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INTRODUCTION: Individuals with substance use disorders (SUDs) are at increased risk for sleep disturbances, creating a bidirectional relationship that may heighten relapse risk. While polysomnography is the gold standard for measuring sleep, many studies have used actigraphy, a noninvasive, wrist-worn device that estimates rest-activity patterns and sleep-wake characteristics. Despite its utility, the use of actigraphy in populations with SUDs remains limited, and findings vary across substances and methodologies. This protocol outlines a systematic review and meta-analysis aiming to synthesize evidence on actigraphy-derived sleep outcomes across various substances. METHOD AND ANALYSIS: We will include peer-reviewed observational or interventional studies involving individuals aged 18 or older with a diagnosis of substance use (e.g., alcohol, benzodiazepines, cannabis, cocaine, opioids, methamphetamine, or nicotine) who use actigraphy to assess sleep compared to matched controls. Studies will be excluded during screening if they do not use actigraphy, do not include populations with SUDs, or focus on participants younger than 18. There will be no restrictions on location, setting, or language. Databases to be searched include PubMed, Scopus, Web of Science, ProQuest, ClinicalTrials.gov, CINAHL, PsycINFO, and Embase. Titles and abstracts will be screened in the first phase, followed by full-text screening using eligibility criteria. At least two independent reviewers will assess risk of bias using the Risk Of Bias In Non-randomized Studies of Exposures (ROBINS-E) tool. A synthesis will summarize key findings, including study characteristics, population differences, and methodological variations. DISCUSSION: This review will offer a clear and comprehensive assessment of the current literature on actigraphy to examine sleep in SUD and to inform future research to study sleep and its implications in SUD populations. PROTOCOL REGISTRATION NUMBER: International Prospective Register for Systematic Reviews (PROSPERO) number CRD420251072028. Copyright: © 2026 Paredes Naveda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Background: Stimulant use disorder (StUD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur. This comorbidity complicates treatment and worsens clinical outcomes. Despite the high prevalence, shared vulnerability and clinical relevance of this comorbidity, evidence on effective pharmacotherapies among individuals with this dual diagnosis remains limited. Materials and methods: This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement and will include randomized controlled trials involving adults with comorbid StUD (cocaine, amphetamines, or methamphetamines) and ADHD. The following databases will be searched: PubMed, Embase, Scopus, and Web of Science. Covidence will be used to support independent screening and data extraction. Two reviewers will independently screen studies (title/abstract and full text). One author will extract data, which will be independently verified by a second reviewer. Quality assessment of included articles will be assessed using the Cochrane Risk of Bias instrument, and certainty of the evidence for each outcome will be assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Primary outcomes include duration of continuous abstinence, odds of stimulant-negative urine samples, ADHD symptom changes, and medication adverse events. Where feasible, meta-analyses will be conducted using random-effects models. Significance and dissemination: This review will synthesize existing evidence on the efficacy of pharmacotherapies (stimulants and non-stimulants) for individuals with co-occurring StUD and ADHD. The results of this study will likely inform clinical practice by evaluating outcomes such as reduction in stimulant use and abstinence, and improvement in ADHD symptoms. Findings will be disseminated through peer-reviewed publication and presentations to reach both clinical and academic audiences. Systematic review registration: PROSPERO, CRD420250655356. Copyright © 2025 Oliva, Pulido-Saavedra, Paredes-Naveda, Forselius, Potenza, Jegede and Angarita.
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