Abstract

Objective: Mental health and substance use disorders are commonly associated with disrupted sleep and circadian rest-activity rhythms. How these disorders in combination relate to sleep and circadian organization is not well studied. We provide here the first quantitative assessment of sleep and rest-activity rhythms in inpatients with complex concurrent disorders, taking into account categories of substance use (stimulant vs. stimulant and opioid use) and psychiatric diagnosis (psychotic disorder and mood disorder). We also explore how sleep and rest-activity rhythms relate to psychiatric functioning. Methods: A total of 44 participants (10 female) between the age of 20–60 years (median = 29 years) wore wrist accelerometers over 5–70 days and completed standardized questionnaires assessing chronotype and psychiatric functioning (fatigue, psychiatric symptom severity, and impulsiveness). To examine potential influences from treatment, we computed (1) length of stay; (2) days of abstinence from stimulants and opioids as a measure of withdrawal; and (3) a sedative load based on prescribed medications. Results: Participants exhibited a sustained excessive sleep duration, frequent nighttime awakenings, and advanced rest-activity phase related to sedative load. Sleep disruptions were elevated in participants with a history of opioid use. Patients with a psychotic disorder showed the longest sleep and most fragmented and irregular rest-activity patterns. Non-parametric circadian rhythm analysis revealed a high rhythm amplitude by comparison with population norms, and this was associated with greater psychiatric symptom severity. Psychiatric symptom severity was also associated with greater fatigue and later MCTQ chronotype. Conclusions: This pilot study provides initial information on the prevalence and severity of sleep and circadian rhythm disturbances in individuals with severe concurrent disorders. The results underline the need for further studies to start to understand the role of sleep in the disease and recovery process in this understudied population.

摘要

目的：心理健康和物质使用障碍通常与睡眠和昼夜休息活动节律紊乱有关。这些疾病如何与睡眠和昼夜节律组织相关尚未得到充分研究。我们在这里提供了对患有复杂并发疾病的住院患者的睡眠和休息活动节律的首次定量评估，同时考虑了物质使用类别（兴奋剂与兴奋剂和阿片类药物的使用）和精神病学诊断（精神病和情绪障碍）。我们还探讨了睡眠和休息活动节律如何与精神功能相关。方法：共有 44 名年龄在 20-60 岁（中位数 = 29 岁）之间的参与者（10 名女性）佩戴手腕加速度计超过 5-70 天，并完成了评估时间表和精神功能（疲劳、精神症状严重程度和冲动性）的标准化问卷. 为了检查治疗的潜在影响，我们计算了 (1) 住院时间；(2) 兴奋剂和阿片样物质的戒断天数作为戒断措施；(3) 基于处方药的镇静负荷。结果：参与者表现出持续过度的睡眠时间、频繁的夜间觉醒以及与镇静负荷相关的高级休息活动阶段。有阿片类药物使用史的参与者的睡眠中断情况有所增加。患有精神病的患者表现出最长的睡眠时间和最零散和不规则的休息活动模式。非参数昼夜节律分析显示，与人群常态相比，节律振幅较高，这与精神症状的严重程度有关。精神症状的严重程度也与更严重的疲劳和后来的 MCTQ 时间型有关。结论：这项试点研究提供了关于患有严重并发疾病的个体睡眠和昼夜节律紊乱的普遍性和严重性的初步信息。结果强调需要进一步研究，以开始了解睡眠在这一未被充分研究的人群的疾病和康复过程中的作用。