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The Effects of Alcohol on Quality of Sleep


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Background Alcohol is traditionally known to have a relaxing effect. However, persons who consume alcohol in excessive amounts suffer from poor sleep quality and patients with alcohol use disorders commonly report insomnia. In this study, we aimed to evaluate the effects of alcohol use on sleep quality. Methods A questionnaire-based cross-sectional survey was conducted with 234 men and 159 women who had visited a general hospital. We used structured questionnaires, including Alcohol Use Disorder Identification Test-Korean revised version (AUDIT-KR) and the Pittsburgh Sleep Quality Index-Korean version (PSQI-K). We analyzed the association between scores for all subcategories of the PSQI-K and the AUDIT-KR and then analyzed the correlation between AUDIT-KR and global PSQI-K scores. Results The global PSQI-K score for men was positively correlated with the AUDIT-KR score (P=0.008) after adjusting for age, chronic disease, tobacco use, exercise, depression, and anxiety. The AUDIT-KR score was significantly associated with subjective sleep quality (P=0.005), sleep duration (P=0.047), and sleep disturbance (P=0.048); it was not associated with sleep latency, sleep efficiency, or daytime dysfunction. Sleep disturbances due to snoring were significantly associated with total AUDIT-KR score (P=0.008). There was no correlation between the global PSQI-K and AUDIT-KR scores for women (P=0.333). However, daytime dysfunction showed a significant association with total AUDIT-KR score (P=0.048). Conclusion Men with higher AUDIT-KR scores tended to suffer from poor sleep quality. AUDIT-KR scores showed significant correlations with subjective sleep quality, sleep duration, and sleep disturbances in men.
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The Effects of Alcohol on Quality of
Soon-Yeob Park
, Mi-Kyeong Oh
*, Bum-Soon Lee
, Haa-Gyoung Kim
, Won-Joon Lee
, Ji-Ho Lee
, Jun-Tae Lim
Jin-Young Kim
Department of Family Medicine, Gangneung Asan Hospital, University of Ulsan, College of Medicine, Gangneung, Korea
Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
Background: Alcohol is traditionally known to have a relaxing effect. However, persons who consume alcohol in
excessive amounts suffer from poor sleep quality and patients with alcohol use disorders commonly report insom-
nia. In this study, we aimed to evaluate the effects of alcohol use on sleep quality.
Methods: A questionnaire-based cross-sectional survey was conducted with 234 men and 159 women who had
visited a general hospital. We used structured questionnaires, including Alcohol Use Disorder Identification Test-
Korean revised version (AUDIT-KR) and the Pittsburgh Sleep Quality Index-Korean version (PSQI-K). We analyzed
the association between scores for all subcategories of the PSQI-K and the AUDIT-KR and then analyzed the corre-
lation between AUDIT-KR and global PSQI-K scores.
Results: The global PSQI-K score for men was positively correlated with the AUDIT-KR score (P= 0.008) after ad-
justing for age, chronic disease, tobacco use, exercise, depression, and anxiety. The AUDIT-KR score was significant-
ly associated with subjective sleep quality (P = 0.005), sleep duration (P = 0.047), and sleep disturbance (P = 0.048); it
was not associated with sleep latency, sleep efficiency, or daytime dysfunction. Sleep disturbances due to snoring
were significantly associated with total AUDIT-KR score (P= 0.008). There was no correlation between the global
PSQI-K and AUDIT-KR scores for women (P = 0.333). However, daytime dysfunction showed a significant associa-
tion with total AUDIT-KR score (P= 0.048).
Conclusion: Men with higher AUDIT-KR scores tended to suffer from poor sleep quality. AUDIT-KR scores showed
significant correlations with subjective sleep quality, sleep duration, and sleep disturbances in men.
Keywords: Alcohol Drinking; Sleep Disorders; Sleep Quality
Received: August 31, 2015, Revised: September 24, 2015, Accepted: September 30, 2015
*Corresponding Author: Mi-Kyeong Oh Tel: +82-33-610-3325, Fax: +82-33-641-8130, E-mail:
Korean J Fam Med 2015;36:294-299
Original Article
eISSN: 2092-6715
Soon-Yeob Park, et al.
Alcohol and Sleep Quality
Sleep is commonly known to facilitate recovery from physical,
mental, and brain fatigue caused by daytime activities. Sleep
allows the human body the rest time required for memory and
learning, preservation of energy, development, and growth.
Recently, several studies on sleep have reported that poor qual-
ity sleep not only leads to increased stress, fatigue, and mood
but also raises risks of obesity, metabolic syndrome,
and cardiovascular disease.
Conversely, many diseases also
affect sleep quality. Depression, anxiety, musculoskeletal dis-
orders, obesity, restless leg syndrome, and other chronic dis-
eases are all known to cause sleep disorders.
Moderate alcohol consumption is known to decrease the
risk of mortality,
while excessive drinking can increase the
onset of various diseases and lead to increased risk of mortali-
Excessive drinking also cause a range of problems with
the nervous system; such problems include memory disorders,
movement disorders, peripheral neuropathy, and reduced learn-
ing ability.
As of 2012, the rate of high-risk drinking (average
alcohol consumption of 7+ drinks on 2+ days per week) among
Korean adults males is 21.8%. The high-risk drinking rate ex-
ceeds 25% for those aged 30–59, indicating that a significant
part of the population is exposed to drinking related dangers.
Among women, on the other hand, the high-risk drinking rate
has been reported at 6.0%.
Alcohol consumption also affects sleep quality in various
ways. A number of studies have shown that drinking momen-
tarily increases sleepiness, but later causes frequent nighttime
and early morning awakenings.
Individuals with alcohol use
disorders frequently consume alcohol before sleep in an effort
to improve their sleep. Many moderate alcohol users also drink
before sleep if they suffer from insomnia. On the contrary, oth-
er studies have shown no correlation between drinking pat-
terns and sleep quality.
While it is believed that drinking
patterns are significantly related to sleep patterns, no empirical
correlation has been confirmed to date and studies on the cor-
relation between drinking patterns and sleep quality of Kore-
ans are virtually non-existent.
Therefore, we conducted this study to examine the effects of
alcohol consumption on sleep quality and to provide recom-
mendations for improving sleep quality.
