Alcohol Use for Sleep Strongly Linked to Hazardous vs Moderate Drinking

Laurie Barclay, MD

November 08, 2010

November 8, 2010 — Using alcohol for sleep is strongly linked to hazardous vs moderate drinking, according to a report of a cross-sectional survey in primary care practices from the American Academy of Family Physicians (AAFP) National Research Network, published in the November/December issue of the Annals of Family Medicine.

"Hazardous and harmful drinking and sleep problems are common, but their associations among patients seen in primary care have not been examined," write Daniel C. Vinson, MD, MSPH, from the Department of Family and Community Medicine, University of Missouri in Columbia, and colleagues. "We hypothesized that greater levels of alcohol consumption would be associated with several self-reported sleep problems."

Anonymous, postvisit questionnaires were completed by clinicians (n = 94) as well as by patients (up to 30 consecutive adult patients per clinician; total n = 1984). Patient questions concerned demographics, alcohol drinking, cardinal symptoms of alcohol use disorders, sleep quality, insomnia, sleep apnea, and symptoms of restless legs syndrome. After adjustment for demographics and clustering of patients within physicians, multivariate analyses examined the associations of drinking status — characterized as none, moderate, or hazardous — with sleep problems.

Complete data for analysis were provided by 1699 (85.6%) of patients who responded (mean age, 50.4 ± 17.4 years; 67% women; 72.9% white). Hazardous drinking was reported by 22.3% of respondents, fair or poor overall sleep quality by 47.8%, and diagnosis or treatment of sleep apnea by 7.3%.

Drinking status was not associated with any measure of insomnia, overall sleep quality, or symptoms of restless legs syndrome, based on multivariate analyses. Compared with nondrinkers, those who reported moderate drinking had lower adjusted odds of sleep apnea (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.38 - 1.00). Use of alcohol for sleep was strongly associated with hazardous drinking vs moderate drinking (OR, 4.58; 95% CI, 2.97 - 7.08).

Limitations of this study include cross-sectional design, reliance on patient self-reports, lack of data as to which medications were used to aid in sleep, lack of data on smoking or weight, and failure to stratify hazardous drinkers into subcategories.

"Moderate and hazardous drinking were associated with few sleep problems," the study authors write. "Using alcohol for sleep, however, was strongly associated with hazardous drinking relative to moderate drinking and may serve as a prompt for physicians to ask about excessive alcohol use."

The Robert Wood Johnson Foundation supported this study. The study authors have disclosed no relevant financial relationships.

Ann Fam Med. 2010;8:484-492.

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