The overlap of sleep disturbance and depression in primary care patients treated with buprenorphine

ABSTRACT

Background: Sleep disturbance is common among patients receiving long-term opioid therapies, such as methadone maintenance. However, little is known about sleep disturbances in patients receiving medication treatment with buprenorphine. We sought to determine the frequency of subjective sleep disturbance in a sample of patients receiving medication treatment and to examine clinical factors related to sleep disturbance. Methods: Participants were 328 persons receiving buprenorphine at 3 primary care sites. Sleep difficulty was assessed 2 questions adapted from the Patient Health Questionnaire-9 (PHQ-9) item assessing sleep. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD)-10 and PHQ-2. In addition, information was gathered on participant demographics and treatment characteristics. Demographics, buprenorphine treatment history, and depressive symptoms were compared for those with and without self-reported sleep difficulty. Logistic regression was used to estimate the adjusted association of sleep disturbance with these correlates. Results: Seventy-one percent of persons receiving medication treatment with buprenorphine in the present study reported sleep difficulty. Persons reporting sleep disturbance reported shorter time in buprenorphine treatment and more depressed mood compared with those without sleep difficulty (p < .01). Men were significantly less likely to report disturbed sleep than women (odds ratio [OR] = 0.57, 95% confidence interval [CI]: 0.33, 0.98). Sleep disturbance was not associated significantly with age, ethnicity, educational attainment, or buprenorphine dose. Conclusions: Sleep disturbance is common in patients receiving medication treatment with buprenorphine and is associated with more depressive symptoms as well as a shorter duration of medication treatment. Future research, using subjective and objective sleep measures, is warranted to understand whether sleep disturbance is mitigated by longer buprenorphine treatment and whether difficulty sleeping predicts buprenorphine discontinuation among patients seeking treatment for opioid dependence.

KEYWORDS:

• Buprenorphine
• depression
• primary care
• sleep

Acknowledgments

Dr. Bailey has served as a paid consultant as a member of the advisory boards of Braeburn Pharmaceuticals and Alkermes. She has received honoraria as a speaker for BioDelivery Sciences International, Inc., Alkermes and Indivior. She has received travel funds from Alkermes and Indivior and study drug in kind from Reckitt-Benckiser (Indivior). Dr. Uebelacker's spouse is employed by Abbvie Pharmaceuticals. None of the other authors has conflicts of interest to report.

Funding

This study was supported by National Institute on Drug Abuse (NIDA) grant R34DA032800. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This work does not necessarily reflect the views of NIDA or the NIH.

Author contributions

R.W., L.U., D.H., G.B., and M.S. contributed to study conception and design; R.W., L.U., D.H., G.B., S.G., and M.S. were involved in data collection, B.A. conducted data analyses, and S.G., B.A., K.S., and M.S. contributed to interpretation of results. All authors were involved in the writing and/or revision of the manuscript.