Search

Alcohol use disorder (AUD)-induced disruption of oral microbiota can lead to poor oral health; there have been no studies published examining the longitudinal effects of alcohol use cessation on the oral microbiome. To investigate the oral microbiome during alcohol cessation during inpatient treatment for AUD. Up to 10 oral tongue brushings were collected from 22 AUD patients during inpatient treatment at the National Institutes of Health. Alcohol use history, smoking, and periodontal disease status were measured. Oral microbiome samples were sequenced using 16S rRNA gene sequencing. Alpha diversity decreased linearly during treatment across the entire cohort (P = 0.002). Alcohol preference was associated with changes in both alpha and beta diversity measures. Characteristic tongue dorsum genera from the Human Microbiome Project such as Streptococcus, Prevotella, Veillonella and Haemophilus were highly correlated in AUD. Oral health-associated genera that changed longitudinally during abstinence included Actinomyces, Capnocytophaga, Fusobacterium, Neisseria and Prevotella. The oral microbiome in AUD is affected by alcohol preference. Patients with AUD often have poor oral health but abstinence and attention to oral care improve dysbiosis, decreasing microbiome diversity and periodontal disease-associated genera while improving acute oral health. [ABSTRACT FROM AUTHOR]

Due to the success of endocrine therapy, the mortality of patients with estrogen receptor- positive tumors has declined significantly in recent years. In contrast, triple-negative breast cancers (TNBC) lack clinical expression of estrogen and progesterone receptors and HER-2 receptor overexpression and cannot be treated with current endocrine or HER2-targeted therapies. TNBC occurs in only 10-15% of patients, yet this disease accounts for a large proportion of all breast cancer deaths. TNBCs are heterogeneous (with most, but not all, categorized as basal-like on gene expression analyses) and occur often in younger and African American women. Although initially responsive to some chemotherapies, TNBCs tend to relapse early and metastasize, leading to poor patient survival. It is urgent to develop new therapeutics. Emerging evidence from epidemiologic and preclinical work suggests that metformin, the most widely used drug to treat type 2 diabetes mellitus, exerts anticancer activity in breast cancer. Diabetic patients treated with metformin have a reduced incidence of and better survival from breast cancer. Moreover, TNBC cells are reportedly uniquely sensitive to metformin, and the antitumor effects of metformin appear to be enhanced at high doses of the drug or by IV administration. Thus, we reason that structural analogs of metformin can be designed and synthesized with even more potent anticancer activity and target specificity than metformin. We now report on development of novel metformin analogues with superior anti- TNBC effects based on preclinical tumor models. We tested metformin and new structural analogues of metformin in TNBC and in estrogen receptor-positive MCF-7 cells. Using cell proliferation assays, cells were treated for 72 hours in the presence of metformin or analogues. Inhibition of cell proliferation was dose-dependant and significant at low concentrations (0.01-1mM) of metformin analogues (P < 0.01) in TNBC cell lines (MDAMB231, HCC1937, HCC1806, HCC38 and CRL2335) but not in nonmalignant control cells. Metformin analogues also induced apoptosis in TNBC cells as determined by established methods. The antitumor effects of metformin in breast and other tumors have been attributed largely to activation of the LKB1-AMPK pathway. Similarly, we find that stimulation of TNBC cells with metformin analogues for 24 hours stimulates phosphorylation of AMP kinase as determined by PAGE/Western immunoblots. Furthermore, metformin analogues significantly reduced the downstream phosphorylation of mTORC1 signaling pathway components (p70 S6K, S6 ribosomal protein and 4E-BP1). Tumor xenograft studies on the activity of metformin analogues are in progress. These studies suggest that analogues of metformin have potent anticancer activity in preclinical work with TNBC cells. This structure-activity research on metformin has not previously been done. Since there are currently no specific treatments for TNBC in the clinic, identification of a new targeted therapeutic could be very significant for patients afflicted with this deadly disease. [Funded by JCCF, Stiles Program in Oncology]. [ABSTRACT FROM AUTHOR]

