A80-1-08 Sleep Deficiency and Recurrent Opioid Use in the Clouds Prospective Cohort Study

Background

Opioid use disorder (OUD) is a chronic brain disease and a major public health crisis, affecting over two million individuals in the United States and contributing to approximately one overdose death every 20 minutes. Although effective behavioral interventions and FDA-approved medications for opioid use disorder (MOUD) exist, treatment response is variable, and recurrent non-prescribed opioid use remains common. Sleep deficiency, including short sleep duration, non-circadian sleep, and poor sleep quality, is highly prevalent in individuals with OUD and may impair reward processing, stress responsivity, executive function, pain, and mood. However, its contribution to recurrent opioid use during MOUD treatment is not well defined.

Methods

The Collaboration Linking Opioid Use Disorder and Sleep (CLOUDS) Study is a prospective observational cohort of 222 adults with OUD recently stabilized on MOUD at a large opioid treatment program in Connecticut. At baseline, participants completed ambulatory polysomnography, wrist actigraphy, and validated sleep and circadian questionnaires. Sleep deficiency was defined a priori as any of the following: average total sleep time <5 hours (actigraphy); social jet lag >2 hours (difference in mid-sleep timing between workdays and free days assessed by the Munich Chronotype Questionnaire); poor sleep quality (PROMIS Sleep Disturbance T-score >60 or Insomnia Severity Index ≥15); or severe sleep-disordered breathing (apnea-hypopnea index ≥30 events/hour). Participants were followed weekly for six months to assess the primary outcome: percent of days with recurrent non-prescribed opioid use, measured by timeline follow-back and confirmed by weekly urine drug testing. Recurrent use was categorized ordinally (0%, 0-20%, 20-60%, >60%). Proportional odds models adjusted for age, sex, race/ethnicity, treatment site, and Charlson Comorbidity Index.

Results

Among 220 participants with complete data, 135 (61.3%) met criteria for sleep deficiency at baseline. Over six months, the mean percentage of days with recurrent opioid use was 33.4% (SD 30.3). After multivariable adjustment, sleep deficiency was independently associated with higher categories of recurrent opioid use (odds ratio 1.76, 95% CI 1.03-3.02; p = 0.03).

Conclusion

In this prospective cohort of adults receiving MOUD, sleep deficiency was common and independently associated with higher rates of recurrent opioid use. Addressing sleep and circadian dysfunction may represent a novel and actionable strategy to improve treatment response in OUD.

This abstract is funded by: NIH NHLBI HEAL