R. Gregory Lande, Cynthia Gragnani. Relationships Between Polypharmacy and the Sleep Cycle Among Active-Duty Service Members. J Am Osteopath Assoc 2015;115(6):370–375. doi: 10.7556/jaoa.2015.077.
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Context: Sleep disorders are frequent clinical presentations, especially among active-duty service members. Medications are one factor that can affect sleep in many ways.
Objective: To determine the effect of increasing numbers of medications on the sleep cycle of active-duty service members.
Methods: Medical records for active-duty service members who completed enhanced sleep assessments at the Psychiatry Continuity Service at Walter Reed National Military Medical Center from October 1, 2010, through November 30, 2013, were retrospectively reviewed. Data were collected on home sleep study findings, sleep-related self-report instrument scores, and active medications.
Results: A total of 135 medical records were reviewed. One hundred patients (74.07%) had an active prescription for a psychoactive drug. Among all patients, the mean (SD) number of active medications per participant was 2.52 (2.09), with 118 patients (82.96%) having an active medication for depression or insomnia. As the number of prescribed medications increased, the percentage of the sleep cycle in deep sleep decreased (P=.049), the percentage of light sleep increased (P=.016), the percentage of rapid eye movement sleep decreased (P=.083), and the first episode of deep sleep was delayed (P=.056). An increased number of medications had no significant impact on total sleep time (P>.05).
Conclusion: An increasing number of medications did not influence total sleep time but negatively affected the sleep cycle.
Abbreviations: AHI, apnea/hypopnea index; BMI, body mass index; ODI, oxygen desaturation index; PCL-M, Posttraumatic Stress Disorder Checklist – Military Version; PIRS, Pittsburg Insomnia Rating Scale; RDI, respiratory disturbance index; REM, rapid eye movement.
a Table lists only medications comprising >5% of the identified drug.
b A total of 135 medications met the >5% threshold. Most participants had more than 1 current medication.
a Statistical tests were 2-tailed.
Abbreviation: REM, rapid eye movement.
a Seven participants had more than 6 current medications (data not shown).
b Statistical tests were 2-tailed.
Abbreviation: NA, not applicable.
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