studies have addressed the issue of sleep quality among illicit drug dependent subjects. Methods: This cross-sectional study explored sleep quality in drug dependent subjects in China. We studied 2178 illicit drug dependent subjects from drug rehabilitation centres in Changsha and 2236 non-drug-using subjects, all of whom completed the self-report Pittsburgh Sleep Quality Index (PSQI). Results: We found that the prevalence of sleep disturbance was much higher in drug users (68.5%, PSQI >5; specifically, 80.24% in heroin users, 54.16% in methamphetamine users and 81.98% in ketamine users with PSQI >5) than non-users (26.4%, PSQI >5). Drug users had approximately twice the sleep latency than nondrug users (37.7 minutes V.S 18.4 minutes). Although drug users and non-users reported similar sleep duration (about 7.4 hours), drug users showed poorer subjective sleep quality and habitual sleep efficiency. They reported more sleep disturbance and need for sleep medications, more daytime dysfunction and poorer subjective sleep quality compared with nondrug users. The total PSQI score positively correlated with the duration of drug use (rp = 0.164, p < 0.001). We also found a link between sleep problems and cigarette smoking, alcohol drinking, and duration of drug use. Conclusions: Poor sleep quality is common among illicit drug dependent subjects. Long-term substance users had more sleep problems. Future research aiming at quantifying the benefits of treatment interventions should not neglect the influence of sleep problems. Gaining more insight into the impact of sleep quality on the addiction treatment could also help to target future intervention measures more effectively. Keywords: Sleep problems, Sleep quality, Illicit drug dependent subjects, Self-reported survey Background Although the actual number of drug addicts in China is Illicit drug abuse and drug addiction have been recog- not known, it has the world’s largest population of illicit nized as major problems such as the increased risk of drug users [1,2]. spreading HIV and other blood-borne viruses, drug- Sleeping is one of essential maintenance activities in related criminal activities, drug-related financial prob- every individual’s life. Sleep problems may lead to phys- lems, family issues, and public healthcare expenditures ical and mental disorders, and even social disturbances. in our society. Drug abuse has been recognized as a For example, poor sleep quality has been associated with major problem in China since the 1980s and has quickly treatment-resistant hypertension [3] and suicidal idea- and dramatically increased during the past decade [1]. tion [4]. Sleep disturbances are common in the general population [5,6], and more pronounced in drug-using populations [7-9]. Preclinical studies suggest that chronic * Correspondence: [email protected]; [email protected] sleep deprivation had effects on drug-seeking and drug- 1Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan taking behaviors. It also had an effect on the willingness to 410011, P. R. China work for drugs, and greatly enhanced response for cocaine Full list of author information is available at the end of the article © 2015 Tang et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Tang et al. BMC Psychiatry (2015) 15:28 Page 2 of 7 in rats [10]. Similarly, clinical studies suggest that poor Subjects sleep quality was associated with increased frequency of Participants were recruited from November 2010 to April drug use and relapse [8]. Several studies have reported 2014 in Changsha city, Hunan province, China. We re- sleep problems associated with the use of alcohol [11-14]. cruited 2315 illicit drug dependent subjects from two drug There were also some studies of sleep problems in opioid rehabilitation centres (1949 subjects came from the use and methadone maintenance subjects. Assessing by Kangda Voluntary Drug Rehabilitation Centre in Hunan the Pittsburgh Sleep Quality Index (PSQI), our prelimin- Province and 366 subjects came from the Department of ary study with 140 Chinese heroin-dependent patients Addiction Medicine, Hunan Brain Hospital) and 2390 found that the majority of them reported poor sleep qual- healthy nondrug users with negative illicit drug use test ity (96.30% had PSQI ≥ 8) [7]. 96.6% of the drug users in a through a combination of targeted site sampling, advertise- 30 subjects sample study reported a total PSQI score of 6 ment and snowball sampling referrals. Among them, 2178 or higher, suggestive of poor quality of sleep [15]. 