Habitual Khat and Concurrent Khat and Tobacco Use Are Associated With Subjective Sleep Quality
Open accessAbstract
INTRODUCTION: Khat (Catha edulis) is widely used in East Africa and the Middle East, often in combination with tobacco smoking. Sleep disturbance has been linked with habitual khat use; however, no systematic attempt has been made to test the hypothesis that use of khat and khat and tobacco in combination are related to sleep disturbance. Sleep disturbances are associated with dysregulations in emotional and physiological functions and can increase health risks. METHODS: We developed and used the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) to conduct a cross-sectional study in Yemen examining subjective sleep quality in 151 concurrent users of khat and tobacco, 141 khat-only users, and 92 nonusers. Measures on subjective mood were also collected. A series of analyses of variance and χ(2) tests were conducted to test whether khat and tobacco use was linked with sleep disturbances. RESULTS: Concurrent users of tobacco and khat and khat-only users showed greater sleep disturbances than nonusers as assessed by the PSQI global scores (all P values < .001) and component scores. PSQI scores were correlated with negative and positive mood (all P values < .004). CONCLUSION: Sleep disturbances may be 1 mechanism of the link between khat, tobacco, and negative health outcomes. Our findings may be useful in developing targeted prevention and harm-reduction strategies to minimize health care burdens associated with these substances. Our study also provides initial support for the Arabic version of PSQI.
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Prior cross-sectional studies have identified an association between alcohol consumption and poor sleep quality.
“The previously conducted cross-sectional studies have identified that there is association between sex, residence, and substance use [31] (such as alcohol [32], khat [33–37], smoking [38, 39], caffeinated beverages [35, 40], and other stimulants) in different countries with poor sleep quality.”
From Prevalence and Associated Factors of Sleep Quality among Adults in Jimma Town, Southwest Ethiopia: A Community-Based Cross-Sectional Study (2018) · cites this paper as [32]
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Cites
The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989) · Psychiatry Research · doi:10.1016/0165-1781(89)90047-4 · Cited by 35,234 · see citing works
Psychometric evaluation of the pittsburgh sleep quality index
Carpenter, J. S., & Andrykowski, M. A. (1998) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(97)00298-5 · Cited by 1,618 · see citing works
Mackay, J. M., & Eriksen, M. P. (2002) · Medical Entomology and Zoology · Cited by 1,322 · see citing works
Sex Differences in Insomnia: A Meta-Analysis
Zhang, B., & Wing, Y.-K. (2006) · Sleep · doi:10.1093/sleep/29.1.85 · Cited by 1,286 · see citing works
Doi, Y., Minowa, M., Uchiyama, M., Okawa, M., Kim, K., Shibui, K., & Kamei, Y. (2000) · Psychiatry Research · doi:10.1016/s0165-1781(00)00232-8 · Cited by 992 · see citing works
Insomnia with Objective Short Sleep Duration is Associated with a High Risk for Hypertension
Vgontzas, A. N., Liao, D., Bixler, E. O., Chrousos, G. P., & Vela-Bueno, A. (2009) · Sleep · doi:10.1093/sleep/32.4.491 · Cited by 748 · see citing works
Gender differences in sleep disorders
Krishnan, V., & Collop, N. A. (2006) · Current Opinion in Pulmonary Medicine · doi:10.1097/01.mcp.0000245705.69440.6a · Cited by 497 · see citing works
The involvement of dopamine in the modulation of sleep and waking
Monti, J. M., & Monti, D. (2007) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2006.08.003 · Cited by 419 · see citing works
Adverse effects of khat: a review
Cox, G., & Rampes, H. (2003) · Advances in Psychiatric Treatment · doi:10.1192/apt.9.6.456 · Cited by 303 · see citing works
Amphetamine‐like effects in humans of the khat alkaloid cathinone.
