1. Effects of Alcohol on U.S. Adolescent Sleep Patterns: A Systematic Review Nancy Carballo, MSIV Shahrzad Bazargan-Hejazi, PhD 2015 DIDARP 10 th Annual Drug Addiction Research Symposium Friday, August 07, 2015

2. Background There is an increasing trend of multiple substance use among adolescents Inadequate sleep duration and quality is known to affect trends in alcohol use On the other hand, the effects of alcohol use on sleep is not well-known Implications of alcohol-related sleep disturbance patterns among minority adolescents are needed in primary care settings Friday, August 07 1 DIDARP 10 th Symposium 2015

3. Objectives Determine how alcohol use/misuse impacts adolescent sleep patterns and sleep quality Identify the role of primary care in reducing the impact of alcohol use/misuse and sleep disruptions among adolescents Friday, August 07 2 DIDARP 10 th Symposium 2015

4. Methods Study design: systematic review 5 database sources (2009 – 2015) Cinahl, Embase/Elsevier, Google Scholar, PsycINFO, PubMed Study eligibility criteria: Articles published in English Peer-reviewed journals Alcohol-use effects on sleep patterns U.S. adolescent 13 – 19 years old All ethnicities Normal health status Hand search using the following terms: “sleep AND alcohol AND adolescent” OR “sleep AND alcohol AND adolescent” OR “sleep AND alcohol AND adolescence” “sleep AND alcohol AND adolescence” Friday, August 07 3 DIDARP 10 th Symposium 2015

5. Data Analysis Studies identified during the database search were assessed for relevancy by reviewing the following: TitleAbstract Descriptor/MeSH terms PRISMA flow diagram Full manuscripts obtained for all potentially relevant studies Table summary report created for all studies meeting inclusion criteria Quality appraisal determined by: Methodological quality Precision External validity Friday, August 07 4 DIDARP 10 th Symposium 2015

6. Results: PRISMA flow diagram for inclusion/exclusion criteria for study selection Friday, August 07 5 DIDARP 10 th Symposium 2015

7. Results: Table Summary Report of Data Extraction for Study Characteristics Friday, August 07 6 DIDARP 10 th Symposium 2015

8. Results: Table Summary Report of Data Extraction for Study Characteristics Friday, August 07 7 DIDARP 10 th Symposium 2015

9. Results: Table Summary Report of Data Extraction for Study Characteristics Friday, August 07 8 DIDARP 10 th Symposium 2015

10. Results: Level of evidence (CEBM & CEBMA) for assessing internal validity and risk within studies Friday, August 07 9 DIDARP 10 th Symposium 2015

11. Results: QATSDD for assessing internal validity and risk within studies Friday, August 07 10 DIDARP 10 th Symposium 2015

12. Results: Summary measures and confidence intervals for measuring precision and results within individual studies Friday, August 07 11 DIDARP 10 th Symposium 2015

13. Results: Generalizability parameters measuring external validity for assessing risk of bias across studies Friday, August 07 12 DIDARP 10 th Symposium 2015

14. Summary of Evidence 30 total studies included in this systematic review 22 studies stratified data by gender and/or ethnicity Risk of bias within studies (internal validity): 1 RCT study = 1b level of evidence 15 out of 30 studies = 4b level of evidence Additional risk of bias within studies (internal validity): QATSDD methodological scores ranging from 29 - 46 Friday, August 07 13 DIDARP 10 th Symposium 2015

15. Summary of Evidence Precision Each study’s screening tool results Assessed by p-value < 0.05, OR, and CI 27 studies were statistically significant for conclusions pertaining to the effects of alcohol on sleep in adolescents 27 studies were statistically significant for conclusions pertaining to the effects of alcohol on sleep in adolescents 3 studies did not incorporate any statistical information pertinent to this review’s objectives 3 studies did not incorporate any statistical information pertinent to this review’s objectives Friday, August 07 14 DIDARP 10 th Symposium 2015

16. Summary of Evidence Analysis of risk of bias across studies (external validity) Most study conclusions generalizable with respect to: available technologies available technologies sufficient sample size sufficient sample size Geographic location was NOT as generalizable: < 50% of the studies reported information for national subjects < 50% of the studies reported information for national subjects very few studies examined the western part of the United States very few studies examined the western part of the United States Friday, August 07 15 DIDARP 10 th Symposium 2015

17. Conclusions Objective 1: Determine how alcohol use/misuse impacts adolescent sleep patterns and sleep quality A significant amount of adolescents use alcohol as a sleep aid Alcohol use/misuse exacerbates circadian misalignment Alcohol impairs ability to shift to changing schedules, and therefore compounds sleep-related health-risk behaviors Alcohol use/misuse leads to inadequate sleep, and can have an effect on other risk behaviors: lower school performance lower school performance higher incidences of MVAs higher incidences of MVAs multiple substance use multiple substance use EEGs linking heavy drinking to longer REM time and shorter latency EEGs linking heavy drinking to longer REM time and shorter latency Friday, August 07 16 DIDARP 10 th Symposium 2015

18. Conclusions Objective 2: Identify the role of primary care in reducing the impact of alcohol use/misuse and sleep disruptions among adolescents 3 key roles that can be addressed by the primary care physician: 1. Understand the adolescent patient from different angles Alcohol use/misuse; seeing someone cut, stabbed, or shot; worry; and internalized anger are all associated with low-income adolescents Alcohol use/misuse; seeing someone cut, stabbed, or shot; worry; and internalized anger are all associated with low-income adolescents 2. Ask the adolescent patient the right supplementary questions Heavy drinking, living conditions, and other SES factors are associated with a shorter sleep duration (< 6 h/day) Heavy drinking, living conditions, and other SES factors are associated with a shorter sleep duration (< 6 h/day) 3. Brief interventions can reduce the quantity and frequency of alcohol use/misuse Effects would probably be greatest among adolescents who already drink Effects would probably be greatest among adolescents who already drink Friday, August 07 17 DIDARP 10 th Symposium 2015

19. Limitations U.S. adolescents grouped with adults Definitions for age groups varied across studies 18 – 25 year-olds considered young adults or late adolescents Inherent limitations with respect to: each individual study assessing mixed studies Insufficient CI data to formulate a forest plot A few studies grouped non-U.S. along with U.S. adolescents Ethnicities not equally distributed Friday, August 07 18 DIDARP 10 th Symposium 2015

20. Thank you! Q & A Friday, August 07 19 DIDARP 10 th Symposium 2015