1. Subjects
This study was conducted on patients, and their guardians,
who visited Gangneung Asan Hospital in Gangneung, Korea
from January 2014 to July 2014. Among 560 adults who volun-
tarily completed the informed consent process, subjects diag-
nosed with conditions known to affect sleep, including life-thre-
atening critical diseases, depression, anxiety, restless leg syn-
drome, and sleep apnea were excluded. Thus, we selected 234
men and 159 wo men who sincerely answered study question-
naires. This study was conducted after being reviewed and ap-
proved by the hospital’s institutional review board (GNAH IRB
2. Survey Methods
1) Structured questionnaire
In order to assess basic subject characteristics, a questionnaire
was administered asking about a subject’s age, gender, and med-
ical history (e.g., hypertension, diabetes, dyslipidemia, chronic
musculoskeletal disease, etc.). In order to identify smoking pat-
terns, subjects were categorized as current smokers, former
smokers, or non-smokers. Subjects were also asked about their
exercise habits, including total number and duration of exer-
cise sessions per week. This data was used to categorize sub-
jects into one of three exercise levels: those exercising less than
once per week, those exercising 1–2 times per week, and those
exercising 3 times or more per week.
Although persons with a history of depression or anxiety
were excluded from the study, we used a depression and anxi-
ety screening tool, which has been standardized in Korea; this
tool was used in order to correct for the role of depression or
anxiety that are known to affect sleep quality. More specifically,
we used the ‘two-question depression test’ and those who an-
swered yes to one or both of the questions were assumed to be
experiencing some level of depression.
We also asked sub-
jects four questions covering primary symptoms of anxiety,
adapted from the Korean-translated Goldberg Anxiety Scale
(GAS). Those who answered yes to two or more of the four ques-
tions were assumed to be experiencing some level of anxiety.
2) Alcohol drinking state assessment questionnaire
In order to investigate alcohol consumption rates, we used the
Alcohol Use Disorder Identification Test-Korean revised ver-
sion (AUDIT-KR), a tested and validated Korean version of the
AUDIT that is widely used for assessment of alcohol use disor-
ders and hazardous drinking.
The AUDIT-KR consists of 10
questions, with each question rated on a 4-point scale. The high-
er the respondent’s alcohol dependency, the higher the total
score. The maximum possible score is 40 points. The cutoff val-
ue for alcohol use disorders is 10 points for men and 8 points
for women.
3) Sleep quality assessment questionnaire
In order to evaluate subjects’ sleep quality, we used the Pitts-
burgh Sleep Quality Index-Korean version (PSQI-K), a tested
and validated Korean-language version of the Pittsburgh Sleep
Quality Index (PSQI), which has been widely used as a sleep
quality assessment tool since its translation in 2012.
We in-
Soon-Yeob Park, et al.
Alcohol and Sleep Quality296
vestigated the scores of the 7 components of the PSQI-K that
affect sleep quality: subjective sleep quality, sleep duration,
sleep latency, habitual sleep efficiency, sleep disturbance, use
of sleep medication, and daytime dysfunction. The global score
of the PSQI-K is the sum of all component scores. The mini-
mum possible score is 0, indicating ideal sleep quality, and the
maximum possible score is 21, indicating poor sleep quality.
Subjects with total scores of 5 and below were defined as ‘good
sleepers,’ and those with total scores of 6 and above were de-
fined as ‘poor sleepers.’ The 7 component scores are rated on a
3-point ascending scale, with 0 points indicating ideal sleep
quality and 3 points indicating poor sleep quality. Each com-
ponent score of 0–1 points was determined as having good ef-
fects on sleep quality, while scores of 2–3 points were determin-
ed as having bad effects on sleep quality.
3. Statistical Analysis
In this study, we used PASW SPSS Statistics ver. 18.0 (SPSS Inc.,
Chicago, IL, USA) for statistical analyses with significance level
set at less than 0.05 for all statistical operations. We performed
chi-square tests and independent sample t-tests to assess gen-
der differences in initial reports of underlying disease, smoking
status, exercise frequency, depressive symptoms, and anxiety
symptoms. We used the Wilcoxon two-sample test to assess
gender differences in AUDIT-KR scores. To investigate the rela-
tionship between global or component scores of the PSQI-K
and AUDIT-KR scores, we performed the Mann-Whitney test.
In order to analyze the correlation between AUDIT-KR scores
and PSQI-K scores, we performed a multiple linear regression
analysis adjusting for age, chronic disease, current smoking
status, regular exercise, two-question depression test scores,
and GAS scores. Any subjects diagnosed with hypertension, di-
abetes, ischemic heart disease, stroke, or chronic musculoskel-
etal diseases and undergoing treatment at the hospital for any
of these conditions were defined as having chronic disease, for
the purposes of this study. Subjects who reported that they ex-
ercised 3 times or more per week were defined as regular exer-
1. Baseline Characteristics of Subjects
The average age of the subjects was 51.1± 12.0 years for men
and 48.6 ± 10.0 years for women. The number of subjects cate-
gorized as having chronic disease was significantly greater among
men as compared to women (P = 0.001). As for smoking status,
the number of current smoker and former smokers were sig-
nificantly greater among men than women (P< 0.001). Report-
ed frequency of weekly exercise was also significantly greater
among men than women in this study (P= 0.004).
Total AUDIT-KR scores were significantly higher among men
than women (P< 0.001) and the number of subjects categorized
as having an alcohol use disorder was also significantly greater
among males than females (P<0.001). According to results of
the depression and anxiety screening tests, there were no sig-
nificant gender differences between subjects with symptoms of
depression and those with symptoms of anxiety. While global
PSQI-K score was significantly higher among men than women
(P = 0.033), when subjects were categorized by sleep quality
(good sleepers and poor sleepers) the ratio of poor sleepers be-
came non-significant (P= 0.114) (Table 1).