Background: Cooking is an identified dietary strategy that is positively associated with optimal diet quality. Prior to initiating cooking interventions, evaluating the prospective acceptability of the intervention among community members living within low food access areas and understanding geospatial food shopping locations may aid in designing community-tailored interventions., Methods: A sequential mixed methods study was conducted to determine the prospective acceptability of a planned community-located cooking intervention among African American adults living in a low food access area and with at least one cardiovascular disease risk factor. A semi-structured guide was used to conduct five virtual focus groups. Qualitative data were analyzed using thematic analysis and validated through participant check-in interviews. Survey responses were analyzed based on descriptive data. Geospatial analysis of participant locations that were reported for food shopping was conducted to show food environment utilization., Results: Focus groups with study participants (n = 20, all female, mean age 60.3, SD 9.3, mean cooking frequency per week 4.0, food insecure n = 7) were conducted between March and April, 2021. Thematic analysis of the focus group transcripts identified five main themes as follows: (A) Barriers to Cooking (family and caregiving, transportation, COVID-19 pandemic, time availability, household composition); (B) Motivators for Cooking (family, caregiving, health, enjoyment, COVID-19 pandemic); (C) Strategies (food shopping, social support, social media, meal planning); (D) Neighborhood (gentrification, perceived safety, stigmatization, disparities in grocery stores); (E) and Acceptability of the Intervention (reasons to participate, barriers, recruitment, intervention delivery). Participant validation interviews confirmed the themes and subthemes as well as the illustrative quotes. Geospatial analysis showed a majority of locations were outside of the participants' residential areas., Conclusions: Prospective acceptability of a community-tailored cooking intervention found that the planned intervention could be modified to address individual level factors, such as caregiving and health, community contextual factors, such as perceived safety, and the general health needs of the community.

Background: Sedentary behaviours have been associated with increased risks of some common cancers in epidemiological studies; however, it is unclear if these associations are causal., Methods: We used univariable and multivariable two-sample Mendelian randomisation (MR) to examine potential causal relationships between sedentary behaviours and risks of breast, colorectal and prostate cancer. Genetic variants associated with self-reported leisure television watching and computer use were identified from a recent genome-wide association study (GWAS). Data related to cancer risk were obtained from cancer GWAS consortia. A series of sensitivity analyses were applied to examine the robustness of the results to the presence of confounding., Results: A 1-standard deviation (SD: 1.5 h/day) increment in hours of television watching increased risk of breast cancer (OR per 1-SD: 1.15, 95% confidence interval [CI]: 1.05-1.26) and colorectal cancer (OR per 1-SD: 1.32, 95% CI: 1.16-1.49) while there was little evidence of an association for prostate cancer risk (OR per 1-SD: 0.94, 95% CI: 0.84-1.06). After adjusting for years of education, the effect estimates for television watching were attenuated (breast cancer, OR per 1-SD: 1.08, 95% CI: 0.92-1.27; colorectal cancer, OR per 1-SD: 1.08, 95% CI: 0.90-1.31). Post hoc analyses showed that years of education might have a possible confounding and mediating role in the association between television watching with breast and colorectal cancer. Consistent results were observed for each cancer site according to sex (colorectal cancer), anatomical subsites and cancer subtypes. There was little evidence of associations between genetically predicted computer use and cancer risk., Conclusions: Our univariable analysis identified some positive associations between hours of television watching and risks of breast and colorectal cancer. However, further adjustment for additional lifestyle factors especially years of education attenuated these results. Future studies using objective measures of exposure can provide new insights into the possible role of sedentary behaviour in cancer development., (© 2023 World Health Organization; licensed by John Wiley & Sons Ltd. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Observational studies have found some evidence of an association between elevated blood pressure and prostate cancer risk; however, the results are inconclusive. We tested whether systolic blood pressure (SBP) influences prostate cancer risk and evaluated the effect of calcium channel blockers (CCB) on the disease using Mendelian randomization (MR) approach., Methods: We used 278 genetic variants associated with SBP and 16 genetic variants in CCB genes as instrumental variables. Effect estimates were obtained from the UK Biobank sample of 142,995 males and from PRACTICAL consortium (79,148 cases and 61,106 controls)., Results: For each 10 mm Hg increase in SBP the estimated effect was OR 0.96 (0.90-1.01) for overall prostate cancer; and OR 0.92 (0.85-0.99) for aggressive prostate cancer. The MR-estimated effect of a 10 mm Hg- SBP lowering through CCB genetic variants was OR 1.22 (1.06-1.42) for all prostate cancers and OR 1.49 (1.18-1.89) for aggressive