Heavy Caffeine Use Research Articles

0458 Smoking and Caffeine Consumption Differ Between Insomnia Phenotypes Based on Objective Sleep Duration

Abstract Introduction The insomnia with short sleep phenotype (ISS), in contrast to the normal sleep phenotype (INS), is characterized by physiological hyperarousal including activation of the stress system and cardiometabolic morbidity. The aim of this study was to assess whether these two insomnia phenotypes differ in terms of the use of two common stimulants (i.e., caffeine and nicotine). Methods Data from the Penn State Adult Cohort (N=1741) was used in this study (52.2% women, 48.8±13.6 years). A 1-night, 8-hour, polysomnography (PSG) was used to classify subjects into normal (≥6h) and short (<6h) sleep duration groups. Self-reported sleep difficulty was defined based on three levels of severity as normal sleep (n=1022), poor sleep (n=520) and insomnia (n=199). Self-reported heavy caffeine use was defined as ≥3 cups daily and heavy smoking as ≥20 cigarettes daily. Multinomial logistic regression analyses were conducted adjusting for covariates such as age, gender, and race. Results Compared to normal sleepers, ISS (OR=0.55, 95% CI=0.31-0.97, p=0.04), but not INS (OR=0.92, 95% CI=0.52-1.64, p=0.77), was associated with significantly less heavy caffeine use. In contrast, INS (OR=2.20, 95% CI=1.10-4.40, p=0.03), but not ISS (OR=0.95, 95% CI=0.41-2.17, p=0.90), was associated with significantly more heavy smoking. Conclusion These results indicate that the use of common stimulants (i.e., smoking cigarettes and drinking caffeine) is higher in the INS phenotype than the ISS phenotype. Individuals with the ISS phenotype may be using less caffeine and tobacco to avoid further stimulation of the already hyperaroused physiologic system, which may result in worsening of their insomnia. In the INS phenotype, changes in health behaviors should be an important part of a multidimensional approach to treatment. Support American Heart Association (14SDG19830018), National Institutes of Health (R01HL51931, R01HL40916)

Neonatal Withdrawal Following in Utero Exposure to Kratom

In recent years, the clinical definition of neonatal abstinence syndrome (NAS) has been expanded to describe neonates experiencing withdrawal due to in utero exposure to numerous neuroactive substances, not exclusively opioids. Complex NAS cases involving exposure to multiple and unusual narcotics have become widespread. Kratom is one such substance. It is extracted from tropical tree leaves, and can be used both as a recreational drug and to mitigate opioid withdrawal. Although kratom may potentially serve as a viable opioid alternative, its activity and the consequences of controlled use are largely unstudied, particularly in the pregnant population. A newborn male infant was not initially identified as being at risk for withdrawal due to no maternal admission of substance use and maternal urine drug screen was negative. On the first day of life (DOL), the neonate was observed to exhibit significant signs of withdrawal including high-pitched crying, facial grimacing, irregular respiratory pattern, mottling, and mild undisturbed tremors. Upon interview with the mother it was noted that there was heavy caffeine use, daily cigarette smoking, daily use of the “herbal alternative” (kratom) throughout the pregnancy. In this report, we present a case of NAS precipitated by in utero exposure to kratom, discuss the present body of research regarding kratom and consider potential implications of escalating kratom use on the incidence and severity of NAS. For this prenatally exposed neonate, clonidine was successfully used to control withdrawal symptoms. Int J Clin Pediatr. 2018;7(4):55-58 doi: https://doi.org/10.14740/ijcp317w

Nicotinic acetylcholine receptor availability in cigarette smokers: effect of heavy caffeine or marijuana use.

