The relationship between subjective sleep disturbances and illness insight in individuals with alcohol-related cognitive disorders

Abstract

Background: Sleep disturbances are often observed in people with alcohol-related cognitive disorders. In addition to their cognitive disorders, illness insight may be compromised in these patients, complicating addiction treatment adherence. Aim of this study was to examine the relationship between illness insight and subjective sleep disturbances in individuals with alcohol use disorder (AUD) without cognitive impairment, individuals with alcohol-related cognitive impairments (ARCI) and people with Korsakoff’s syndrome (KS) in a convenience sample. In addition, this study examines the role of illness insight in dysfunctional beliefs and attitudes about sleep.

Methods: Twenty-four individuals with KS, 17 individuals with ARCI and 21 individuals with AUD participated in this study. Illness insight was measured using the Q8 questionnaire. Subjective sleep disturbances were measured using the Pittsburg Sleep Quality Index and the Dysfunctional Beliefs and Attitudes about Sleep questionnaire. General cognitive functioning was assessed with the Montreal Cognitive Assessment.

Results: Comparable levels of subjective sleep disturbances across the three diagnostic groups were found. Also, no significant relation was found between subjective sleep disturbances and illness insight in the three groups.

Conclusion: This study suggests that the level of illness insight does not appear to play a role in the self-report of sleep disturbances.

Keywords

alcohol use disorder / alcohol-related cognitive disorders / illness insight / Korsakoff's syndrome / sleep disturbances

References

[1] Sharma R, Parikh M, Mishra V, Zuniga A, Sahota P, Thakkar M. Sleep, sleep homeostasis and arousal disturbances in alcoholism. Brain Res Bull. 2022; 182: 30-43. https://doi.org/10.1016/j.brainresbull.2022.01.022

[2] Chakravorty S, Chaudhary NS, Brower KJ. Alcohol dependence and its relationship with insomnia and other sleep disorders. Alcohol Clin Exp Res. 2016; 40(11): 2271-2282. https://doi.org/10.1111/acer.13217

[3] Laniepce A, Lahbairi N, Cabé N, Pitel A, Rauchs G. Contribution of sleep disturbances to the heterogeneity of cognitive and brain alterations in alcohol use disorder. Sleep Med Rev. 2021; 58: 1-15. https://doi.org/10.1016/j.smrv.2021.101435

[4] Koob GF, Colrain IM. Alcohol use disorder and sleep disturbances: a feed-forward allostatic framework. Neuropsychopharmacology. 2020; 45(1): 141-165. https://doi.org/10.1038/s41386-019-0446-0

[5] Zhabenko N, Wojnar M, Brower KJ. Prevalence and correlated of insomnia in a Polish sample of alcohol-dependent patients. Alcohol Clin Exp Res. 2012; 36(9): 1600-1607. https://doi.org/10.1111/j.1530-0277.2012.01771.x

[6] Kranzler HR, Soyka M. Diagnosis and pharmacotherapy of alcohol use disorder: a review. JAMA. 2018; 320(8): 815-824. https://doi.org/10.1001/jama.2018.11406

[7] Brooks AT, Wallen GR. Sleep disturbances in individuals with alcohol-related disorders: a review of cognitive-behavioral therapy for insomnia (CBT-I) and associated non-pharmacological therapies. Subst Abuse Res Treat. 2014; 8: 55-62. https://doi.org/10.4137/SART.S18446

[8] Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017; 9: 151-161. https://doi.org/10.2147/NSS.S134864

[9] Tuason R, Brooks A, Krumlauf M, et al. 1004 I was sleeping, or so I thought: comparison of subjective and objective reports in individuals with alcohol dependence during an inpatient rehabilitation treatment program. Sleep. 2018; 41(suppl_1): 372. https://doi.org/10.1093/sleep/zsy061.1003

[10] Bruijnen CJWH, Dijkstra BAG, Walvoort SJW, et al. Prevalence of cognitive impairment in patients with substance use disorder. Drug Alcohol Rev. 2019; 38(4): 435-442. https://doi.org/10.1111/dar.12922

[11] Caballeria E, Maier M, Balcells-Oliveró M, et al. Rehabilitation gaming system for alcohol-related cognitive impairment: a pilot usability study. Alcohol Alcohol. 2022; 57(5): 595-601. https://doi.org/10.1093/alcalc/agab043