2. Relationship between Each Component of Sleep Quality
and Alcohol Use Disorder Identification Test-Korean
Revised Version Score
When our subjects were categorized by sleep quality, based
upon their total PSQI-K scores, there were no significant differ-
ences between the two groups and AUDIT-KR scores for either
men or women. Examination of the correlation between each
PSQI-K component score and AUDIT-KR score among men,
revealed that the group with poor subjective sleep quality show-
ed significantly higher AUDIT-KR scores than the group with
good subjective sleep quality (P = 0.005). Additionally, subjects
with short sleep duration ( < 6 hours of sleep per night on aver-
Table 1. Baseline characteristic of study subjects
Variable Men (n = 234) Women (n=159) P-value*
Age (y) 51.1
12.0 48.6
10.0 0.075
Underlying disease
Ischemic heart disease
Rheumatic disease
Chronic disease
83 (35.5)
27 (11.5)
12 (5.1)
1 (0.4)
18 (7.7)
112 (47.9)
32 (20.1)
7 (4.4)
3 (1.9)
4 (2.5)
11 (6.9)
49 (30.8)
Smoking status
Current smoker
67 (28.6)
114 (48.7)
53 (22.6)
3 (1.9)
6 (3.8)
150 (94.3)
< 0.001
1–2 times a week
At least 3 times a week
96 (41.0)
87 (37.2)
51 (21.8)
91 (57.2)
48 (30.2)
20 (12.6)
Depressive mood 64 (27.4) 49 (30.8) 0.456
Anxious mood 33 (14.1) 23 (14.5) 0.920
AUDIT-KR 9 [3,16]
1 [0,3]
< 0.001
Alcohol use disorder
120 (51.3)
114 (48.7)
141 (88.7)
18 (11.3)
< 0.001
Pittsburgh Sleep Quality
Index-Korean version
Good sleeper (score 5) (%)
Poor sleeper (score > 5) (%)
5 [3, 7]
136 (58.1)
98 (41.9)
4 [3, 6]
105 (66.0)
54 (34.0)
Values are presented as mean
standard deviation or number (%).
AUDIT-KR, Alcohol Use Disorder Identification Test-Korean Revised.
*By independent sample t-test or chi-square test.
Values are presented as median
[25 percentile, 75 percentile].
By Wilcoxon two-sample test.
Alcohol use disorder is
indicated by an of AUDIT-KR cutoff value greater than 10 points in men and 8 points
in women.
Soon-Yeob Park, et al.
Alcohol and Sleep Quality
age) showed significantly higher AUDIT-KR scores than those
with longer sleep duration (P= 0.047). Among men, those with
more sleep disturbances showed significantly higher AUDIT-
KR scores than those with fewer sleep disturbances (P= 0.048).
No significant differences in the correlation between AUDIT-
KR scores were noted for sleep latency, sleep efficiency, and
daytime dysfunction components. Although there was no sta-
tistical significance among individual sleep efficiency items,
the group with lower efficiency tended to have higher AUDIT-
KR scores as compared to the group with higher efficiency (P =
0.09). Subjects waking up from sleep, due to snoring, at least
once per week showed significantly higher AUDIT-KR scores
than other subjects (P= 0.008) (Table 2).
Among women, those with more daytime dysfunction showed
significantly higher AUDIT-KR scores than those with lower
daytime dysfunction (P= 0.048), but the differences in AUDIT-
KR scores were insignificant in relation to other components
(Table 2).
3. Multiple Linear Regression Analysis between Alcohol Use
Disorder Identification Test-Korean Revised Version
Scores and Sleep Quality Scores
When a linear regression analysis was performed on the corre-
lation between male AUDIT-KR and PSQI-K scores, a signifi-
cant positive correlation was found when the factors affecting
sleep were not corrected (P= 0.001). A significant correlation
was found, even after correcting for age, chronic disease, cur-
rent smoking status, regular exercise, depression symptoms,
and anxiety symptoms (P = 0.008). Depression symptoms and
anxiety symptoms were also positively correlated with PSQI-K
Table 2. Relationship between component score of PSQI-K and AUDIT-KR
Component score of PSQI-K
Men Women
No. AUDIT-KR P-value* No. AUDIT-KR P-value*
Total PSQI-K score
Good sleeper (total score 5) 136 9.21
7.62 0.105 105 2.45
4.15 0.333
Poor sleeper (total score > 5) 98 11.53
9.42 54 3.74
Subjective sleep quality
Good 162 9.04
7.81 0.005 125 2.78
4.63 0.674
Poor 72 12.74
9.29 34 3.29
Sleep latency
30 min 179 9.99
8.21 0.77 116 2.98
4.64 0.075
> 30 min 55 10.78
9.36 43 2.63
Sleep duration
6 h 207 9.67
8.04 0.047 145 2.81
4.79 0.305
< 6 h 27 14.07
10.71 14 3.64
Sleep efficiency
75% 207 9.74
8.11 0.094 148 2.84
4.79 0.574
< 75% 27 13.56
10.48 11 3.45
Sleep disturbance
No 197 9.52
7.84 0.048 136 2.74
4.74 0.422
Yes 37 13.68
10.76 23 3.74
Daytime dysfunction
No 169 9.87
8.21 0.445 122 2.25
3.93 0.048
Yes 65 10.98
9.16 37 4.97
< 1 time/wk 167 9.20
8.15 0.008 141 2.87
4.91 0.966
1 time/wk 67 12.55
8.89 18 2.83
Values are presented as mean
standard deviation.
PSQI-K, Pittsburgh Sleep Quality Index-Korean version; AUDIT-KR, Alcohol Use Disorder Identification Test-Korean Revised version.
*By Mann-Whitney test.
Hours asleep/hours in bed × 100.
Nighttime awakenings due to snoring.
Table 3. Multiple linear regression analysis of sleep quality by global Pittsburgh
Sleep Quality Index-Korean version score
Men Women
* P-value
* P-value
Model 1
AUDIT-KR 0.215 0.001 0.110 0.166
Model 2
AUDIT-KR 0.222 0.001 0.071 0.411
Age 0.003 0.969 -0.150 0.142
Chronic disease -0.049 0.482 0.153 0.112
Current smoker -0.004 0.955
Regular exercise
-0.122 0.062 -0.114 0.154
Model 3
AUDIT-KR 0.171 0.008 0.014 0.861
Age -0.026 0.707 -0.104 0.264
Chronic disease -0.028 0.676 0.096 0.271
Current smoker 0.010 0.871
Regular exercise
-0.088 0.181 -0.167 0.083
Depressive mood 0.175 0.008 0.258 0.001
Anxious mood 0.175 0.009 0.323 < 0.001
PSQI-K, Pittsburgh Sleep Quality Index-Korean version; AUDIT-KR, Alcohol Use Disorder
Identification Test-Korean revised version.
