Sleep Disturbance During Smoking Cessation: Withdrawal or Side Effect of Treatment?
Sleep Disturbance During Smoking Cessation: Withdrawal or Side Effect of Treatment?
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DOI：
10.1017/jsc.2016.11
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发表时间：
2017-06-01
影响因子：
0.9
通讯作者：
Schnoll, Robert A.
中科院分区：
文献类型：
--
作者：
Ashare, Rebecca L.;Lerman, Caryn;Schnoll, Robert A.
引言：尼古丁-代谢物比值（NMR）可预测治疗反应，并与治疗副作用严重程度相关。睡眠障碍可能是一个重要的副作用，但了解睡眠障碍对戒烟的影响是复杂的，因为尼古丁戒断也会产生睡眠障碍。目的：评估戒断和治疗副作用对睡眠障碍的影响。方法：这是对临床试验数据的二次分析（Lerman et al.，2015），随机分配至安慰剂组（n = 363）、经皮尼古丁组（TN; n = 381）或伐尼克兰组（n = 392），并根据NMR进行分层（559例慢代谢者; 577例正常代谢者）。在基线和目标戒烟日期（TQD）后1周评估睡眠障碍。我们还研究了睡眠障碍是否预测7天的点患病率戒烟结束时的治疗（EOT）。结果：伐尼克兰和TN组表现出更大的增加睡眠障碍（与安慰剂;治疗x时间的相互作用; p = 0.005），特别是在那些戒烟1周后TQD。存在NMR的主效应（p = 0.04），但与给药无相互作用。TN和伐尼克兰减轻了与睡眠无关的戒断症状（与安慰剂相比）。更大的基线睡眠障碍预测复发在EOT（p = 0.004）。结论：现有的治疗可能不会减轻戒断相关的睡眠障碍和连续治疗，目标睡眠障碍可能会提高戒断率。
Introduction: The nicotine-metabolite ratio (NMR) predicts treatment response and is related to treatment side effect severity. Sleep disturbance may be one important side effect, but understanding sleep disturbance effects on smoking cessation is complicated by the fact that nicotine withdrawal also produces sleep disturbance.Aims: To evaluate the effects of withdrawal and treatment side effects on sleep disturbance.Methods: This is a secondary analysis of data from a clinical trial (Lerman et al., 2015) of 1,136 smokers randomised to placebo (n = 363), transdermal nicotine (TN; n = 381), or varenicline (n = 392) and stratified based on NMR (559 slow metabolisers; 577 normal metabolisers). Sleep disturbance was assessed at baseline and at 1-week following the target quit date (TQD). We also examined whether sleep disturbance predicted 7-day point-prevalence abstinence at end-of-treatment (EOT).Results: The varenicline and TN groups exhibited greater increases in sleep disturbance (vs. placebo; treatment x time interaction; p = 0.005), particularly among those who quit smoking at 1-week post-TQD. There was a main effect of NMR (p = 0.04), but no interactions with treatment. TN and varenicline attenuated withdrawal symptoms unrelated to sleep (vs. placebo). Greater baseline sleep disturbance predicted relapse at EOT (p = 0.004).Conclusions: Existing treatments may not mitigate withdrawal-related sleep disturbance and adjunctive treatments that target sleep disturbance may improve abstinence rates.