INCREASED PRESSURE FOR RAPID EYE-MOVEMENT SLEEP AT TIME OF HOSPITAL ADMISSION PREDICTS RELAPSE IN NONDEPRESSED PATIENTS WITH PRIMARY ALCOHOLISM AT 3-MONTH FOLLOW-UP

Objective: To determine whether polygraphic sleep recordings, obtained at the time of admission to an inpatient alcohol treatment program, p redict abstinence and relapse 3 months following hospital discharge in nondepressed patients with primary alcoholism. Design: Two independen t, consecutive cohorts of patients (group 1, n=28; group 2, n=17) unde rwent all-night polygraphic sleep recordings and other clinical evalua tions during the first and fourth weeks of a 1-month inpatient treatme nt program within a Veteran Affairs Medical Center. They were reevalua ted 3 months following discharge to the community. None were treated w ith disulfiram or other medications during or after hospitalization. P atients: All subjects were male veterans with primary alcoholism and w ithout significant preexisting, secondary, or comorbid diagnoses such as major medical problems, depression, antisocial personality, or drug addiction. Outcome Measures: Relapse was defined as any alcohol consu mption between discharge from the hospital and 3-month follow-up. Resu lts: Ten (36%) of 28 patients in group 1 were Relapsers at 3-month fol low-up. Relapsers in group 1 showed significantly shorter Rapid Eye Mo vement (REM) latency, increased Rapid Eye Movement percent (REM%), and increased REM Density during their admission sleep studies compared w ith Abstainers. To replicate these observations, group 2 was then stud ied as a validation sample. Six (35%) of 17 patients relapsed. As in g roup 1, Relapsers had significantly shorter REM latency and increased REM% compared with Abstainers; REM Density was not significantly diffe rent in the Relapsers as compared with Abstainers in group 2. Using a principal components analysis based on these three REM sleep measures to determine ''REM pressure,'' three separate discriminant function an alyses (DFAs) were calculated: one for each group and one for all pati ents (n=45) together. The DFA from group 1 correctly classified 22 (78 .6%) of the 28 patients in group 1 and 13 (76.5%) of the 17 patients i n group 2 as Relapsers or Abstainers. The DFA from group 2 correctly c lassified 13 (76.5%) of the 17 patients in group 2 and 23 (82.1%) of t he 28 patients in group 1. The DFA formed from both groups together co rrectly classified 36 (80%) of the 45 patients. When the REM sleep mea sures at hospital admission and discharge were compared, no statistica lly significant effect of time was observed. Abstinence and relapse we re not consistently related to other clinical measures at the time of hospital admission such as age, duration and severity of alcoholism, m arital status, employment, hepatic enzyme levels, cognitive performanc e, or depression ratings. Conclusion: Short REM latency, increased REM %, and, possibly, increased REM Density at the time of admission to a 1-month inpatient alcohol treatment program predict relapse in nondepr essed patients with primary alcoholism by 3 months following hospital discharge.