Brenneisen, R., Fisch, H. U., Koelbing, U., et al. (1990) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.1990.tb05447.x · Cited by 262 · see citing works
A review of the neuropharmacological properties of khat
Feyissa, A. M., & Kelly, J. P. (2008) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2007.12.033 · Cited by 199 · see citing works
Pharmacological properties of the stimulant khat
Kalix, P. (1990) · Pharmacology & Therapeutics · doi:10.1016/0163-7258(90)90057-9 · Cited by 199 · see citing works
The prevalence and socio‐demographic correlates of khat chewing in Butajira, Ethiopia
Alem, A., Kebede, D., & Kullgren, G. (1999) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1999.tb10699.x · Cited by 192 · see citing works
Balint, E. E., Falkay, G., & Balint, G. A. (2009) · Wiener klinische Wochenschrift · doi:10.1007/s00508-009-1259-7 · Cited by 183 · see citing works
The potential adverse effects of habitual use ofCatha edulis(khat)
Al‐Habori, M. (2005) · Expert Opinion on Drug Safety · doi:10.1517/14740338.4.6.1145 · Cited by 178 · see citing works
Al’Absi, M., Wittmers, L. E., Erickson, J., Hatsukami, D. K., & Crouse, B. J. (2002) · Pharmacology Biochemistry and Behavior · doi:10.1016/s0091-3057(02)01011-0 · Cited by 173 · see citing works
Self-citationUpdate on Sleep and Psychiatric Disorders
Sateia, M. J. (2009) · CHEST Journal · doi:10.1378/chest.08-1834 · Cited by 141 · see citing works
Shochat, T., Tzischinsky, O., Oksenberg, A., & Peled, R. (2007) · PubMed · Cited by 136 · see citing works
The Magnitude of Khat Use and Its Association With Health , Nutrition and Socio-Economic Status
Belew, M. (1997) · PubMed · doi:10.20372/nadre/13023 · Cited by 130 · see citing works
A transcultural pattern of drug use: Qat (khat) in the UK
Griffiths, P., Gossop, M., Wickenden, S., et al. (1997) · The British Journal of Psychiatry · doi:10.1192/bjp.170.3.281 · Cited by 125 · see citing works
Moghaddam, J. F., Nakhaee, N., Sheibani, V., Garrusi, B., & Amirkafi, A. (2008) · Sleep And Breathing · doi:10.1007/s11325-008-0233-3 · Cited by 108 · see citing works
Lemma, S., Patel, S. V., Tarekegn, Y. A., Tadesse, M. G., Berhane, Y., Gelaye, B., & Williams, M. A. (2012) · Sleep Disorders · doi:10.1155/2012/583510 · Cited by 103 · see citing works
The effect of chewing Khat leaves on human mood
Hassan, N. A. G. M., Gunaid, A. A., El-Khally, F. M., et al. (2002) · Saudi Medical Journal · doi:10.15537/1658-3175.1768 · Cited by 83 · see citing works
Gender Differences in Patterns and Correlates of Khat and Tobacco Use
Nakajima, M., Al’Absi, M., Dokam, A., et al. (2012) · Nicotine & Tobacco Research · doi:10.1093/ntr/nts257 · Cited by 45 · see citing works
Self-citationCorrelates of Nicotine Dependence in U.K. Resident Yemeni Khat Chewers: A Cross-Sectional Study
Kassim, S., Islam, S., & Croucher, R. E. (2011) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntr180 · Cited by 44 · see citing works
Patterns of cortisol and craving by menstrual phase in women attempting to quit smoking
Allen, A. M., ALLEN, S. S., Widenmier, J., & Al’Absi, M. (2009) · Addictive Behaviors · doi:10.1016/j.addbeh.2009.03.024 · Cited by 27 · see citing works
Self-citationCONCURRENT USE OF TOBACCO AND KHAT: ADDED BURDEN ON CHRONIC DISEASE EPIDEMIC
Al’Absi, M., & Grabowski, J. G. (2012) · Addiction · doi:10.1111/j.1360-0443.2011.03684.x · Cited by 24 · see citing works
Self-citation
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Berhanu, H., Mossie, A., Tadesse, S., & Geleta, D. (2018) · Sleep Disorders · doi:10.1155/2018/8342328 · Cited by 103 · see citing works
- Authors
- Nakajima, M., Dokam, A., Kasim, A. N., Alsoofi, M., Khalil, N. S., & al’Absi, M.
- Affiliations
- University of Minnesota (US)
- Taiz University (YE)
- Sana'a University (YE)
- Corresponding author
- Nakajima, Motohiro
- Venue
- Preventing Chronic Disease
- Published
- 2014-05-22
- Volume
- 11
- Pages
- E86-E86
- ISSN
- 1545-1151 (ISSN-L)
- PMC
- PMC4032057
- OpenAlex
- W1978736685
- Cited by
- 26
- References
- 27
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 5 · 2016: 2 · 2015: 2 · 2014: 1
- FWCI
- 4.62
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- public-domain
- Locations
- Preventing Chronic Disease (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute on Drug Abuse (R21DA024626, DA024626)
- Fogarty International Center (R03TW007219)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- khat, tobacco use, concurrent substance use, sleep disorders, subjective sleep quality, Pittsburgh Sleep Quality Index, Arabic version, mood, Yemen
- MeSH terms
- Adolescent, Adult, Analysis of Variance, Cross-Sectional Studies, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Surveys and Questionnaires, Severity of Illness Index, Sleep Stages, Tobacco Use Disorder, Yemen, Comorbidity, Treatment Outcome, Plant Leaves, Catha, Young Adult
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