Upregulation of α4β2* nicotinic acetylcholine receptors (nAChRs) is one of the most well-established effects of chronic cigarette smoking on the brain. Prior research by our group gave a preliminary indication that cigarette smokers with concomitant use of caffeine or marijuana have altered nAChR availability. We sought to determine if smokers with heavy caffeine or marijuana use have different levels of α4β2* nAChRs than smokers without these drug usages. One hundred and one positron emission tomography (PET) scans, using the radiotracer 2-FA (a ligand for β2*-containing nAChRs), were obtained from four groups of males: non-smokers without heavy caffeine or marijuana use, smokers without heavy caffeine or marijuana use, smokers with heavy caffeine use (mean four coffee cups per day), and smokers with heavy marijuana use (mean 22days of use per month). Total distribution volume (Vt/fp) was determined for the brainstem, prefrontal cortex, and thalamus, as a measure of nAChR availability. A significant between-group effect was found, resulting from the heavy caffeine and marijuana groups having the highest Vt/fp values (especially for the brainstem and prefrontal cortex), followed by smokers without such use, followed by non-smokers. Direct between-group comparisons revealed significant differences for Vt/fp values between the smoker groups with and without heavy caffeine or marijuana use. Smokers with heavy caffeine or marijuana use have higher α4β2* nAChR availability than smokers without these drug usages. These findings are likely due to increased nicotine exposure but could also be due to an interaction on a cellular/molecular level.

Energy Drinks: What Teenagers (and Their Doctors) Should Know

1. Kwabena L. Blankson, MD* 2. Amy M. Thompson, DO† 3. Dale M. Ahrendt, MD‡ 4. Vijayalakshmy Patrick, MD§ 1. *Maj, US Air Force, Adolescent Medicine, Naval Medical Center, Portsmouth, VA. 2. †Maj, US Army, Adolescent Medicine Fellow, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio, TX. 3. ‡Lt Col, US Air Force, Program Director, Adolescent Medicine, Fellowship, SAUSHEC, San Antonio, TX. 4. §Psychiatrist, Brooke Army Medical Center Associate Professor, University of Texas Health Science Center, San Antonio, TX. Hundreds of different energy drinks are available and are marketed to adolescents, carrying the potential for substance abuse that involves caffeine and alcohol. Clinicians must be educated to deal with their patients’ use of these products. After reading this article, readers should be able to: 1. Understand the size and scope of the energy drink market and recognize common energy drink brands. 2. Know that adolescents are high consumers of energy drinks and use them as performance enhancers. 3. Know the contents of energy drinks and their adverse effects and safety concerns. 4. Know that energy drinks can be a cause of tachycardia, hypertension, obesity, and other medical problems in adolescents. 5. Know the dangers of mixing energy drinks with alcohol. 6. Understand the relationship between caffeine tolerance/dependence and alcohol tolerance/dependence. 7. Understand the importance of screening teenagers for energy drink use in the office setting and offering appropriate counseling. Energy drinks are caffeinated beverages advertised as boosting the immune system, enhancing performance, and creating a “buzz” or a “high.” Some of these drinks contain alcohol, and sometimes consumers mix them with alcoholic beverages. This article reviews current information about the content, benefits, and risks of the use of these energy drinks by adolescents. Adolescents are no strangers to energy drinks, and over the past 2 years, media reports have heightened the awareness of doctors, parents, and lawmakers. In 2010, nine university students in Washington State were hospitalized and one almost died; their illness was attributed to a fruit-flavored, caffeinated alcoholic drink. A month earlier, on a college campus in New Jersey, 23 students were hospitalized after becoming intoxicated, again reportedly after drinking the same …

The effect of caffeine on pregnancy outcome variables.

The American public consumes a wide array of caffeinated products as coffee, tea, chocolate, cola beverages, and caffeine-containing medication. Therefore, it seems of value to inform both the scientific community and the consumer about the potential effects of excessive caffeine consumption, particularly by pregnant women. The results of this literature review suggest that heavy caffeine use (> or = 300 mg per day) during pregnancy is associated with small reductions in infant birth weight that may be especially detrimental to premature or low-birth-weight infants. Some researchers also document an increased risk of spontaneous abortion associated with caffeine consumption prior to and during pregnancy. However, overwhelming evidence indicates that caffeine is not a human teratogen, and that caffeine appears to have no effect on preterm labor and delivery. More research is needed before unambiguous statements about the effects of caffeine on pregnancy outcome variables can be made.

