Alcohol Use & its Effect on Sleep. Alcohol Consumption in US 5/1/2013

Transcription

1 //23 Alcohol Use & its Effect on Sleep Subhajit Chakravorty, M.D. Philadelphia Veterans Affairs Medical Center University of Pennsylvania Alcohol Consumption in US Statistics in US Adults ( 8 years) Infrequent drinkers ( drinks/last year): 3.6% Current Regular Drinkers ( 2 drinks/past year):.9% Health Related Implications of Heavy Drinking Unintentional injuries (e.g., car crashes, falls, burns, drowning) Intentional injuries (e.g., firearm injuries, sexual assault, domestic violence) Alcohol poisoning Sexually transmitted diseases Unintended pregnancy Children born with Fetal Alcohol Spectrum Disorders Hypertension, stroke, and other cardiovascular diseases Liver disease Neurological damage Sexual dysfunction Poor control of diabetes sheets/binge drinking.htm

2 //23 Alcohol Use Terminology Standard Drink 2 oz of beer oz of table wine. oz of brandy. oz of 8 proof spirits Heavy Drinking Men 4 drinks per day, or 4 drinks per week Women 3 drinks per day, or 7 drinks per week 2 3 oz of liqueur/aperitif Effect of Alcohol on EEG Sleep Study Methods Results Rundell OH, 972 MacLean AW, Cairns J, 982 Williams DL, et al, 983 Rouhane S, et al, 989 Roehrs T, et al, 99 Fiege B, et al, 26 males, ages 2 3,.9 gm/kg of 9% males, mean age 23.6yrs, nights with,.2,.,.7, or gm/kg of 9% proof alcohol women, mean age 9. years, nights with,.,.7 of gm/kg 9% proof alcohol 4 adults, 2 years,.2 gm/kg of 9% alcohol in the afternoon Normal sleep duration of 8 hours, and partial sleep dep (SD=4 hours) men (age 3±6years) + women (age 3±9years), alcohol use at N3, at BAL.3 vs.%), washout on N6 7 One Etoh night: REM st episode, rebound in REM in 2 nd half of N. Three nights: WASO, SWS With increasing Etoh doses: SOL, REM in hour #, and in SWS during st 3 hours Increasing Etoh doses: SOL, WASO, in SWS during st 3 ⁰, S during hrs 4 6, REM : NAW, S, # of stage changes : TST, S3, REM%; Ø change: SOL, S4. : SE, S, REM : S2 BAL of.%: st half of night SOL, WASO, S, SWS, REM density; 2 nd half of night S. REM ed on D/C; Ø change on.3% BAL Effect of Alcohol on Breathing in Sleep 4 Apnea Hypopnea Index 62 Heart Rate AHI HR 2 2 Control Alcohol Control Alcohol P =.6 P <. Scanlan MF, et al, 2 2

3 //23 Habitual Moderate Alcohol Use & SDB Women Odds Ratio Men Odds Ratio Peppard PE, et al; 27 Effect of Alcohol on PLMs (% with PLMI>2 /hour) Women Men Low Etoh 42 8 High Etoh No OSA OSA Low Etoh 39 High Etoh No OSA OSA Aldrich MS, Shipley JE, 993 Alcohol & Sleep Duration (S.D.) y/o students drinking 3 4 beverages a week hours 7 8 hours 9 hours 7 N (%) Schuckit M, Bernstein LI; 98 3

4 //23 Is SUD Comorbid with Sleep Disorders? Study Population Findings Teplin D, 26 Ontario sleep disorder center N = 46 MAST/DAST Mahfoud Y, 29 ADRC, Cleveland Clinic (N = 3) PSQI, ISI, Berlin Questionnaires Suggestive of Alcoholism (3%) Indicative of Alcoholism (%) Low Level Drug Use (33%) Substantial Drug Use (2%) Diagnoses: Alcohol abuse/dep (8%) Opiate Abuse/Dep (4%) BZF abuse/dep (3%) Cannabis abuse/dep (23%) Cocaine abuse/dep (7%) Scale Scores: PSQI 6 (97%) ISI 4 (83.4%) ESS (6.6%) Insomnia & Risk of Substance Abuse Study Details Results Ford & Kamerow, 989 N = 794, baseline, F/U yr Baseline insomnia (.2%) At Follow up MDD (OR = 39.8[2,8]) Alcohol Abuse (OR = 2.4 [,6]) Anxiety Disorder (OR = 6.3 [4,]) Weissman M, 997 N = 44/73, F/U in year At Follow up: MDD 2.7% (OR =.4[2.6,.3]) Alcohol Abuse 3.3% (OR = 2.3[.2,4.3]) Panic Disorder.% (OR = 2.3[4,93]) Crum R, 24 N = 344, median F/U = 2.6 years Losing sleep because of worry (6.2%) At Follow up Alcohol Related Problems RR = 2.32 [.3,4] Association Between Alcohol Consumption & Sleep Duration in the US (N = 299) Predictor Subgroup Unadjusted (Model ) Adjusted (Model 2) Adjusted (Model 3) β ±SE P β ±SE P β ±SE P Alcohol Quantity : Light User.8 ± ± ± : At Risk User.6 ± ± ± *Alcohol Quantity *Alcohol Frequency At Risk Drinking (Ref = No) *Alcohol Frequency Drinks/Day Past 2 mo Days Drinking Past 2 Mo. Alcohol Quantity Days Drinks Past 2 Mo..3 ± ±.4.9. ± ±.4..4 ± ±...22 ± ± ± ± ± ±.27.2 Data Source: NHANES Model : Unadjusted Model Model 2: Adjusted for Age, BMI, Gender, Race, Marital Status, Education, Income, Depression, Insurance, Health Status. Anxiety, Mental Health, and Exercise Model 3: Model 2 + Insomnia status and daytime sleepiness Chakravorty S, et al; Submitted for publication 4

5 //23 Alcohol and Sleepiness 2 Sleep Duration of 8 hours ** ** Placebo Ethanol Sl Eff SOL Stage % Stage 2% SWS% REM% SOL (MSLT) * p <., ** p <. Roehrs T, et al; 2 Alcohol and Sleepiness 2 ** Sleep Duration of 4 hours ** Sl Eff SOL Stage % Stage 2% SWS% REM% SOL (MSLT) Placebo Ethanol * p <., ** p <. Roehrs T, et al; 2 Relationship Between Daytime Sleepiness, Sleep Duration, and Binge Drinking Days p =.4 Chakravorty S, et al; Submitted for publication

6 //23 Summary Alcohol may initially improve sleep Beyond 4 alcohol may disrupt sleep Alcohol may respiratory events in sleep Alcohol may PLMs in sleep Heavy drinking is associated with short SD Heavy drinking and short SD may lead to day me sleepiness Acknowledgments Philadelphia Veterans Affairs Medical Center VISN 4 MIRECC Perelman School of Medicine Center for Sleep & Circadian Neurobiology Division of Behavioral Sleep Medicine Mentors & Collaborators Allan Pack, MBBCh, PhD David Oslin, MD Michael Perlis, PhD Samuel Kuna, MD Michael Grandner, PhD Nicholas Jackson, MPH 6