Association of sleep disturbance with chronicity and remission of alcohol dependence: Data from a population-based prospective study

Objective: We assessed the association of three types of self-reported sleep disturbances (insomnia, hypersomnia, and sleep disturbance caused by worry) among individuals with chronic and remitted alcohol dependence, using prospectively gathered data from a population-based sample. Methods: Probability samples of area residents were selected by census tracks and households in Baltimore, MD, in 1981, as part of the Epidemiologic Catchment Area program (n = 3481). Between 1993 and 1996, the original cohort was traced, and 73% of the survivors were re-interviewed (n = 1920). Three groups for alcohol dependence status were identified: (1) chronic, (2) remitted, and (3) no lifetime or current history of dependence. Logistic regression models were used to assess the association between alcohol dependence status for each type of sleep disturbance. Results: Of the 248 individuals with alcohol dependence, most had achieved remission of dependence by the time of the median 13-year follow-up interview (n = 211). A total of 37 met criteria for chronic dependence. After holding constant potential confounders (age, sex, race, educational level, marital status, psychiatric and illicit drug disorder history, health services use, and age of onset of first alcohol-related problem), we found that chronic dependence was associated with insomnia (odds ratio = 2.60; 95% confidence interval = 1.11-6.08; p = 0.03), relative to those without a history of dependence. Remitted dependence was not associated with sleep disturbance in the models adjusted for covariates. In supplemental analyses, we assessed the association of drinking status with alcohol dependence remission. Conclusions: Individuals with persistent alcohol dependence have greater odds of insomnia than those whose alcohol dependence remits. The need for prospectively gathered data from community-based samples to assess further the temporal relationships of sleep disturbance, alcohol dependence, and alcohol consumption level is discussed.