Caffeine intake, toxicity and dependence and lifetime risk for psychiatric and substance use disorders: an epidemiologic and co-twin control analysis

Although caffeine is the most commonly used psychoactive substance and often produces symptoms of toxicity and dependence, little is known, especially in community samples, about the association between caffeine use, toxicity and dependence and risk for common psychiatric and substance use disorders. Assessments of lifetime maximal caffeine use and symptoms of caffeine toxicity and dependence were available on over 3600 adult twins ascertained from the population-based Virginia Twin Registry. Lifetime histories of major depression (MD), generalized anxiety disorder (GAD) and panic disorder, alcohol dependence, adult antisocial behavior and cannabis and cocaine abuse/dependence were obtained at personal interview. Logistic regression analyses in the entire sample and within monozygotic (MZ) twin pairs were conducted in SAS. In the entire sample, measures of maximal caffeine use, heavy caffeine use, and caffeine-related toxicity and dependence were significantly and positively associated with all seven psychiatric and substance use disorders. However, within MZ twin pairs, controlling for genetic and family environmental factors, these associations, while positive, were all non-significant. These results were similar when excluding twins who denied regular caffeine use. Maximal lifetime caffeine intake and caffeine-associated toxicity and dependence are moderately associated with risk for a wide range of psychiatric and substance use disorders. Analyses of these relationships within MZ twin pairs suggest that most of the observed associations are not causal. Rather, familial factors, which are probably in part genetic, predispose to both caffeine intake, toxicity and dependence and the risk for a broad array of internalizing and externalizing disorders.

Tobacco, alcohol and caffeine use in a low-income, pregnant population

This study examined the relationship between smoking, drinking and heavy caffeine use (>three caffeinated drinks per day) among pregnant women who reported smoking cigarettes and drinking alcohol prior to conception. Demographic predictors of smoking, drinking and caffeine use during pregnancy were also identified. Pregnant women (n=237) attending a university-based, public clinic were identified during screening for a larger intervention study. Logistic regression analyses revealed a significant relationship between pregnancy smoking and drinking (OR=8.1), as well as between smoking and harmful caffeine use (OR=3.1). Age predicted smoking and drinking in pregnancy, with older women being more likely to use both substances. Caucasian women were more likely to continue smoking, while African-American women were more likely to continue drinking. Increased attention should be paid to the co-occurrence of multiple health risk behaviours during pregnancy and to the specific needs of subgroups of high-risk women.

Caffeine intake, tolerance, and withdrawal in women: a population-based twin study.

Caffeine is by far the most commonly consumed psychoactive substance. The use and abuse of most other licit and illicit psychoactive drugs have been shown to be substantially heritable. However, the impact of genetic factors on caffeine consumption, heavy use, intoxication, tolerance, and withdrawal is largely unknown. Caffeine consumption, in the form of brewed coffee, instant coffee, tea, and caffeinated soft drinks, as well as caffeine intoxication, tolerance, and withdrawal, were assessed by personal interviews of 1,934 individual twins from female-female pairs ascertained from the population-based Virginia Twin Registry. The sample included both members of 486 monozygotic and 335 dizygotic pairs. Twin resemblance was assessed by probandwise concordance, odds ratios, and tetrachoric correlations. Biometrical model fitting was also performed. The resemblance in twin pairs for total caffeine consumption, heavy caffeine use, caffeine intoxication, caffeine tolerance, and caffeine withdrawal was substantially greater in monozygotic than in dizygotic twin pairs. Model fitting suggested that twin resemblance for these measures could be ascribed solely to genetic factors, with estimated broad heritabilities of between 35% and 77%. Caffeine is an addictive psychoactive substance. Similar to previous findings with other licit and illicit psychoactive drugs, individual differences in caffeine use, intoxication, tolerance, and withdrawal are substantially influenced by genetic factors.