*Standard regression coefficient.
3 or more exercise sessions per week.
Soon-Yeob Park, et al.
Alcohol and Sleep Quality298
scores (P= 0.008 and P = 0.009, respectively) (Table 3).
Among women, no significant correlation was found between
AUDIT-KR and PSQI-K scores. However, depression symptoms
and anxiety symptoms were found to be significantly and posi-
tively correlated with PSQI-K score (P= 0.001 and P < 0.001, re-
spectively) (Table 3).
In the present study, which focused on the effects of alcohol
consumption on sleep quality among adults aged 20 years and
older, we found that AUDIT-KR and PSQI-K scores were signifi-
cantly correlated among male subjects. In particular, we learned
that alcohol consumption patterns are related to subjective sleep
quality, sleep duration, and sleep continuation. In contrast, sleep
latency was not correlated with alcohol consumption level. In
other words, it appears that men with more alcohol consump-
tion suffer from overall poor sleep quality, experience difficulty
in maintaining sleep rather than falling asleep, suffer from short-
er overall sleep duration, and therefore have worse subjective
sleep quality. Among factors that disturb sleep, it was learned
that snoring, in particular, is linked with alcohol consumption.
Among female subjects, AUDIT-KR and PSQI-K scores were
not correlated. Perhaps this is because the number of female
hazardous drinkers was notably lower than among male sub-
jects and, therefore, the number of subjects with sleep disorder
caused by alcohol might have been too low to yield any statisti-
cally significant result. When examining the correlation between
the subcategories of the PSQI-K and the AUDIT-K among wom-
en, daytime dysfunction was shown to be significantly correlat-
ed with the AUDIT-K; this finding provides a basis for the con-
clusion that alcohol does not affect nighttime sleep duration
among women as greatly as it deteriorates the recovery func-
tions of sleep leading to daytime dysfunction.
Among both men and women, depression symptoms and
anxiety symptoms were significantly correlated with increased
PSQI-K values. In this study, we found that anxiety symptoms
were more strongly correlated with PSQI-K values than depres-
sion symptoms and that women showed greater correlation
between PSQI-K values and anxiety or depression symptoms
as compared to men.
The correlation between alcohol consumption and sleep quali-
ty among men in this study was consistent with results previous-
ly reported by Roehrs and Roth
that alcohol generally disturbs
Chang et al.
and Vinson et al.
found that drin king
does not have significant effects on sleep quality. However, these
two studies did not control for gender and it could be posited that
women act as an effect modifier. In our study, drinking did not
significantly impact sleep quality among women likely because
of generally low rates of alcohol consumption. It follows that
women with problematic alcohol consumption experienced
poorer sleep quality, similar to trends observed among men.
In a laboratory study in which healthy individuals were in-
structed to drink alcohol and then undergo polysomnography,
it was shown that rapid eye movement (REM) sleep was sup-
pressed during the first half of the sleep cycle followed by an
increase during the second half of the sleep cycle.
consumption could induce deep sleep at the beginning of the
sleep cycle, but if sleep continues for a longer duration, overall
sleep quality could deteriorate due to the decreased amount of
slow wave sleep and REM sleep rebound. This is in agreement
with our findings that, among men, drinking decreased overall
sleep duration and increased sleep disturbances.
It has also been reported that alcohol consumption increas-
es sleep apnea
and our study confirmed that number of
nighttime awakenings due to snoring was related to alcohol
consumption. As mentioned above, alcohol prevents entry into
deep sleep and therefore makes a person more susceptible to
sleep disturbances given the same conditions. It has also been
suggested that alcohol relaxes the upper airway muscles, in-
creasing resistance during inhalation, which directly and sig-
nificantly impedes breathing.
A number of studies have reported that depression and anxi-
ety deteriorate overall sleep quality.
Similarly, in this study,
we found a significant correlation between anxiety or depres-
sion symptoms and deterioration in sleep quality among both
men and women. This significant correlation, which remained
after excluding persons already diagnosed with anxiety or de-
pression, reaffirms the importance of effective management of
depression and anxiety for improving sleep quality.
One limitations of this study is that the results may not reflect
the general population because the study only sampled per-
sons who visited a hospital; another limitation is that the num-
ber of female subjects with high alcohol consumption levels
was low and thus yielded limited statistical significance. We
believe that it would be meaningful to conduct further studies
on female subjects to compare the sleep quality between haz-
ardous drinkers or patients with alcohol use disorder and mod-
erate drinkers or persons who do not drink at all. In addition,
further studies are recommended focused on the correlation
between alcohol consumption and sleep apnea or restless leg
syndrome, both of which were found to be significant in the
present study.
No potential conflict of interest relevant to this article was re-
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course, and comorbidity of insomnia and depression in young adults.
Sleep 2008;31:473-80.
... Alcohol consumption has been shown to be associated with poorer sleep quality in observational [51,52] and clinical settings [53]. A large community study [51] found a dose-response relationship between alcohol consumption and worse sleep quality six years later and that after adjusting for confounders, "consumption of hard liquor [spirits] but not beer or wine, was significantly associated with poor sleep quality". ...
... A large community study [51] found a dose-response relationship between alcohol consumption and worse sleep quality six years later and that after adjusting for confounders, "consumption of hard liquor [spirits] but not beer or wine, was significantly associated with poor sleep quality". By contrast, Ref. [52] found increasing alcohol consumption was associated with shorter sleep duration in young males but not in a small sample of females. Our study found a positive association between the amount of pre-pregnancy beer and TIB, a negative association for wine and, in multiple regression, that a history of pre-pregnancy consumption of spirits was associated with shorter TIB. ...