prostate cancer., Conclusion: The results of our study did not support a causal relationship between SBP and prostate cancer; however, we found weak evidence of a protective effect of high SBP on aggressive prostate cancer and we found that blocking calcium channel receptors may increase prostate cancer risk., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Identifying mechanisms to maintain CBPR studies during an infectious disease pandemic is vital. The current paper describes the changes in methods and processes conducted within a CBPR mixed-methods study to a virtual setting during the novel coronavirus (COVID-19) pandemic., Method: The DC Community Organizing for Optimal Culinary Knowledge study with Heart (DC COOKS with Heart) was designed to assess the feasibility of a dietary behavior intervention among African-American adults that are at risk for cardiovascular disease (CVD). The study is under the umbrella of an ongoing CBPR study and community advisory board that facilitates community involvement in study design and promotes ongoing engagement with community members and leaders. The study population for D.C. COOKS with Heart consists of adult African-American individuals who live in two low-resource neighborhoods in Washington, D.C., which were impacted disproportionately by COVID. Eligible study participants who previously participated in the DC CHOC community-based studies were contacted to participate in Phase 1. The quantitative part of the mixed-methods included survey data collection., Results: Due to the pandemic, the mode of data collection for surveys changed from self-administered face-to-face to internet-based. All virtual study procedures were conducted between March and April, 2021. Anticipated benefits of the virtual setting included participant safety during the pandemic, ease of logistics for participants. Anticipated challenges included administration of electronic devices to participants, research team training, and potential threats to established trust related to the privacy and confidentiality of participants., Conclusion: The transition to a virtual setting for study procedures in a mixed-methods study was conducted successfully in terms of recruitment, retention of participants, and training of research team members. The virtual transition required established and ongoing engagement through the community advisory board and CBPR practices, institutional support through virtual research policies, collaborations with information technology-based teams, and equipment administration for the study., Trials Registration: NCT04305431 . Registered on March 12, 2020., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

The sleep regularity index (SRI) is used to measure an individual's sleep/wake consistency over time. The SRI has been associated with certain health risks; to date, research investigating the relationship between the SRI and relapse in individuals with alcohol use disorder (AUD) is lacking. The aim of this work was to evaluate the SRI and relapse in individuals with AUD following inpatient treatment. Individuals with AUD (n = 77, mean age = 49.5 ± 10.86) were assessed for 28-days following discharge from an inpatient treatment program. Logistic regression was applied to examine the impact of SRI on relapse as the outcome variable of interest. Sleep quality was lower in individuals who relapsed compared to those who did not. Moreover, SRI scores were significantly worse in those who relapsed compared to those who did not. Over the entire patient cohort, lower weekly SRI scores were significantly correlated with longer weekly nap duration. Logistic regression model results indicated that the overall SRI was a significant predictor of relapse. The SRI represents a relevant aspect of sleep health and should be considered when assessing an individual's sleeping patterns. Behavior based interventions related to the importance of individualized consistency in sleep and wake patterns may be particularly important for treatment seeking individuals with AUD not only during inpatient treatment, but also once these individuals have transitioned into their outpatient phase of recovery. These findings support the notion of SRI as a separate facet of sleep health worth investigating in at-risk, disease specific groups., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Cardiovascular disease is a leading cause of morbidity and mortality. Oral health is associated with smoking and cardiovascular outcomes, but there are gaps in knowledge of many mechanisms connecting smoking to cardiovascular risk. Therefore, the aim of this review is to synthesize literature on smoking and the oral microbiome, and smoking and cardiovascular risk/disease, respectively. A secondary aim is to identify common associations between the oral microbiome and cardiovascular risk/disease to smoking, respectively, to identify potential shared oral microbiome-associated mechanisms. We identified several oral bacteria across varying studies that were associated with