(80) PTSD Symptomatology Associated with Insomnia Severity Among Women Receiving Buprenorphine

Background & Introduction: Relapse and OUD treatment discontinuation rates remain high (~60%) among individuals receiving medications for opioid use disorder (MOUD). Tailoring treatments to individuals’ needs is an avenue to improve outcomes. PTSD and sleep disturbances, especially insomnia (difficulty falling asleep or staying asleep), are incredibly common among individuals receiving MOUD. As these co-morbidities are associated with negative OUD treatment outcomes (e.g., relapse), elucidating related targets may be an avenue to advance OUD therapeutics. This study takes a first step towards achieving a better understanding of this intersection among a sample of women receiving buprenorphine in outpatient OUD treatment. The study’s primary aim was to identify differences in insomnia symptom severity by presence of PTSD symptomatology; we also explored the association between degree of PTSD symptomatology and insomnia severity. We focus on women given the known differences in OUD, PTSD, and insomnia between men and women that warrants investigations through a sex/gender-informed lens.

Methods: This study was a secondary analysis of participants from a parent study assessing insomnia that enrolled non-pregnant people stabilized on buprenorphine for at least 6 weeks from an outpatient addiction clinic (recruitment rate 76%). For the primary outcome of insomnia symptomatology, participants completed the Insomnia Severity Index (ISI); ISI total scores were calculated. The 20-item PCL-5 identified clinically significant PTSD symptomatology with a total score of 31 or greater. T-tests/chi-squared assessed differences in insomnia symptoms between PTSD groups. A multiple regression analysis explored associations between degrees of PTSD and insomnia symptomatology, adjusting for age, social support, behavioral treatment, and psychiatric medication.

Results: Our sample consisted of N=79 women (all identified as female sex, cisgender) who identified as white (57%) or Black race (37%), non-Hispanic ethnicity (94%). Participants had been receiving a median buprenorphine dose of 24 mg (4-30 mg) for over two years (mean months 57, range X-Y). The majority (n=46; 58%) exhibited clinically significant PTSD symptomology. ISI scores were significantly higher among this PTSD group (17.6+6.2) than their counterparts (10.1+7.8), with a higher prevalence of reporting difficulty falling (87% vs. 61%), staying asleep (89% vs. 70%), and waking up too early (94% vs. 67%). Multiple regression analysis revealed PTSD symptomology (t(69) = 3.325, p = .001) was associated with insomnia symptom severity when accounting for covariates.

Conclusion & Discussion: Our results demonstrate an association between PTSD symptomatology and insomnia symptom severity in a sample of women receiving buprenorphine. These results reinforce the importance of addressing sleep health among women on MOUD treatment and will inform future investigations elucidating therapeutic targets to improve OUD treatment outcomes at the intersection of insomnia and PTSD.

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