Sleep alterations in substance use disorders: a systematic review and meta-analysis

Background Sleep disturbances are common in individuals with substance use disorders (SUDs), often persisting beyond initial abstinence and hindering recovery. However, the underlying sleep abnormalities warrant further investigation, particularly given mixed findings regarding specific substances. Methods This systematic review and meta-analysis aimed to identify sleep-related abnormalities associated with alcohol (AUD), benzodiazepine (BUD), cannabis (CaUD), cocaine (CoUD), methamphetamine (MUD), nicotine (NUD), and opioid (OUD) use disorders. We systematically searched Embase, PsycINFO, PubMed, Scopus, and Web of Science until November 2025, following a pre-registered protocol (PROSPERO: CRD42024531160). Findings We conducted a systematic review of 43 eligible publications involving approximately 7500 participants, using both objective (eg, polysomnography) and subjective (eg, Pittsburg Sleep Quality Index [PSQI]) measures. Results showed that total sleep time (TST) was reduced in AUD (−14.32, 95% CI=−16.69 to −11.96; I 2 = 0%), NUD (−0.33, 95% CI=−0.59 to −0.06; I 2 = 37%), and OUD (−38.16, 95% CI=−63.04 to −13.28; I 2 = 0%). Slow-wave sleep (SWS) was reduced in AUD (−3.68, 95% CI −4.99 to 2.38; I 2 = 73%) and CoUD (−30.69, 95% CI=−47.27 to −14.10; I 2 = 90%). Sleep quality, measured by the PSQI, was poorer in AUD (4.89, 95% CI=3.01 to 6.77; I 2 = 98%), CoUD (0.98, 95% CI=0.04–1.93; I 2 = 0%) and NUD (2.64, 95% CI=0.41–4.88; I 2 = 96%). Results for CaUD could not be meta-analyzed due to scarcity of data. No study met criteria to be included for BUD or MUD. Interpretation These findings suggest specific relationships between specific addictive substances and sleep, highlight areas of convergence in these relationships, and indicate instances in which the same drug is related with both objective and subjective alterations. Further research is needed to explore further, at a meta-analytical level, relationships between sleep and specific substances. Funding National Institute on Drug Abuse.