Examining circadian rhythm dysregulation using actigraphy among treatment-seeking individuals with alcohol use disorder

Background Identifying factors predictive of relapse in patients with alcohol use disorder (AUD) following a period of abstinence and/or treatment is essential to discover effective treatment plans for this disease. Previous evidence found that individuals with AUD who relapsed had lower sleep regularity scores than those who did not relapse. This analysis aimed to extend previous work to explore the relationship between circadian rhythms and relapse. Methods Treatment-seeking individuals with AUD ( n = 126) were admitted to an inpatient treatment program for approximately 28 days and, upon discharge, wore Philips Respironics Actiwatches® for the subsequent 4 weeks during an unprotected environment. A subset of these participants wore the devices prior to discharge for up to 7 days inpatient ( n = 36). Relapse status was assigned if a participant consumed any alcohol during the outpatient period of data collection. Inpatient and outpatient circadian rhythm nonparametric statistics were calculated for all participants including weekly interdaily stability (IS) and intradaily variability (IV), and daily most active 10 h (M10), least active 5 h of the day (L5), relative amplitude (RA), and the wake time. Linear and logistic generalized mixed models were fitted to estimate the effect of discharge on circadian rhythms, the effect of preceding circadian rhythms on the probability of relapse, and the effect of relapse on circadian rhythms. All analyses accounted for within-patient repeated measurements. Results The final cohort size was n = 103 for the outpatient subset and n = 36 for the inpatient subset after actigraphy data filtering. Participants were 48.6 ± 11.3 years of age, and 32% were female. A total of 26 (25.2%) participants relapsed. There were significant decreases in IV and L5 and increases in M10, RA, and wake time between inpatient and outpatient settings, whereas IS did not substantially differ between the two settings. Following relapse, there was a moderate decrease in hourly IV and an increase in (later) wake time of ~1 h; no other circadian variables were significantly predictive of relapse. Conclusion Overall, circadian rhythms shifted after discharge but were not predictive of relapse. Instead, relapse was followed by a delayed average wake time and a moderate reduction of daily activity patterns. These results highlight the potential value of monitoring circadian changes as indicators of relapse occurrence rather than relapse risk.