Sleepin Detoxified Alcoholics:Impairment of Most Standard SleepParametersand IncreasedRisk for Sleep Apnea, but not for Myoclonias-A Controlled Study O. LE BON, M.D., P. VERBANCK, M.D., PH.D., G. HOFFMANN, PH.D.,J.R. MURPHY, PH.D.,* L. STANER, M.D.,* D. DE GROOTE, M.D., S. MAMPUNZA, M.D., A. DEN DULK, M.D., C. VACHER, M.D., CH. KORNREICH, M.D., A•D I. PELC, M.D., PH.D. Universitd Libre de Bruxelles, H•pital Universitaire Brugmann, Service de Psychiatrie et de Psychologie Mddicale, Place Van Gehuchten 4-1020 Bruxelles, Belgium ABSTRACT. Objective: To assess recently alcohol-abstinent chronic alcoholic patients for selected parameters indicative of sleep quality. Method:Patients (n = 24, 14 male), abstinent 3-6 weeks, andhealthy controls (n = 20) wereadmitted to a clinicalsleep unit.Measurements included sleep respiratory events andperiodic limb movements, using strict methodology. Results: Clear signs of sleep deterioration and a high prevalence of apneic/hypopneic episodes wereobserved. Apneas were found at thesame frequency for men and women; this has notbeen de- scribed before.No periodiclimb movement was found. Conclusions: Considering the high degree of morbidity and mortality observed in sleep apneic syndrome, systematic screening for sleep apneas is recom- mended for alcoholics seeking help.(J. Stud. Alcohol 58:30-36 1997) EPENDENCE on alcohol and sleep disorders are both common and the two disorders are often seen in combi- nation. It is not knownif theircombined presentation repre- sents a causal or casual relationship. Sleep disorders maybe an important factor in theprognosis for recovery from alco- holism. Since effectivetreatments are availablefor many sleep disorders, the definition of the sleep disturbances ob- served in alcohol-related disorders could leadto theapplica- tion of specific therapies. A number of studies in the last30 years have investigated sleep disorders related to alcohol in- gestion with electroencephalographical polysomnographies. These studies canbe classified by patient status andtime of evaluation asfollows: (1) intoxicated through the first days of withdrawal(Allen et al., 1971; Gross et al., 1973; Mello and Mendelson, 1970); (2) after a few weeksof abstinence (Aldrich et al., 1993; Gillin et al., 1990; Lesteret al., 1973; Snyder and Karacan, 1985; Williams and Rundell, 1981); (3) months or yearsafter withdrawal (Adamson and Burdick, 1973; Williams and Rundell, 1981). Results of the studies made at 3 to 5 weeks of abstinence (second paradigm) have generally been convergent; they sup- port a moderate to severe degradation of the sleep quality, with somewhat morelight sleep, less deep sleep andmore awakenings. However, there exists some discrepancy about the relative frequencies of thevarious sleep stages, especially Received: April 3, 1995. Revision: December 11, 1995. *J.R. Murphyis with the HealthScience Center at Houston, University of Texas, Houston. L. Staneris with the Servicede Psychiatrie, Centre hospitallet de Luxembourg, 4 rueBarbl6,1210Luxembourg, Grand-Duch6 de Luxembourg. 30 of REM sleep. Tan et al. (1985) werethefirstto demonstrate that sleep apneas/hypopneas (Guilleminaultand Dement, 1978) were common in sober chronic alcoholics.Similar findings weremade by Mamdani et al. (1989). Aldrich et al. (1993) alsoconfirmed a high prevalence of alcohol-linked sleep respiratory disturbances and showed a strong link with age, bodymass indexandmalesex.Thereare also sugges- tionsthat periodic limb movements (Montplaisir and God- bout, 1989) could contribute to the poorquality of sleep in alcoholic patients. Aldrich and Shipley(1993) found,in a general hospital population undergoing a sleep study, an in- creased myoclonic index in male and female patients who re- ported a moderate useof alcohol versus those who did not. These sleep disturbances may, in turn,be partially responsi- ble for the poorquality of life of chronic alcoholic patients (for example, excessive daytimesomnolence is frequently observed, withpossible influences onirritability, anxiety and mood quality during the day). Poorquality of sleep andits daytime consequences mayalso bea cause of alcohol relapse: alcohol is known to induce sleep in cases of insomnia, or is taken for its stimulating effects in cases of daytime sleepi- ness. A relationship hasbeen demonstrated between sleep respiratory eventsand cardiovascular morbidityand mor- tality (He et al., 1988;Partinen andTelakivi, 1992;Rossner et al., 1991). It is reasonable to assume thatthisfactorwould also playa rolein alcoholic patients. To ourknowledge, only the study by Gillin et al. (1990) strictly used the DSM-III-R criteria (American Psychiatric Association [APA], 1987)for thedetermination of alcohol dependence. Mostother studies have not employed well established criteria for measuring the severity of the pathology. Thefrequency of drinking episodes