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We consider the relationship between time in bed (TIB) and sleeping difficulties with demographic variables and nutrient intakes in the second (T2) and third (T3) trimester of pregnancy. Data were acquired from a volunteer sample of New Zealand pregnant women. In T2 and T3, questionnaires were administered, diets were obtained from one 24 h recall and three weighed food records, and physical activity was measured with the use of three 24 h diaries. In total, 370 women had complete information in T2 and 310 in T3. In both trimesters, TIB was associated with welfare or disability status, marital status and age. In T2, TIB was associated with work, childcare, education and pre-pregnancy alcohol consumption. There were fewer significant lifestyle covariates in T3. In both trimesters, TIB declined with increasing dietary intake, especially water, protein, biotin, potassium, magnesium, calcium, phosphorus and manganese. Adjusted for weight of dietary intake and welfare/disability, TIB declined with increasing nutrient density of B vitamins, saturated fats, potassium, fructose and lactose; and TIB increased with carbohydrate, sucrose and vitamin E. Subjective sleeping difficulties increased with the week of gestation, morning sickness severity, anxiety, dairy and saturated fat intake, and they decreased with fruit, vegetable and monounsaturated fat intake. The study highlights the changing influence of covariates throughout the pregnancy and corroborates several published findings on the relationship of diet and sleep.
... The current finding was similar to studies done in other parts of the world. [62][63][64] The possible explanation for the association could be that alcohol consumption has the following effects on the sleep cycle; alcohol use induces deep sleep during the initial phase of the sleep cycle, but, the quality of sleep is compromised when sleep continues 26,65 Moreover, alcohol increases sleep-induced apnea by preventing the entry into deep sleep as a result of relaxing muscles in the upper airway and due to increased resistance during air entry into the lung, which can impede breathing severely. [66][67][68] According to this study, cognitive impairment was positively linked with AUD. ...
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Background: The aim of this study was to investigate the magnitude and associated factors of alcohol use disorder among the elderly living in 3 towns in South West Ethiopia. Method: Cross-sectional community-based study was done among 382 elderly people aged 60 or more from February to March 2022 in South West Ethiopia. The participants were selected by a systematic random sampling method. Alcohol use disorder, quality of sleep, cognitive impairment, and depression were assessed by using AUDIT, Pittsburgh Sleep Quality Index, Standardized Mini Mental State Examination, and geriatric depression scale, respectively. Also, suicidal behavior, elder abuse, and other clinical and environmental factors were assessed. The data was entered into Epi Data Manager Version 4.0.2 before being exported to SPSS Version 25 for analysis. A logistic regression model was used, and variables with a P-value less than .05 in the final fitting model were stated as independent predictors of alcohol use disorder (AUD). Result: The magnitude of alcohol use disorder, current alcohol use, and life-time alcohol use among the elderly was 27.5%, 52.4%, and 89.3%, respectively. Also, 7%, 23%, 8.9%, and none of the elderly had nicotine, khat, inhalants, and cannabis use disorder, respectively. Furthermore, AUD was associated with cognitive impairment (AOR, 95% CI; 2.79 (1.47-5.30)), poor sleep quality (AOR, 95% CI; 3.27 (1.23-8.69)), chronic medical illness (AOR, 95% CI; 2.12 (1.20-3.74)), and suicidal ideation (AOR, 95% CI; 5.27 (2.21-12.60)). Conclusion: Problematic alcohol use was higher among the elderly, and cognitive impairment, poor sleep quality, having chronic medical illness, and suicidal ideation were risk factors for AUD. Therefore, community level screening for AUD and comorbid risk factors among this particular age group and managing them is crucial to prevent further complications due to AUD.
... The third subsection referred to phone use and time spent on the Internet, by category (social media, study, reading, entertainment). Finally, a number of sleep-related questions were included: self-assessed time spent asleep, bedtime hours, a number of sleep quality questions adapted from the Pittsburgh Sleep Quality Index (PSQI questionnaire) [35], and a few questions related to partaking in sleep-perturbing behavior namely having variable meal timing [36,37], drinking coffee or energy drinks less than 2 h before bed [38,39], alcohol [40,41], tobacco [42,43], or other substances use [44], administration of sedatives or other types of medicine [45], or other unspecified behaviors as identified by the students. ...
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Background and aims. The COVID-19 lockdowns are reported to have negatively influenced the wellbeing and learning efficacy of students. In this context, we analyzed the psychological impact of the COVID-19 quarantine on healthcare students, a subpopulation experiencing high stress levels. Methods. Our survey-based, cross-sectional study assessed wellbeing indicators, lifestyle and learning behaviors before and during the quarantine for 388 Romanian healthcare students. Results. Our findings included the increase in phone and social media use, at the expense of formal and independent study time; deteriorations in mood, self organization capacity and learning efficacy, and increased procrastination behaviors. Unexpectedly, our study identified an improvement in sleep quality and duration. The increase in social media use was less severe among rural students. We identified correlations between study time, online activities (including social media), wellbeing indicators and procrastination. Conclusion. Our study draws attention to quarantine-induced deteriorations of wellbeing and learning capacity in an important category of students.
... The most commonly used CNS depressant, alcohol, can create drowsiness and sleep; however, it is not restful sleep as even at low dose levels, alcohol disturbs the natural sleep cycle of users, producing increased daytime sleepiness the following day (Van Schrojenstein Lantman et al., 2017) Alcohol consumption contributes to the development of insomnia with chronic use (Park et al., 2015), shortens nightly sleep amounts, creates circadian abnormalities, and can aggravate breathing-related sleep difficulties including sleep apnea (He et al., 2019). There is a bidirectional association between alcohol use and sleep, as alcohol creates sleep disturbances, but likewise sleep disturbances lead to a greater use of alcohol, with difficulty in sleeping cited as a risk factor for relapse to substance use. ...
As a necessary part of physiological and emotional well-being, sleep is often overlooked or undervalued in Western society, in spite of the role restorative sleep plays in growth, healing, and recovery, immune response, and emotional regulation. The effect of psychoactive drugs on sleep, including pharmacological substances meant to assist in sleep, is notable and profound, especially in their disruption of REM sleep, the stage of sleep associated with dreaming. This article provides an overview of sleep stages, the brain and sleep, sleep disorders, and the effect of various psychoactive drugs on sleep architecture and hygiene. Future research, which treats substance use and sleep as bi-directional in nature and longitudinally explores sleep-related interventions in treatment and longer-term recovery that are sustainable and person-centered is merited.
