RESUMEN
STUDY OBJECTIVES: Opioid withdrawal is an aversive experience that often exacerbates depressive symptoms and poor sleep. The aims of the present study were to examine the effects of suvorexant on oscillatory sleep-electroencephalography (EEG) band power during medically managed opioid withdrawal, and to examine their association with withdrawal severity and depressive symptoms. METHODS: Participants with opioid use disorder (Nâ =â 38: age-range:21-63, 87% male, 45% white) underwent an 11-day buprenorphine taper, in which they were randomly assigned to suvorexant (20 mg [nâ =â 14] or 40 mg [nâ =â 12]), or placebo [nâ =â 12], while ambulatory sleep-EEG data was collected. Linear mixed-effect models were used to explore: (1) main and interactive effects of drug group, and time on sleep-EEG band power, and (2) associations between sleep-EEG band power change, depressive symptoms, and withdrawal severity. RESULTS: Oscillatory spectral power tended to be greater in the suvorexant groups. Over the course of the study, decreases in delta power were observed in all study groups (ßâ =â -189.082, dâ =â -0.522, pâ =â <0.005), increases in beta power (20 mg: ßâ =â 2.579, dâ =â 0.413, pâ =â 0.009 | 40 mg ßâ =â 5.265, dâ =â 0.847, pâ <â 0.001) alpha power (20 mg: ßâ =â 158.304, dâ =â 0.397, pâ =â 0.009 | 40 mg: ßâ =â 250.212, dâ =â 0.601, pâ =â 0.001) and sigma power (20 mg: ßâ =â 48.97, dâ =â 0.410, pâ <â 0.001 | 40 mg: ßâ =â 71.54, dâ =â 0.568, pâ <â 0.001) were observed in the two suvorexant groups. During the four-night taper, decreases in delta power were associated with decreases in depressive symptoms (20 mg: ßâ =â 190.90, dâ =â 0.308, pâ =â 0.99 | 40 mg: ßâ =â 433.33, dâ =â 0.889 pâ =â <0.001), and withdrawal severity (20 mg: ßâ =â 215.55, dâ =â 0.034, pâ =â 0.006 | 40 mg: ßâ =â 192.64, dâ =â -0.854, pâ =â <0.001), in both suvorexant groups and increases in sigma power were associated with decreases in withdrawal severity (20 mg: ßâ =â -357.84, dâ =â -0.659, pâ =â 0.004 | 40 mg: ßâ =â -906.35, dâ =â -1.053, pâ =â <0.001). Post-taper decreases in delta (20 mg: ßâ =â 740.58, dâ =â 0.964 pâ =â <0.001 | 40 mg: ßâ =â 662.23, dâ =â 0.882, pâ =â <0.001) and sigma power (20 mg only: ßâ =â 335.54, dâ =â 0.560, pâ =â 0.023) were associated with reduced depressive symptoms in the placebo group. CONCLUSIONS: Results highlight a complex and nuanced relationship between sleep-EEG power and symptoms of depression and withdrawal. Changes in delta power may represent a mechanism influencing depressive symptoms and withdrawal.