Longitudinal disturbances of objective sleep architecture in cocaine use disorder: A translational systematic review.

Cocaine use disorder (CUD) is associated with significant sleep disturbances that evolve throughout cocaine use and withdrawal phases. This systematic review offers a comprehensive and longitudinal depiction of objective sleep alterations in CUD, during and after active use, in both human and animal models. Following PRISMA guidelines, a systematic search was conducted in PubMed, PsycInfo, and Google Scholar from inception to December 2024. Inclusion criteria focused on studies using objective sleep measurements, comparing individuals with CUD to controls or across different phases of use and withdrawal. Poly-substance use (except nicotine) was an exclusion criterion to isolate cocaine-specific effects. Nineteen studies met inclusion (12 human, 7 animal). Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (humans) and the ARRIVE Essential 10: Compliance Questionnaire (animals). In both human and animal studies, the most robust findings were that cocaine use reduces total sleep time (TST), increases sleep onset latency, reduces sleep efficiency, and reduce rapid eye movement (REM) sleep. Early withdrawal is characterized by transient increase in TST and REM sleep, despite sleep fragmentation. In late withdrawal, gradual normalization occurs, although with notable inter-study variability due to differences in timing. This temporal profile may largely reflect cocaine's impact on dopaminergic and noradrenergic transmission. Given persistent sleep disruptions across all stages, personalized interventions targeting sleep could improve long-term outcomes in CUD treatment. PROSPERO REGISTRATION NUMBER: CRD42024565238 FUNDING: IReSP (AAP-2024-CADDOC-363585).