Polysomnographic Correlates for the Risk of Relapse in Detoxified Opiate-Misuse Patients

Introduction: Substance abuse is a complex issue requiring multi-disciplinary management. Protracted abstinence syndrome leads to persistent discomfort even after detoxification lasting months, resulting in poor sleep duration and quality. Despite being a major contributor to relapse and sleep disturbances, no objective assessment procedures to monitor sleep after the detoxification have been reported. The study aims to assess sleep structure after detoxification via polysomnography and psychometrically assess sleep over the next 6 months in abstinent and relapsing patients. Methods: Sixty successfully detoxified males (35.8 +/- 7.3 years) with a history of heroin abuse (DSM-V) (mean composite scores (ASI): 1.3 +/- 0.06, 3.48 +/- 0.38, 5.45 +/- 0.63, 1.2 +/- 0.19, 3.93 +/- 0.9, and 2.61 +/- 0.8 for medical status, employment/support status, alcohol/drugs status, legal status, family/social relationships, and psychiatric status, respectively) were recruited immediately following their detoxification, without giving additional psychoactive substances or medications. Polysomnography was done in the second week following detoxification to allow washout of medications, followed by a monthly sleep assessment through sleep diary and daytime sleepiness using a visual analog scale. Relapse was proved by a urine test. Polysomnographic parameters and ASI subscales for relapsing and nonrelapsing participants were compared using a 2-tailed Student's t-test (p<0.05). Results: Eighteen participants relapsed by 6 months (12 by 3 months). Only the ASI legal problems score was significantly different for the two groups (p=0.001). The differences were significant for NREM stages I (p=0.001) and II (p=0.002), bilateral limb movement (p=0.009), and arousal indices (p=0.001). Conclusion: Measuring polysomnographic parameters (percentage of NREM I and II, arousal index, and limb movement index) for sleep disturbance in detoxified heroin-abuse patients can be potential predictors for relapse in a 6-month follow-up.