smoking. Atopobium, Gemella, Megasphaera, Mycoplasma, Porphyromonas, Prevotella, Rothia, Treponema, and Veillonella were increased, while Bergeyella, Haemophilus, Lautropia, and Neisseria were decreased in the oral microbiome of smokers versus non-smokers. Several bacteria that were increased in the oral microbiome of smokers were also positively associated with cardiovascular outcomes including Porphyromonas, Prevotella, Treponema, and Veillonella. We review possible mechanisms that may link the oral microbiome to smoking and cardiovascular risk including inflammation, modulation of amino acids and lipids, and nitric oxide modulation. Our hope is this review will inform future research targeting the microbiome and smoking-related cardiovascular disease so possible microbial targets for cardiovascular risk reduction can be identified., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent's interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved African-American adults ( n = 11) at risk for cardiovascular disease who were recruited from a community-based participatory research study in Washington, D.C., to participate in a focus group-based cognitive interview. Cognitive interview methodologies included the verbal think-aloud protocol and the use of retrospective probes. Thematic analysis and evaluation of verbalized cognitive processes were conducted using verbatim transcripts. Five thematic themes related to the survey were generated: (1) Clarity and relevancy of question items; (2) influence of participants' perspectives and gender roles; (3) participant social desirability response to questions; (4) concern regarding question intent. Eleven survey items were determined as difficult by participants. Cooking topics for these items were: cooking practices, cooking skills, cooking perception (how one defines cooking), food shopping skills, and socialization around cooking. Question comprehension and interpreting response selections were the most common problems identified. Cognitive interviews are useful for cooking research as they can evaluate survey questions to determine if the meaning of the question as intended by the researcher is communicated to the respondents-specific implications from the results that apply to cooking research include revising questions on cooking practice and skills. Focus-group-based cognitive interviews may provide a feasible method to develop culturally grounded survey instruments to help understand disparities in behavior for culturally relevant diet behaviors such as cooking., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Farmer, Powell-Wiley, Middleton, Brooks, Mitchell, Troncoso, Ceasar, Claudel, Andrews, Kazmi, Johnson and Wallen.)

Background: High levels of sleep disturbances reported among individuals with alcohol use disorder (AUD) can stimulate inflammatory gene expression, and in turn, may alter pro-inflammatory cytokines levels. We aimed to investigate associations between pro-inflammatory cytokine markers with subjective measures of sleep quality, psychological variables and alcohol consumption among individuals with AUD., Methods: This exploratory study is comprised of individuals with AUD ( n = 50) and healthy volunteers ( n = 14). Spearman correlation was used to investigate correlations between plasma cytokine levels and clinical variables of interest (liver and inflammatory markers, sleep quality, patient reported anxiety/depression scores, and presence of mood and/or anxiety disorders (DSM IV/5); and history of alcohol use variables., Results: The AUD group was significantly older, with poorer sleep quality, higher anxiety/depression scores, and higher average drinks per day as compared to controls. Within the AUD group, IL-8 and MCP-1 had positive significant correlations with sleep, anxiety, depression and drinking variables. Specifically, higher levels of MCP-1 were associated with poorer sleep ( p = 0.004), higher scores of anxiety ( p = 0.006) and depression ( p < 0.001), and higher number of drinking days ( p = 0.002), average drinks per day ( p < 0.001), heavy drinking days ( p < 0.001) and total number of drinks ( p < 0.001). The multiple linear regression model for MCP-1 showed that after controlling for sleep status and heavy drinking days, older participants ( p = 0.003) with more drinks per day ( p = 0.016), and higher alkaline phosphatase level ( p = 0.001) had higher MCP-1 level., Conclusion: This exploratory analysis revealed associations with cytokines MCP-1 and IL-8 and drinking consumption, sleep quality, and anxiety and depression in the AUD group. Furthermore, inflammatory and liver markers were highly correlated with certain pro-inflammatory cytokines in the AUD group suggesting a possible relationship between chronic alcohol use and inflammation. These associations may contribute to prolonged inflammatory responses and potentially higher risk of co-morbid chronic diseases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kazmi, Wallen, Yang, Alkhatib, Schwandt, Feng, Gao, Diazgranados, Ramchandani and Barb.)