70.2% of drug users (1824 subjects came from the Kangda Voluntary patients had PSQI scores >5 in a 121 heroin addicts who Drug Rehabilitation Centre in Hunan Province and 354 were receiving MMT sample [16], compared with those subjects came from the Department of Addiction Medi- methadone maintenance treatment (MMT) patients who cine, Hunan Brain Hospital) and 2236 nondrug users from had history of longer duration of opiate usage and a seven communities in Hunan province completed all ques- shorter period in MMT with no methadone take-home tions. Sampling of nondrug users was collected by visiting doses (THD) (80.6%, PSQI > 5). MMT patients who had demographically matched households. The data of illicit two weeks achievement of THD showed lower rates of drug dependent subjects was collected following comple- poor sleep (56%, PSQI > 5) [17]. tion of a 10-day detoxification-treatment. All these drug According to 2013 National Drug Abuse Monitoring An- use subjects met the Diagnostic and Statistical Manual of nual Report, the abuse of traditional drugs (mainly heroin) Mental Disorders, fourth edition criteria for lifetime keta- has been decreased recently. But the abuse of synthetic mine dependence determined from the Structured Clinical drugs (mainly methamphetamine and ketamine) showed a Interview. Control subjects were included only if they had rising trend (http://www.sda.gov.cn/WS01/CL1404/107039. never used any drugs. Control subjects were excluded if html, Chinese). However, little work has been done on they reported major medical or psychiatric disorders. investigating sleep quality in stimulants (mostly meth- amphetamine, also called “ice”) and ketamine dependent Assessment measures subjects. The present study aimed to investigate the fre- In addition to some demographic information, self- quency of poor sleep quality among 2178 illicit drug report measure of Pittsburgh Sleep Quality Index (PSQI) dependent subjects and 2236 non drug users, and to [20] was used. Since its introduction in 1989, the PSQI assess the correlation between sleep quality as well as dur- had been widely used and well-validated measure of ation of drug use. Based on previous studies, we hypothe- sleep quality in various cultures. It is a self-rating ques- sized that most illicit drug dependent subjects would have tionnaire used to assess subjective sleep quality during poorer sleep quality, and prevalence of poor sleep quality the previous month. It contains 19 self-rated questions, subjects will be much higher in illicit drug users when resulting in both a global score and 7 component sub- compared with non drug using controls. Duration of sub- scores: subjective sleep quality, sleep latency, sleep dur- stance abuse may have impact on quality of sleep. Peles E ation, sleep efficiency, sleep disturbance, use of sleep found that subjects with a longer duration of opiate usage medication and daytime dysfunction. Each component had poorer sleep [17]. Pasch KE Found a longitudinal bi- has been scored from 0 to 3, resulting in global PSQI directional relationships between sleep quality and addict- score between 0 and 21, with higher scores indicating a ive substance use (such as cigarettes, alcohol or marijuana) lower quality of sleep. A PSQI global score greater than [18]. Furthermore, our previous study showed that dur- 5 indicates ‘poor sleep’ with a sensitivity of 89.6–98.7% ation of ketamine use has been associated with alteration and specificity of 84.4–86.5% [20,21]. Also, there has a of brain structure [19]. Thus, we also hypothesized that suggestion of a cut-off of the global score at higher than self-reported poor sleep quality would be associated with 8, which means a severe sleep problem [22,23]. The the longer duration of substance use. questionnaire is easy to handle and can be completed within 5 min. The Chinese language version of PSQI is Methods well validated, reliable and widely used in patients and Design general populations [24,25]. A cross-sectional descriptive survey design was used to explore sleep quality in illicit drug (including marijuana) Procedure dependent subjects in two drug rehabilitation centres in Before conducting the study, both the study and oral in- Changsha, China. formed consent were approved from the Second Xiangya Tang et al. BMC Psychiatry (2015) 15:28 Page 3 of 7 Hospital of Central South University Institutional Re- Table 1 Demographic, cigarette smoking and alcohol view Board (No.S117, 2009).
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