Factors Related to Treatment Resistance in Hypertension

Hypertension which is resistant to treatment carries a relatively bad prognosis. Factors associated with treatment resistance were examined in a case-control study in a hospital hypertension clinic. Patients with resistant hypertension had more severe hypertension and more frequently had evidence of end-organ damage on presentation to the clinic. The prevalence of accelerated phase hypertension, renovascular disease and impaired renal function was also higher in these patients. Cigarette smoking, and the combination of cigarette smoking and heavy caffeine use, were greater in patients with resistant hypertension. Resistant hypertension did not appear to be associated with older age, obesity, regular alcohol use, various psychological factors or non-compliance. These findings support an aggressive investigation policy in resistant hypertension, and underline the harmful effects of cigarette smoking to hypertensive subjects.

CAFFEINE AND THE RISK OF HIP FRACTURE: THE FRAMINGHAM STUDY

Caffeine increases urinary calcium output and has been implicated as a risk factor for osteoporosis. The authors examined the effect of caffeine on hip fracture risk in 3,170 individuals attending the 12th (1971-1973) Framingham Study examination. Coffee and tea consumption, age, Framingham examination number, weight, smoking, alcohol consumption, and estrogen use were used to evaluate hip fracture risk according to caffeine intake. Hip fractures occurred in 135 subjects during 12 years of follow-up. Fracture risk over each 2-year period increased with increasing caffeine intake (one cup of coffee = one unit of caffeine, one cup of tea = 1/2 unit of caffeine). For intake of 1.5-2.0 units per day, the adjusted relative risk (RR) of fracture was not significantly elevated compared with intake of one or less units per day. Consumption of greater than or equal to 2.5 units per day significantly increased the risk of fracture. Overall, intake of greater than two cups of coffee per day (four cups of tea) increased the risk of fracture. In summary, hip fracture risk was modestly increased with heavy caffeine use, but not for intake equivalent to one cup of coffee per day. Since caffeine use may be associated with other behaviors that are, themselves, risk factors for fracture, the association may be indirect. Further studies should be performed to confirm these findings.

Biochemical validation of self-reported caffeine consumption during caffeine fading.

Increasing concern about caffeine as a drug with potential for abuse has resulted in the development of procedures for effecting reductions in caffeine consumption among heavy users. However, the reliability of reported findings may be questioned, since previous studies have relied on subject self-report as the principal measure of caffeine use. The present study employed bioanalytic methods for assessing the reliability of self-reported caffeine intake during a caffeine-fading regime. Twelve subjects, each with a history of heavy caffeine use, provided baseline, treatment, and follow-up blood samples which were assayed for caffeine and its major metabolites. General support was provided for the reliability of self-report as a measure of caffeine consumption. The general efficacy of caffeine fading was also supported, although there were indications that maintenance effects may have been over-estimated in previous studies.

Reasons for consumption and heavy caffeine use: Generalization of a model based on alcohol research

The extent of alcohol consumption and problems has been found to be related to the types of reasons for consuming. At least two types of motives have been identified (“personal effects” and “social”) with “personal effects” motives related to higher consumption and more alcohol problems. The present study tested the applicability of this model to caffeine consumption, in particular, coffee and tea. Eighteen motives for consuming coffee and tea were used to predict coffee/tea consumption, dependence, and problems. Principal component analyses identified four types of motives: two social (“sociability” and “beverage”) and two personal effects (“stimulant” and “relief”). Overall, the “relief” and “stimulant” types of motives were the best predictors for all criterion measures (consumption, dependence and problems); “beverage” motives strongly predicted consumption and dependence; and “sociability” motives were least useful in predicting all criterion measures. These results are consistent with research on the relationship between extent of alcohol consumption/problems and reasons for consuming.

Somatic and psychological health implications of heavy caffeine use.

SummaryConflicting results have been reported as to whether habitual caffeine use is associated with symptoms of poorer health. The aim of the present study was to further examine the association between caffeine use and somatic and psychological symptomatology while controlling for potentially confounding influences such as concurrent substance use. Information was obtained on the somatic and psychological health, substance use, and biographic background of 96 individuals divided into three equal‐sized groups matched on age and sex. One group consisted of subjects who were chosen specifically because of their habitually high caffeine intake. The other two groups consisted of comparison subjects of psychiatric patients and university students who represented widely varying levels of somatic and psychological health. The results indicated that at high intake levels caffeine may have detrimental effects on somatic and psychological health.