Objectives: To explore the correlation of anxiety levels of medical students measured before, during and after assessments with their performance in formative assessments., Methods: A repeated measures cross-sectional study was conducted at Shifa College of Medicine, Islamabad with data collection at three points in time, from April-May 2020. A validated test anxiety questionnaire was used to assess anxiety. Eighty-two medical students recorded their responses on the questionnaire before, during and after three consecutive formative assessments in an integrated module. Relevant statistical tests were applied to investigate the correlation of anxiety levels at different stages with assessment scores., Results: The mean scores of anxiety measured before, during and after the three consecutive formative assessments were 29.78±7.77, 28.0±8.88 and 26.11±7.83, respectively. The difference of means of anxiety measured at different stages during assessments was statistically significant (p<0.001). The negative correlation between anxiety level and academic scores of female students was statistically significant (p=0.05)., Conclusion: Fluctuation in anxiety scores at different stages of assessments affects academic performance. Identification of the effect of anxiety may help improve the academic performance of medical students., Competing Interests: Conflict of Interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

The Rho GTPase family consists of 20 genes encoding intracellular signalling proteins that influence cytoskeletal dynamics, cell migration and cell cycle progression. They are implicated in breast cancer progression but their role in breast cancer aetiology is unknown. As aberrant Rho GTPase activity could be associated with breast cancer, we aimed to determine the potential for a causal role of Rho GTPase gene expression in breast cancer risk, using two-sample Mendelian randomization (MR). MR was undertaken in 122,977 breast cancer cases and 105,974 controls, including 69,501 estrogen receptor positive (ER+) cases and 105,974 controls, and 21,468 ER negative (ER-) cases and 105,974 controls. Single nucleotide polymorphisms (SNPs) underlying expression quantitative trait loci (eQTLs) obtained from normal breast tissue, breast cancer tissue and blood were used as genetic instruments for Rho GTPase expression. As a sensitivity analysis, we undertook co-localisation to examine whether findings reflected shared causal variants or genomic confounding. We identified genetic instruments for 14 of the 20 human Rho GTPases. Using eQTLs obtained from normal breast tissue and normal blood, we identified evidence of a causal role of RHOD in overall and ER+ breast cancers (overall breast cancer: odds ratio (OR) per standard deviation (SD) increase in expression level 1.06; (95% confidence interval (CI) 1.03, 1.09; P = 5.65 × 10 -5 ) and OR 1.22 (95% CI 1.11, 1.35; P = 5.22 × 10 -5 ) in normal breast tissue and blood respectively). There was a consistent direction of association for ER- breast cancer, although the effect-estimate was imprecisely estimated. Using eQTLs from breast cancer tissue and normal blood there was some evidence that CDC42 was negatively associated with overall and ER + breast cancer risk. The evidence from colocalization analyses strongly supported our MR results particularly for RHOD. Our study suggests a potential causal role of increased RHOD gene expression, and, although the evidence is weaker, a potential protective role for CDC42 gene expression, in overall and ER+ breast cancers. These finding warrant validation in independent samples and further biological investigation to assess whether they may be suitable targets for drug targeting., (© 2022. The Author(s).)

