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Sleep Disturbance During Smoking Cessation: Withdrawal or Side Effect of Treatment?

Published online by Cambridge University Press:  12 April 2016

Rebecca L. Ashare ,
Caryn Lerman ,
Rachel F. Tyndale ,
Larry W. Hawk ,
Tony P. George ,
Paul Cinciripini  and
Robert A. Schnoll
Rebecca L. Ashare*
Affiliation:
Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104
Caryn Lerman
Affiliation:
Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104
Rachel F. Tyndale
Affiliation:
Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, 1001 Queen Street West, Toronto, Ontario, Canada, M6J 1H4 Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, University of Toronto, Toronto, Ontario, Canada, M5S 1A6
Larry W. Hawk
Affiliation:
Department of Psychology, State University of New York at Buffalo, Buffalo, NY, 14260
Tony P. George
Affiliation:
Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, 1001 Queen Street West, Toronto, Ontario, Canada, M6J 1H4
Paul Cinciripini
Affiliation:
Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Cancer Prevention Building (Room CPB3.3309) 1155 Pressler, Houston, TX, 77030
Robert A. Schnoll
Affiliation:
Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104
*
Address for correspondence: Rebecca Ashare, PhD, Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA 19104, USA. Email: rlashare@mail.med.upenn.edu
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Abstract

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 × 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.

Type
Original Articles
Information
Journal of Smoking Cessation , Volume 12 , Issue 2 , June 2017 , pp. 63 - 70
Copyright
Copyright © The Author(s) 2016 

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