INCREASED REM-SLEEP DENSITY AT ADMISSION PREDICTS RELAPSE BY 3 MONTHSIN PRIMARY ALCOHOLICS WITH A LIFETIME DIAGNOSIS OF SECONDARY DEPRESSION

Background: Having previously reported that 3-month relapse was associ ated with increased admission REM pressure in nondepressed primary alc oholics, we hypothesized that baseline polysomnography would predict o utcome in primary alcoholics with a lifetime diagnosis of secondary de pression. Methods: Twenty-one primary alcoholics with secondary depres sion received polysomnography and the Hamilton Depression Rating Scale during the first and fourth weeks of a 1-month inpatient alcohol trea tment program, Exclusion criteria included serious illness, current ma jor alcohol withdrawal symptoms, other Axis I diagnoses, sleep apnea, nocturnal myoclonus, and psychoactive substances within 14 days of pol ysomnography. Relapse was defined as drinking any alcohol between hosp ital discharge and 3-month follow-up. Results: Relapsers' total sleep time was reduced and REM density (reflecting REM sleep ocular activity ) was increased significantly throughout admission compared with absta iners. Sleep continuity and Hamilton scores improved by discharge in s ober and relapsing alcoholics. Factors derived from admission REM late ncy, REM percent, and REM density predicted sobriety vs. relapse withi n 3 months after hospital discharge in 76% of patients. Admission REM density was greater, and total sleep time was less in relapsers than i n patients sober at 3 months. Conclusions: Results suggest that increa sed REM density and decreased total sleep time at about 2-4 weeks of a bstinence predict relapse by 3 months in depressed alcoholics. Publish ed 1998 Society of Biological Psychiatry.