Prevalence and Association between Substance Use and Sleep Disturbances: A Systematic Review and Meta-Analysis

Background
Sleep disturbances have become a worldwide public issue among adolescents. A number of factors have been reported to contribute to sleep disturbances and one of the most common factors is substance use. The use of alcohol, marijuana, coffee, and smoking is known to negatively alter sleep architecture and neurotransmitters. Adolescents’ brain is not fully developed such that using these substances tend to put them at a high risk of sleep disturbances. Most previous studies explored the prevalence and association between substance use among adults and the general population. Few studies reported on adolescents however, most of them focused on individual substances and sleep disturbances. In, addition, other review studies failed to perform a meta-analysis to determine the overall results. This meta-analysis investigated the overall prevalence rate and the association between substance use and sleep disturbances including categories of sleep disturbances among adolescents.
Methods
Potentially relevant studies were systematically searched in CINHAL (with EBSCOHOST), PubMed, Scopus, Ovid Medline, Embase, PsychINFO (with EBSCOHOST), and Web of Science from inception to October 2021. Two independent reviewers extracted data. To determine the quality of the studies Joanna and Briggs Institute’s critical appraisal tool was used to assess the studies. Comprehensive Meta-Analysis version 3 software was used to pool the prevalence rates and Odds Ratios (OR) with 95% Confidence Intervals (CI) with a random-effects model. Heterogeneity was visually examined using the forest plots and statistically, significant heterogeneity was confirmed by p-values of less than 0.05. Proportions of heterogeneity were determined by chi-square values. Subgroup analysis and meta-regression were used to compare groups and identify potential sources of heterogeneity. To determine the stability of the results, sensitivity analysis was performed using a leave-one-out and a large sample size removal method. Publication bias was visually assessed by funnel plot and statistically evaluated using Egger’s test and Duval and Twidee’s trim and fill method.
Results
A comprehensive search in the databases and other searches yielded 16804 studies and after the screening, a total of 20 studies published between 1993 and 2021 were included in the systematic review and meta-analysis. The findings indicated a significant 29 % (95 % CI: 0.201-0.403) prevalence rate of sleep disturbances. In addition, the results revealed that the use of substances could more likely contribute to the experience of sleep disturbances OR = 1.70 (95 % CI: 1.49-1.94) among adolescents. Furthermore, a comparison of subgroups showed that sleep disturbances are highly prevalent (37 %, 95 % CI:1.75-.4.45) among adolescents who used marijuana, however, those that used alcohol were more likely to experience more sleep disturbances compared to those that use other substances (OR=1.77, 95 % CI: 1.55-2.03). Among the sleep disturbance categories, a high prevalence rate (31 %, 95 % CI: 0.156-0.509) of insomnia was indicated among alcohol users and the risk was also high (OR = 1.82, 95 % CI:1.43-2.33) in this group. Hypersomnolence though non-significant, was found to be highly prevalent among adolescent smokers (46 %, 95 % CI: 0.232-0.700), however, the likelihood of alcohol users reporting hypersomnolence was significantly high (OR = 1.40, 95 % CI:0.67-1.84). Regarding Sleep-related Breathing Disorders, results showed that adolescent smokers were more likely to report Sleep-Related Breathing Disorders (OR =2.30, 95 % CI:1.23-4.30) as compared to alcohol users. Meta-regression analysis results indicated statistically significant variations in the school setting, cross-study design, and geographical location (Asia). Furthermore, sensitivity analysis indicated that the results were stable using both one leave-out and a large sample size removal method. No publication bias was observed in both prevalence and association meta-analyses (t = 1.05227, p =.0.30) and (t =1.36228, p =0.19).
Conclusion
In conclusion, this study implied that sleep disturbances are highly prevalent and are associated with the use of substances among adolescents. A higher prevalence rate of sleep disturbances was found among marijuana users; however, the risk was significantly higher with the use of alcohol. The prevalence rate of insomnia was high among alcohol users and the risk for insomnia in the alcohol users was also high. School, cross-sectional study, and Asia geographical location were the characteristics that were significantly related to sleep disturbances and substance use among adolescents. The results suggest that sleep disturbances among adolescents with substance use are a very crucial concern that needs to be addressed globally. Preventive measures and targeted interventions are needed to reduce substance use in order to effectively prevent sleep disturbance among adolescent