[12] Le Berre A. Emotional processing and social cognition in alcohol use disorder. Neuropsychology. 2019; 33(6): 808-821. https://doi.org/10.1037/neu0000572

[13] Walvoort SJW, van der Heijden PT, Wester AJ, Kessels RPC, Egger JIM. Self-awareness of cognitive dysfunction: self-reported complaints and cognitive performance in patients with alcohol-induced mild or major neurocognitive disorder. Psychiatry Res. 2016; 245: 291-296. https://doi.org/10.1016/j.psychres.2016.08.007

[14] Oscar-Berman M, Valmas MM, Sawyer KS, Ruiz SM, Luhar RB, Gravitz ZR. Profiles of impaired, spared and recovered neuropsychologic processes in alcoholism. In: EV Sullivan, A Pfefferbaum, eds. Handbook of Clinical Neurology. Elsevier; 2014: 183-210.

[15] Laniepce A, Segobin S, Lannuzel C, et al. Neuropsychological and neuroimaging examinations of self-reported sleep quality in alcohol use disorder with and without Korsakoff’s syndrome. Alcohol Clin Exp Res. 2019; 43(5): 952-964. https://doi.org/10.1111/acer.13997

[16] Fidder H, Veenhuizen RB, Gerridzen IJ, et al. Impaired awareness in people with severe alcohol-related cognitive deficits including Korsakoff’s syndrome: a network analysis. J Clin Med. 2023; 12: 1-14. https://doi.org/10.3390/jcm12093139

[17] Laniepce A, Segobin S, André C, et al. Distinct sleep alterations in alcohol use disorder patients with and without Korsakoff’s syndrome: relationship with episodic memory. J Clin Med. 2023; 12(6): 1-17. https://doi.org/10.3390/jcm12062440

[18] Lairie M, Pottier M. Quelques remarques à propos du sommeil dans le syndrome de Korsakoff. Rev Electroencéphalogr Neurophysiol Clin. 1979; 9(3): 277-285. https://doi.org/10.1016/S0370-4475(79)80009-X

[19] Martin PR, Loewenstein RJ, Kaye WH, Ebert MH, Weingartner H, Gillin JC. Sleep EEG in Korsakoff’s psychosis and Alzheimer’s disease. Neurology. 1986; 36(3): 411-414. https://doi.org/10.1212/wnl.36.3.411

[20] Lincoln R, Rosenthal CF, Malte CA, Simpson T. A pilot study of memory impairment associated with discrepancies between retrospective and daily recall of alcohol consumption. Am J Addict. 2011; 20(6): 568-574. https://doi.org/10.1111/j.1521-0391.2011.00178.x

[21] Verdejo-García A, Pérez-García M. Substance abusers’ self-awareness of the neurobehavioral consequences of addiction. Psychiatry Res. 2008; 15: 172-180. https://doi.org/10.1016/j.psychres.2006.08.001

[22] Spikman JM, van der Naalt J. Indices of impaired self-awareness in traumatic brain injury patients with focal frontal lesions and executive deficits: implications for outcome measurement. J Neurotrauma. 2010; 27(7): 1195-1202. https://doi.org/10.1089/neu.2010.1277

[23] Morin CM. Insomnia: Psychological Assessment and Management. Guilford Press; 1993.

[24] Jin L, Zhou J, Peng H, Ding S, Yuan H. Investigation on dysfunctional beliefs and attitudes about sleep in Chinese college students. Neuropsychiatric Dis Treat. 2018; 14: 1425-1432. https://doi.org/10.2147/NDT.S155722

[25] Harvey AG. A cognitive theory of and therapy for chronic insomnia. J Cognit Psychother. 2005; 19: 41-60. https://doi.org/10.1891/jcop.19.1.41.66332

[26] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev. American Psychiatric Association; 2022. https://doi.org/10.1176/appi.books.9780890425787

[27] Kopelman MD. Disorders of memory. Brain. 2002; 125(10): 2152-2190. https://doi.org/10.1093/brain/awf229

[28] Duits A, Kessels R. Schatten van het premorbide functioneren [estimating premorbid functioning]. In: M Hendriks, RPC Kessels, M Gorissen, B Schmand, eds. Neuropsychologische diagnostiek: De klinische praktijk. Boom; 2014: 173-186.

