Abstract
Background: The present study investigated polysomnographically assessed sleep parameters
in alcohol-dependent patients after withdrawal and in healthy control subjects during
baseline and after a cholinergic stimulation paradigm. The aim of the study was to
test whether sleep parameters, especially rapid eye movement (REM) sleep variables,
may serve as predictors for relapse in alcohol-dependent patients.
Methods: Forty patients diagnosed with alcohol dependence were admitted to a specialized
ward for alcohol withdrawal and were investigated by polysomnography at three time
points: 2–3 weeks after withdrawal (T0) and at follow-up investigations 6 (T1) and
12 (T2) months after discharge from the hospital. A subgroup of patients (n = 17) was studied at T0 after challenge with galanthamine, a reversible cholinesterase
inhibitor (cholinergic REM induction test, CRIT). Patients were compared with two
control groups: a) 30 healthy control subjects (matched for age- and gender-distribution)
for comparison at baseline conditions; and b) 17 age- and gender-matched control subjects
for comparison with the CRIT.
Results: At baseline the patients showed significant disturbances of sleep continuity
and sleep architecture (decreased slow-wave sleep, SWS) and exhibited an increase
of “REM sleep pressure” (a combined index of REM latency, REM density, and REM sleep
percent). Galanthamine provoked significant alterations of sleep continuity, sleep
architecture (reduced SWS), and increased most of the components of REM pressure,
taking patients and control subjects together. Apart from SWS %SPT (sleep period time)
no significant drug-group interactions occurred. Patients who remained abstinent (n = 11) for at least 6 months at follow-up exhibited significantly less abnormalities
of REM sleep at T0 compared to the group of patients that relapsed at 6 months follow-up.
Conclusions: It is concluded that increased REM sleep pressure after alcohol withdrawal
is a robust predictor of vulnerability to relapse. Thus, a subgroup of alcoholic patients
appears to exhibit distinct neurobiological abnormalities assessable by polysomnography
that are related to an increased vulnerability for alcoholism and early relapse.
Keywords
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Article info
Publication history
Accepted:
April 11,
2001
Received in revised form:
April 4,
2001
Received:
November 1,
2000
Identification
Copyright
© 2001 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
