The only study available on disulfiram showed reduced REM sleep .
Acamprosate showed no/little effect on self-reported sleep but improved sleep continuity and architecture measured by polysomnography .
The two opioidergic drugs naltrexone and nalmefene had mainly detrimental effect on sleep , giving increased insomnia and /or somnolence compared with placebo , although not always significant .
The meta- analysis confirmed significantly increased somnolence and insomnia in the naltrexone group , compared with the placebo .
Overall , the currently available evidence s show more sleep problems with the opioidergic drugs ( especially naltrexone ) , while acamprosate seems to be well tolerated or even beneficial .
Acamprosate might be a more suitable choice when patients with AUD report sleep problems .
Background : Sleep disorders are commonly associated with acute and chronic use of alcohol and with abstinence .
To date , there are four approved drugs to treat alcohol use disorder ( AUD ) : disulfiram , acamprosate , naltrexone , and nalmefene .
These AUD therapies reduce the craving and risk of relapse into heavy drinking , but little is known about their effect on sleep .
As recent evidence s indicate a crucial role of sleep disorders in AUD , cl aim ing that sleep problems may trigger alcohol abuse and relapses , it is fundamental to clarify the impact of those drugs on the sleep quality of AUD patients .
This systematic review aims to answer the question : how does the pharmacotherapy for AUD affect sleep ?
Comparison of acamprosate and placebo in long-term treatment of alcohol dependence
BACKGROUND About 50 % of alcoholic patients relapse within 3 months of treatment . Previous studies have suggested that acamprosate may help to prevent such relapse . The aim of our study was to assess the efficacy and safety of long-term acamprosate treatment in alcohol dependence . METHODS In this multicentre , double-blind , placebo-controlled study , we recruited 455 patients , aged 18 - 65 years , with chronic or episodic alcohol dependence . Patients were r and omly allocated treatment with acamprosate ( 1998 mg daily for bodyweight > 60 kg ; 1332 mg daily for < or = kg ) or placebo for 360 days . Patients were assessed on the day treatment started and on days 30 , 90 , 180 , 270 , and 360 by interview , self-report , question naire , and laboratory screening . Patients were classified as abstinent , relapsing , or non-attending . Time to first treatment failure ( relapse or non-attendance ) was the primary outcome measure . FINDINGS Seven patients were excluded from the intention-to-treat analysis because they did not attend on the first treatment day and therefore received no medication . The acamprosate ( n = 224 ) and placebo ( n = 224 ) groups were well matched in terms of baseline demographic and alcohol-related variables . 94 acamprosate-treated  and 85 placebo-treated patients completed the treatment phase : of those withdrawn , 104 ( 52 in each group ) relapsed , 69 ( 33 vs 36 , respectively ) were lost to follow-up , 63 ( 31 vs 32 ) refused to continue treatment , 16 ( 15 vs 11 ) had concurrent illness , three ( two vs one ) died , ten ( six vs four ) had adverse side-effects , one ( acamprosate treated ) received the wrong medication , and three ( placebo treated ) were non-compliant . The proportion without treatment failure was higher in the acamprosate than in the placebo group throughout the treatment period ( p < 0.001 , Mantel-Cox ) . At the end of treatment , 41 ( 18.3 % ) acamprosate-treated and 16 ( 7.1 % ) placebo-treated patients had been continuously abstinent ( p = 0.007 ) . Mean cumulative abstinence duration was significantly greater in the acamprosate group than in the placebo group ( 138.8 [ SD 137.5 ] vs 103.8 [ 119.0 ] days ; p = 0.012 ) . 148 patients ( 79 acamprosate , 69 placebo ) completed 27 months follow-up : 27 ( 11.9 % ) acamprosate-treated and 11 ( 4.9 % ) placebo-treated patients remained continuously abstinent , and the mean cumulative abstinence duration was 230.8 days ( 259.1 ) and 183.0 days ( 235.2 ) , respectively . Apart from occasional diarrhoea , there was no difference in side-effects between groups . INTERPRETATION Acamprosate is an effective and well-tolerated pharmacological adjunct to psychosocial and behavioural treatment programmes for treatment of alcohol-dependent patients
The only study available on disulfiram showed reduced REM sleep .
Acamprosate showed no/little effect on self-reported sleep but improved sleep continuity and architecture measured by polysomnography .
The two opioidergic drugs naltrexone and nalmefene had mainly detrimental effect on sleep , giving increased insomnia and /or somnolence compared with placebo , although not always significant .
The meta- analysis confirmed significantly increased somnolence and insomnia in the naltrexone group , compared with the placebo .
Overall , the currently available evidence s show more sleep problems with the opioidergic drugs ( especially naltrexone ) , while acamprosate seems to be well tolerated or even beneficial .
Acamprosate might be a more suitable choice when patients with AUD report sleep problems .
Background : Sleep disorders are commonly associated with acute and chronic use of alcohol and with abstinence .
To date , there are four approved drugs to treat alcohol use disorder ( AUD ) : disulfiram , acamprosate , naltrexone , and nalmefene .
These AUD therapies reduce the craving and risk of relapse into heavy drinking , but little is known about their effect on sleep .
As recent evidence s indicate a crucial role of sleep disorders in AUD , cl aim ing that sleep problems may trigger alcohol abuse and relapses , it is fundamental to clarify the impact of those drugs on the sleep quality of AUD patients .
This systematic review aims to answer the question : how does the pharmacotherapy for AUD affect sleep ?