Sleep disturbances are common among individuals with alcohol use disorder (AUD) and may not resolve completely with short-term abstinence from alcohol, potentially contributing to relapse to drinking. The endocannabinoid system (ECS) is associated with both sleep and alcohol consumption, and genetic variation in the ECS may underlie sleep-related phenotypes among individuals with AUD. In this study, we explored the influence of genetic variants in the ECS (Cannabinoid receptor 1/ CNR1 : rs806368, rs1049353, rs6454674, rs2180619, and Fatty Acid Amide Hydrolase/ FAAH rs324420) on sleep quality in individuals with AUD ( N = 497) and controls without AUD ( N = 389). We assessed subjective sleep quality (from the Pittsburgh Sleep Quality Index/PSQI) for both groups at baseline and objective sleep efficiency and duration (using actigraphy) in a subset of individuals with AUD at baseline and after 4 weeks of inpatient treatment. We observed a dose-dependent relationship between alcohol consumption and sleep quality in both AUD and control groups. Sleep disturbance, a subscale measure in PSQI, differed significantly among CNR1 rs6454674 genotypes in both AUD ( p = 0.015) and controls ( p = 0.016). Only among controls, neuroticism personality scores mediated the relationship between genotype and sleep disturbance. Objective sleep measures (sleep efficiency, wake bouts and wake after sleep onset), differed significantly by CNR1 rs806368 genotype, both at baseline ( p = 0.023, 0.029, 0.015, respectively) and at follow-up ( p = 0.004, p = 0.006, p = 0.007, respectively), and by FAAH genotype for actigraphy recorded sleep duration at follow-up ( p = 0.018). These relationships suggest a significant role of the ECS in alcohol-related sleep phenotypes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Soundararajan, Kazmi, Brooks, Krumlauf, Schwandt, George, Hodgkinson, Wallen and Ramchandani.)

Characterizing genetic influences on DNA methylation (DNAm) provides an opportunity to understand mechanisms underpinning gene regulation and disease. In the present study, we describe results of DNAm quantitative trait locus (mQTL) analyses on 32,851 participants, identifying genetic variants associated with DNAm at 420,509 DNAm sites in blood. We present a database of >270,000 independent mQTLs, of which 8.5% comprise long-range (trans) associations. Identified mQTL associations explain 15-17% of the additive genetic variance of DNAm. We show that the genetic architecture of DNAm levels is highly polygenic. Using shared genetic control between distal DNAm sites, we constructed networks, identifying 405 discrete genomic communities enriched for genomic annotations and complex traits. Shared genetic variants are associated with both DNAm levels and complex diseases, but only in a minority of cases do these associations reflect causal relationships from DNAm to trait or vice versa, indicating a more complex genotype-phenotype map than previously anticipated., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: Little is known about cognitive and behavioral predictors of sleep quality and relapse among individuals with alcohol use disorder (AUD). Using the social cognitive theory (SCT), we assessed sleep-related behaviors and cognitions, sleep quality, and relapse to drinking among individuals with AUD transitioning from inpatient to outpatient settings., Method: Individuals (n = 149) seeking treatment for AUD were recruited during their inpatient stay. Self-efficacy for sleep, dysfunctional beliefs about sleep, sleep-related behaviors, sleep quality, and relapse were assessed. Objective (actigraphy) assessment of sleep efficiency and duration was measured using actigraphy. Multiple logistic regression models tested whether self-reported sleep quality or sleep-related beliefs/behavior predicted relapse. Repeated measures linear mixed modeling tested whether there was a change over time in sleep quality as well as the relationships between self-efficacy, sleep-related beliefs, sleep behaviors, sleep quality, and relapse., Results: In our sample, self-efficacy for sleep, dysfunctional beliefs about sleep, and sleep-related behavior were all significantly associated with both sleep quality and relapse. Controlling for pre-discharge sleep-related behaviors (SRBQ) and actigraphy-recorded average sleep time during the first week post-discharge, married participants had lower odds of relapse compared with non-married patients (p = 0.048, OR = 0.119, 95% CI 0.015-0.983). Patients with lower self-efficacy for sleep (SES) scores (p < 0.001) and higher CPRS anxiety scores (p < 0.001) had higher PSQI scores., Conclusion: Our results highlight the importance of self-efficacy and dysfunctional beliefs about sleep as predictors of sleep quality and relapse among individuals with AUD and the utility of the SCT as a sleep research framework.