[29] Kessels RPC, de Vent NR, Bruijnen CJWH, et al. Regression-based normative data for the Montreal Cognitive Assessment (MoCA) and its Memory Index Score (MoCA-MIS) for individuals aged 18-91. J Clin Med. 2022; 11(14):4059. https://doi.org/10.3390/jcm11144059

[30] Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2): 193-213. https://doi.org/10.1016/0165-1781(89)90047-4

[31] Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res. 2002; 53(3): 737-740. https://doi.org/10.1016/s0022-3999(02)00330-6

[32] Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh Sleep Quality Index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev. 2016; 25: 52-73. https://doi.org/10.1016/j.smrv.2015.01.009

[33] Bourgeois ML, Koleck M, Jais E. Validation de l’échelle d’insight Q8 et évaluation de la conscience de la maladie chez 121 patients hospitalisés en psychiatrie [Validation of the insight Q8 scale and evaluation of the awareness disorder in 121 psychiatric inpatients]. Ann Med-Psychol. 2002; 160(7): 512-517. https://doi.org/10.1016/S0003-4487(02)00212-3

[34] Morin CM, Vallières A, Ivers H. Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). Sleep. 2007; 30(11): 1547-1554. https://doi.org/10.1093/sleep/30.11.1547

[35] Hiller RM, Johnston A, Dohnt H, Lovato N, Gradisar M. Assessing cognitive processes related to insomnia: a review and measurement guide for Harvey’s cognitive model for the maintenance of insomnia. Sleep Med Rev. 2015; 23: 46-53. https://doi.org/10.1016/j.smrv.2014.11.006

[36] Verkaik F, Ford ME, Geurtsen GJ, van Someren EJW. Are sleep-related beliefs and behaviours dysfunctional in people with insomnia after acquired brain injury? A cross-sectional study. J Sleep Res. 2024; 33(3): 1-10. https://doi.org/10.1111/jsr.13998

[37] Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4): 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x

[38] Cohen J. Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates; 1988.

[39] Kass RE, Raftery AE. Bayes factors. J Am Stat Assoc. 1995; 90(430): 773-795. https://doi.org/10.2307/2291091

[40] Gerridzen IJ, Joling KJ, Depla MF, et al. Awareness and its relationships with neuropsychiatric symptoms in people with Korsakoff syndrome or other alcohol-related cognitive disorders living in specialized nursing homes. Int J Geriatr Psychiatr. 2019; 34(6): 836-845. https://doi.org/10.1002/gps.5093

[41] Palm A, Vataja R, Talaslahti T, et al. Incidence and mortality of alcohol-related dementia and Wernicke Korsakoff syndrome: a nationwide register study. Int J Geriatr Psychiatr. 2022; 37(8): 1-9. https://doi.org/10.1002/gps.5775

[42] Angarita GA, Emadi N, Hodges S, Morgan PT. Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Addiction Sci Clin Pract. 2016; 11: 1-17. https://doi.org/10.1186/s13722-016-0056-7

[43] Aili K, Astrom-Paulsson S, Stoetzer U, Svartengren M, Hillert L. Reliability of actigraphy and subjective sleep measurements in adults: the design of sleep assessments. J Clin Sleep Med. 2017; 13(1): 39-47. https://doi.org/10.5664/jcsm.6384

[44] Wilkerson AK, Simmons RO, Sahlem GL, et al. Sleep and substance use disorder treatment: a preliminary study of subjective and objective assessment of sleep during an intensive outpatient program. Am J Addict. 2021; 30(5): 477-484. https://doi.org/10.1111/ajad.13194

[45] Egger JIM, Wester AJ, De Mey HRA, Derksen JJL. Korsakoff’s syndrome on the MMPI-2. Acta Neuropsychiatr. 2002; 14(5): 231-236. https://doi.org/10.1034/j.1601-5215.2002.140506.x

[46] Sadeh A. The role and validity of actigraphy in sleep medicine: an update. Sleep Med Rev. 2011; 15(4): 259-267. https://doi.org/10.1016/j.smrv.2010.10.001

[47] de Souza L, Benedito-Silva AA, Pires MLN, Poyares D, Tufik S, Calil HM. Further validation of actigraphy for sleep studies. Sleep. 2003; 26(1): 81-85. https://doi.org/10.1093/sleep/26.1.81

RIGHTS & PERMISSIONS

2025 The Author(s). Sleep Research published by John Wiley & Sons Australia, Ltd on behalf of Chinese Sleep Research Society.