Association between substance use and sleep disturbances among adolescents: Systematic review and meta-analysis

Introduction Substance use is a major factor contributing to sleep disturbances in adolescents, whose developing brains are especially vulnerable. The previous studies have primarily focused on adults or individual substances. Objectives This meta-analysis examined the overall association between substance use and sleep disturbances in adolescents. Methods Relevant studies were systematically searched across multiple databases, including CINHAL (via EBSCOHOST), PubMed, Scopus, Ovid Medline, Embase, PsychINFO (via EBSCOHOST), and Web of Science, from inception until October 2021. A random-effects model was employed to calculate pooled Odds Ratios (OR) with 95% confidence intervals (CIs). Forest plots and Cochran’s Q statistic p values were utilized to assess heterogeneity among the studies. Subgroup and meta-regression analyses were conducted to compare groups and identify sources of heterogeneity. Study quality was evaluated using the Joanna Briggs Institute tool, and sensitivity analysis was performed to test the robustness of the results. Results A comprehensive search identified 16,870 studies, of which 18 were included in the review and meta-analysis (Figure 1), published between 1993 and 2021. The studies were of high quality and had a low risk of bias. The results showed that substance use significantly contributes to sleep disturbances in adolescents (OR = 1.70, 95% CI: 1.49–1.94) (Figure2). Alcohol users, coffee drinkers, and smokers were significantly more likely to experience sleep disturbances (OR = 1.77, OR = 1.58; OR = 1.66), while marijuana showed a non-significant association (OR = 1.29) (Table 1). Additionally, alcohol and smoking were significantly associated with insomnia (OR = 1.82, 95% CI: 1.43- 2.33 and OR = 1.75, 95% CI: 1.31-2.33), hypersomnolence (alcohol: OR = 1.46, 95% CI: 1.18-1-81), and sleep-related breathing disorders (S-RBD) (alcohol: OR = 2.29, 95 % CI: 1.53-3.42; smoking: OR = 2.30, 95% CI: 1.23-4.30), with coffee also significantly associated with insomnia (OR = 1.58, 95% CI: 1.30-193). There was considerable heterogeneity among the studies, however, subgroup and meta-regression analysis indicated no statistically significant sources of heterogeneity. Table 1 Association between individual substance use and sleep disturbances n Study OR 95% CI Lower limit Upper limit Q -value Heterogeneity P-Value I 2 Alcohol 15 1.77 1.55 2.03 102.21 <0.001 86.30 Coffee 3 1.58 1.30 1.93 6.02 <0.005 66.81 Marijuana 3 1.29 0.78 2.13 24.38 <0.001 91.79 Smoking 15 1.66 1.37 2.01 278.13 <0.001 94.96 OR = Odds Ratio, CI = Confidence Interval Image 1: Image 2: Conclusions Substance use significantly increases the risk of sleep disturbances in adolescents, with alcohol, coffee, and smoking showing strong associations. Despite the heterogeneity among studies, the findings underscore the need for targeted interventions to mitigate these risks and improve sleep health in this population. Disclosure of Interest None Declared