The role of circadian rhythm dysregulation in individuals with alcohol use disorder (AUD) before and after relapse following inpatient treatment

Authors

• AN Hughes
• GR Wallen
• KA Maki
• A Ahmed
• RTS Tuason
• JJ Barb

Abstract

Identifying factors predictive of relapse in patients with alcohol use disorder (AUD) is essential to improving treatment for this disorder. Our group previously found that lower sleep regularity was associated with relapse. This secondary analysis extends our previous work to explore the relationship between circadian rhythms and relapse. A cohort of patients who received inpatient treatment for AUD (n=126) wore Philips Respironics Actiwatches following discharge for four weeks. We calculated the circadian rhythm nonparametric statistics interdaily stability (IS), intradaily variability (IV), most-active 10 h/day (M10), least-active 5 h/day (L5), relative amplitude (RA), and the daily wake-time.

After actigraphy data filtering, the final sample size was n=103. Participants were 48.6±11.3 years of age and 32% female. Twenty-six patients (25.2%) experienced a relapse. We fit linear and logistic generalized mixed models in R to estimate the effect of discharge on circadian rhythms, the effect of preceding circadian rhythms on probability of relapse, and the effect of relapse on circadian rhythms, with all analyses accounting for within-patient repeated measurements. Following discharge, there were significant decreases in IV and L5, and increases in M10, RA, and waketime, whereas IS did not substantially change. While none of the variables examined were significantly predictive of relapse, following relapse there was a significant decrease in IV and an increase in waketime of ~1 hour. Our future work will investigate clinical symptom association with circadian rhythms, and we will test hypotheses raised by this work in large cohort studies such as NHANES and All of Us.

Scientific Focus Area: Clinical Research

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