ABSTRAK Latar Belakang: Hemodialisis merupakan prosedur untuk menyaring limbah dan air dari darah sebagai pengganti fungsi ginjal. Salah satu masalah pada pasien hemodialisis adalah gangguan tidur. Gangguan tidur dialami oleh setidaknya 50-80% pasien hemodialisis. Gangguan tidur yang banyak dialami pasien hemodialisis adalah kualitas tidur yang buruk. Mehrabi, Sarikhani, & Roozbeh (2017)menemukan bahwa 90,8% pasien hemodialisis memiliki kualitas tidur yang buruk yang dipengaruhi oleh berbagai faktor. Tujuan: Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kualitas tidur pada pasien hemodialisis. Metode: Sebuah tinjauan pustaka dilakukan. Basis data untuk studi ini dari PubMed, Science Direct dan Google Scholar. Artikel dipilih menggunakan Diagram Alur PRISMA menurut kriteria inklusi dan eksklusi. Penilaian kualitas artikel menggunakan penilaian kritis dari Law, Stewart, Pollock, Letts, Bosch & Wesstmorland (1998). Hasil analisis data disajikan dalam tabel ekstraksi. Hasil: Berdasarkan hasil seleksi artikel terdapat 4 artikel. Berdasarkan studi dari 4 artikel ditemukan bahwa terdapat tiga faktor yang berhubungan dengan kualitas tidur pada pasien hemodialisis. Faktor tersebut adalah faktor demografi yang meliputi umur dan jenis kelamin, faktor biologis yang meliputi status gizi, asidosis metabolik dan faktor gaya hidup termasuk merokok dan konsumsi alkohol. Kesimpulan: Faktor yang berhubungan dengan kualitas tidur pada pasien hemodialisis adalah faktor demografi, faktor biologis, asidosis dan faktor gaya hidup. Kata kunci: Gangguan tidur, kualitas tidur, hemodialisis
Monitoring sleep in real-world conditions requires bespoke equipment, e.g., Actigraphs or similar. However, such equipment is relatively expensive and not always available for large-scale field research. This study tests the possibility that sleep in real-world conditions can be monitored, sufficiently accurately, by tandems of commonly used smartphones (SP) and smartwatches (SW). 10 adult participants were asked to wear Actigraph, and SW for 30 consecutive nights. The accumulated records were analyzed using bi-variate statistics, mixed modeling and epoch-by-epoch analysis. A high degree of correspondence was found between Actigraph, SP/SW, and self-report records (R2 = 0.968–0.983). Although the mixed modeling also indicated high collinearity between Actigraphs and SP/SW tandems (b = 0.991; p < 0.001), it was also shown that SP/SW tandems add ⁓21.9 min to the Actigraph measurements while the self-reports were found to be even less accurate, adding ⁓39.9 min. Concurrently, the epoch-by-epoch analysis showed a good agreement between different types of measurements, varying between 81% and 100%. As we conclude, widely available and affordable SPs and SWs can help researchers to generate fairly reliable data for large-scale field studies, albeit measurement corrections need to be applied. Yet, estimates, obtained from sleep diaries, need to be treated with caution.
Background and objective Although studies have investigated the association between cigarette smoking and sleep outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) use and insufficient sleep among adolescents. The objective of this study was to investigate the cross-sectional association between the use of EVPs and insufficient sleep among adolescents. Methods Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The dependent variable investigated was insufficient sleep, and the main independent variable was the use of EVPs. Results Of the 28,135 adolescents, 22.6%, 19.2%, and 58.2% were current, former, and never users of EVPs, respectively. More than three in four adolescents (76.5%) did not obtain the recommended 8 hours of sleep on an average school night. Controlling for demographic factors and other covariates, adolescents who currently used EVPs had 1.33 times higher odds of having insufficient sleep (AOR = 1.33, p < .001, 95% CI = 1.16–1.52), and adolescents who previously used EVPs had 1.28 times higher odds of having insufficient sleep (AOR = 1.29, p < .001, 95% CI = 1.15–1.44) when compared to adolescents who have never used EVPs. Adolescents were more likely to get insufficient sleep if they were older, non-Hispanic Black, had symptoms of depression, experienced suicidal ideation, engaged in excessive screen-time behaviors, or currently use alcohol. Physical activity had a protective effect on insufficient sleep. Conclusion This study found that EVPs use was associated with insufficient sleep among adolescents over and above demographic and other covariates. As EVP use increases among adolescents, it is important to consider the potential impact on multiple domains, including sleep. Future studies that employ longitudinal designs may offer additional insight into the mechanisms underlying the association between EVPs use and insufficient sleep.
Critically ill patients may be prescribed a variety of medications during their ICU stay, and these can affect sleep through distinct mechanisms. The purpose of this chapter is to review the most likely pathways by which common ICU medications can impact sleep. Medications, particularly those effecting the central nervous, cardiovascular, and respiratory systems, may cause unintended physiologic effects on sleep. Beyond these direct physiologic effects, the administration of medications in the ICU, medications used at home to treat underlying comorbid sleep conditions, and withdrawal states may each disrupt sleep. Although common ICU medications may have a rational physiologic basis for impacting sleep, the clinical data to support ICU medication-sleep effects are often conflicting and generally sparse. In addition, with most patients having multiple medication and non-medication factors known to affect sleep, and the challenges of characterizing sleep in the ICU, current knowledge about the effects of individual medications on sleep quality remains limited. As awareness of ICU sleep disturbances increases, and the use of sleep improvement bundles grows, the impact of medications on sleep should be considered by clinicians as a part of all medication evaluation strategies.KeywordsDrug effectsSleepREMSleepWakefulnessArousalInsomniaSleep architectureSleep disordered breathingCentral nervous systemWithdrawal
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How disrupted sleep contributes to cognitive dysfunction over the dynamic course of Alcohol Use Disorder (AUD) is an emerging topic of investigation. Here, the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate subjective sleep in 90 individuals with AUD sober for an average of 3 months and in 50 healthy controls. Relative to controls, AUD individuals had higher global PSQI scores (worse sleep), higher scores on the Beck Depression Inventory (BDI), worse Quality of Life (QoL) indicators, and poorer performance on cognitive composite tests (executive functioning, attention and working memory, visual and verbal learning or memory). Among AUD individuals, a higher PSQI score correlated with a higher BDI scores and worse QoL, but not with cognitive scales. Also noted in the AUD group were higher global PSQI scores in individuals also diagnosed with major depressive (MDD) or generalized anxiety (GAD) disorders. Together, the 4 variables explained 29.8% of the variance in AUD PSQI scores. In women with AUD, the 4 factors explained 39.3% of the variance in PSQI scores; in AUD men, the 4 measures explained 19.9% of the variance: MDD was salient in women, QoL in men with AUD suggesting differential factors associate with poor sleep in men and women with AUD even with sustained alcohol abstinence. Here, global PSQI scores were related to clinical diagnoses and life functioning but failed to predict cognitive performance in abstinent AUD individuals.
