Sleep, Pain, and Use of Methadone and Opiates among HIV-Positive Adults

Tuesday, 8 July 2008: 3:35 PM
Harvey Davis, RN, PhD , School of Nursing, San Francisco State University, San Francisco, CA

Learning Objective 1: understand sleep terminology and research methodology.

Learning Objective 2: assess for insomnia and understand symptoms of sleep disturbance and its impact on circadian rhythms

Introduction: We examined HIV+ adults who reported pain in the last week and compared the objective and subjective sleep of those using methadone or opiates to a group not using pain medication. We hypothesized that subjects using methadone would have better sleep than those using opiates or those using neither methadone nor opiates.

Methods: As part of a descriptive study of sleep in 201 HIV-infected adults, data were collected on 89 subjects who reported pain in the last week. Urine toxicology was used to determine drug use, and those using illicit drugs were excluded. Wrist actigraphy was used to measure total sleep time (TST), wake after sleep onset (WASO), and circadian activity rhythm (acrophase and amplitude). Participants also completed the Pittsburgh Sleep Quality Index (PSQI).

Results: Results to date are presented for 53 men, 31 women, and 5 transgender adults, primarily Caucasian (40%) and African American (35%). The mean age was 458 years and mean CD4 cell count was 442282 (range = 3 to 1246). Subjects using opiates (n=25) had significantly (p<.05) more TST (40492 minutes) than those using methadone (n=15; 308135), but neither those using opiates nor methadone differed from those using neither drug (n=52; 367103). In addition, those using methadone had significantly (p<.05) more WASO (35.9%22.8) than those using either opiates (18.9%12.6) or neither drug (20.1%15.3). Those using methadone also had a significantly (p<.01) earlier acrophase (13:301:27) than those using neither opiates nor methadone (15:221:22). There were no differences on the PSQI in any of the groups.

Conclusions: Contrary to our hypothesis, methadone use was associated with shorter sleep duration, more sleep disruption, and earlier acrophase than opiate use in this sample of HIV-infected adults with pain. Pain severity, medication efficacy, and their impact on sleep in this population needs further evaluation.