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A total of 85 sleep disorders are described in the International Classification of Sleep Disorders, 2nd ed. Knowledge about those sleep disorders will be essential not only for good and healthy sleep but also for maintaining adequate physical and mental function during daytime. Sleep medicine has a relatively short history compared to other medical fields, thus, many sleep disorders are not familiar to the general public and even to physicians. In this small review about various sleep disorders, I will briefly introduce basic concepts about insomnia, sleep-related breathing disorder, hypersomnia, circadian rhythm sleep disorders, parasomnia and sleep-related movement disorders. These sleep disorders are frequently encountered in clinical settings, and understanding them will give us insight about the basic mechanism of sleep-wake states.
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Our study aimed to examine the relationship between perceived sleep quality and depression using Pittsburgh Sleep Quality Index (PSQI) and Cole's model to materialize the concept of perceived sleep quality in the non-cognitively impaired elderly. Older adults aged 60+ were recruited from the baseline study of Suwon Project between 2009 and 2011 (n = 2,040). Perceived sleep quality was measured using the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K), and depression was accessed using the Korean version of the Geriatric Depression Scale-Short Form (SGDS-K). We excluded the cognitively impaired elderly using the Korean version-Mini Mental Status Examination (K-MMSE) score less than or equal to 17. In multivariable adjusted logistic regression related to PSQI-K components, poor perceived sleep quality, including poor subjective sleep quality (Odds ratio (OR) = 1.27, 95% confidence interval (CI) = 1.01-1.61), longer sleep latency (OR = 1.32, 95% CI = 1.13-1.55) and the frequent use of sleeping medication (OR = 1.30, 95% CI = 1.10-1.53) were significantly associated with depression after adjusting for age, sex, education, living status, current smoking and current alcohol drinking, the number of comorbidity and Beck Anxiety Inventory (BAI). PSQI-K global score also had greater odds of reporting depression (OR = 1.12, 95% CI = 1.07-1.16). These results suggested that poor perceived sleep quality was associated with a greater level of depression in the elderly.
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Objective: Sleep problems and alcohol misuse are common issues experienced by college students that can have detrimental effects on overall health. Previous work indicates a strong relationship between poor sleep quality and alcohol risk in this population. This study explored the moderating effect of drinking motives in the relationship between global sleep quality and experience of alcohol-related negative consequences. Participants: College students (N = 1,878) who reported past-month drinking. Methods: Participants completed online surveys assessing sleep and alcohol-related behaviors. Results: Poorer sleep quality and higher drinking motives (coping, conformity, and enhancement) predicted greater alcohol-related consequences, controlling for drinking. Further, coping motives moderated the relationship between sleep quality and consequences such that participants reporting poor sleep and high coping motives experienced heightened levels of consequences. Conclusions: These findings advance the understanding of the relationship between sleep problems and alcohol-related risk and provide implications for targeted campus-based health promotion interventions.
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There needs to be an amendment to the Korean version of the Alcohol Use Disorder Identification Test (AUDIT) with regards to the recent change in percent alcohol by volume (ABV) Korean liquor. This study was performed to suggest a cutoff value, reliability and validity of AUDIT-Korean revised version (AUDIT-KR), which reflect the change of the ABV of Korean alcohol. The subjects were 435 peoples (210 males and 225 females), who visited the Chungnam National University Hospital for a comprehensive medical examination. The respondents completed the AUDIT-KR. At-risk drinking and alcohol use disorders had been evaluated by diagnostic interview. The Cronbach's alpha value, the receiver operating characteristic curve, the appropriate cutoff value, sensitivity and specificity of the AUDIT-KR were evaluated. There were 190 at-risk drinkers (111 males and 79 females), and 66 people with alcohol use disorders (48 males and 18 females). The cutoff value of the AUDIT-KR for at-risk drinking was 3 points (sensitivity 93.69% and specificity 78.79%) for males and 3 points (sensitivity 92.40% and specificity 78.08%) for females. The cutoff value for alcohol use disorders was 10 points (sensitivity 100.00% and specificity 89.51%) for males and 8 points (sensitivity 100.00% and specificity 93.71%) for females. Cronbach's alpha of the AUDIT-KR was 0.885. The above results suggest that the AUDIT-KR shows a high reliability and validity in identifying at-risk drinking and alcohol use disorders.
Study Objectives (1) To describe the prevalence and prospective course of insomnia in a representative young-adult sample and (2) to describe the cross-sectional and longitudinal associations between insomnia and depression. Design Longitudinal cohort study. Setting Community of Zurich, Switzerland. Participants Representative stratified population sample. Interventions None. Measurements and Results The Zurich Study prospectively assessed psychiatric, physical, and sleep symptoms in a community sample of young adults (n = 591) with 6 interviews spanning 20 years. We distinguished 4 duration-based subtypes of insomnia: 1-month insomnia associated with significant distress, 2- to 3-week insomnia, recurrent brief insomnia, and occasional brief insomnia. The annual prevalence of 1-month insomnia increased gradually over time, with a cumulative prevalence rate of 20% and a greater than 2-fold risk among women. In 40% of subjects, insomnia developed into more chronic forms over time. Insomnia either with or without comorbid depression was highly stable over time. Insomnia lasting 2 weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews; 17% to 50% of subjects with insomnia lasting 2 weeks or longer developed a major depressive episode in a later interview. “Pure” insomnia and “pure” depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both. Conclusions This longitudinal study confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia. The data support a spectrum of insomnia (defined by duration and frequency) comorbid with, rather than secondary to, depression.
Context Moderate alcohol consumption has been shown to be protective for coronary heart disease, but the relationship between moderate alcohol consumption and ischemic stroke is more controversial.Objective To determine the association between alcohol consumption and risk of ischemic stroke.Design Population-based case-control study conducted between July 1993 and June 1997.Setting Multiethnic population in northern Manhattan, New York, NY, aged 40 years or older.Patients and Other Participants Cases (n=677) had first ischemic stroke and were matched to community controls (n=1139) derived through random digit dialing by age, sex, and race/ethnicity. Mean ± SD age of cases was 70.0 ± 12.7 years; 55.8% were women; 19.5% were white, 28.4% black, and 50.7% Hispanic.Main Outcome Measure First ischemic stroke (fatal or nonfatal).Results Moderate alcohol consumption, up to 2 drinks per day, was significantly protective for ischemic stroke after adjustment for cardiac disease, hypertension, diabetes, current smoking, body mass index, and education (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.39-0.67). This protective effect of alcohol consumption was detected in both younger and older groups, in men and women, and in whites, blacks, and Hispanics. In a quadratic model of stroke risk, increased risk of ischemic stroke was statistically significant among those consuming 7 or more drinks per day (OR, 2.96; 95% CI, 1.05-8.29).Conclusions Moderate alcohol consumption was independently associated with a decreased risk of ischemic stroke in our elderly, multiethnic, urban subjects, while heavy alcohol consumption had deleterious effects. Our data support the National Stroke Association Stroke Prevention Guidelines regarding the beneficial effects of moderate alcohol consumption.
Insomnia is one of the most prevalent health concerns in the population and in clinical practice. Clinicians may be reluctant to address insomnia because of its many potential causes, unfamiliarity with behavioral treatments, and concerns about pharmacologic treatments. To review the assessment, diagnosis, and treatment of insomnia in adults. Systematic review to identify and summarize previously published quantitative reviews (meta-analyses) of behavioral and pharmacologic treatments for insomnia. Insomnia is a common clinical condition characterized by difficulty initiating or maintaining sleep, accompanied by symptoms such as irritability or fatigue during wakefulness. The prevalence of insomnia disorder is approximately 10% to 20%, with approximately 50% having a chronic course. Insomnia is a risk factor for impaired function, development of other medical and mental disorders, and increased health care costs. The etiology and pathophysiology of insomnia involve genetic, environmental, behavioral, and physiological factors culminating in hyperarousal. The diagnosis of insomnia is established by a thorough history of sleep behaviors, medical and psychiatric problems, and medications, supplemented by a prospective record of sleep patterns (sleep diary). Quantitative literature reviews (meta-analyses) support the efficacy of behavioral, cognitive, and pharmacologic interventions for insomnia. Brief behavioral interventions and Internet-based cognitive-behavioral therapy both show promise for use in primary care settings. Among pharmacologic interventions, the most evidence exists for benzodiazepine receptor agonist drugs, although persistent concerns focus on their safety relative to modest efficacy. Behavioral treatments should be used whenever possible, and medications should be limited to the lowest necessary dose and shortest necessary duration. Clinicians should recognize insomnia because of its effects on function and health. A thorough clinical history is often sufficient to identify factors that contribute to insomnia. Behavioral treatments should be used when possible. Hypnotic medications are also efficacious but must be carefully monitored for adverse effects.
This review provides a qualitative assessment of all known scientific studies on the impact of alcohol ingestion on nocturnal sleep in healthy volunteer's. At all dosages, alcohol causes a reduction in sleep onset latency, a more consolidated first half sleep and an increase in sleep disruption in the second half of sleep. The effects on rapid eye movement (REM) sleep in the first half of sleep appear to be dose related with low and moderate doses showing no clear trend on REM sleep in the first half of the night whereas at high doses, REM sleep reduction in the first part of sleep is significant. Total night REM sleep percentage is decreased in the majority of studies at moderate and high doses with no clear trend apparent at low doses. The onset of the first REM sleep period is significantly delayed at all doses and appears to be the most recognizable effect of alcohol on REM sleep followed by the reduction in total night REM sleep. The majority of studies, across dose, age and gender, confirm an increase in slow wave sleep (SWS) in the first half of the night relative to baseline values. The impact of alcohol on SWS in the first half of night appears to be more robust than the effect on REM sleep and does not appear to be an epiphenomenon REM sleep reduction. Total night SWS is increased at high alcohol doses across gender and age groups.
Alcohol causes significant sleep disturbance but the causes are not well understood. We investigated the relationship between alcohol use and periodic limb movements in a large population of patients at a sleep disorders center. The likelihood of having a clinically significant number of periodic leg movements (more than 20 per hour of sleep) was increased 3-fold in women who consumed two or more alcoholic drinks per day compared with those who did not (25% versus 8%). A similar relation was found among men (22% versus 13%). In addition, women who consumed two or more drinks per day were more likely to report symptoms of restless legs and to be diagnosed with restless legs syndrome. These findings suggest that periodic leg movements contribute to sleep disturbance in a significant proportion of alcohol users. Alcohol use may increase the frequency of periodic leg movements in susceptible individuals. On the other hand, subjects with symptoms related to periodic leg movements may be using alcohol to relieve symptoms, or the movements may be secondary to alcohol-induced sleep disturbance.
Sleep apnea and related disorders contribute to disturbed sleep in abstinent alcoholics. In an earlier report from our group, sleep-disordered breathing was common and increased with age in a cohort of 75 abstinent alcoholics. We now report an extension of the previous work that includes studies of an additional 103 abstinent alcoholics undergoing treatment for alcoholism (total sample = 188) and a comparison group of 87 normal subjects. The presence and severity of sleep-disordered breathing was assessed with polysomnography. Among the alcoholics, sleep-disordered breathing (defined as 10 or more apneas plus hypopneas per hour of sleep) was present in 3% of 91 subjects under age 40, 17% of 83 subjects age 40 to 59, and 50% of 14 subjects age 60 or over. Subjects with sleep-disordered breathing were more likely to be male and had more severe sleep disruption and nocturnal hypoxemia and more complaints related to daytime sleepiness than subjects without sleep-disordered breathing. In a multiple linear regression analysis, age and body mass index were significant predictors of the presence of sleep-disordered breathing, whereas smoking history and duration of heavy drinking were not predictors after controlling for the effects of age and body mass index. Our findings suggest that sleep-disordered breathing contributes significantly to sleep disturbance in a substantial proportion of older alcoholics and that symptomatic sleep-disordered breathing increases with age in alcoholics. Sleep-disordered breathing, when combined with existing cardiovascular risk factors, may contribute to adverse health consequences in alcoholics.