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Heroin Addiction and Related Clinical Problems: 2026, 28: 59-68

Poor Empathy and High Impulsivity Characterize Individuals with Poor Daytime Sleepiness

Noya Ayali, and Einat Peles

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-8

Summary: Background: Empathy and impulsivity and its relation to sleep and cognition in methadone maintenance treatment (MMT) has never been studied. Methods: 60 MMT patients and 27 controls were studied. Impulsivity task (BART) and questionnaire (BIS-11), sleep quality (PSQI), and sleepiness (ESS), cognition (MoCA), and empathy (EQ60), Pain Empathy (PE), chronic pain (McGill) and substance in urine (or self-report by controls) were studied. Results: Compared with controls, patients from MMT were older, less educated, with lower cognition and pain empathy, worse sleep quality and more pain. More of them abused any substance and they had higher impulsive motor subdomain score. The attentional and non-planning subdomains and daytime sleep scores and empathy were comparable. The entire group, and those with poor daytime sleep only (ESS>10) presented an inverse correlation between EQ60 and total impulsivity (R=-0.4, p=0.009) and attentional (R=-0.4, p=0.007) subdomains. Conclusion: the higher impulsivity the less empathy that particularly shown in individuals with poor daytime sleep, independent whether they suffer from opioid use disorder treated in MMT or healthy controls, suggest the generalization of this relation and the importance of daytime sleep. Further follow-up research is warranted to determine whether improved vigilance may reduce impulsivity and increased empathy.

Keywords: Methadone maintenance treatment (MMT); Opioid use disorder (OUD); Impulsive trait (BIS-11); BART task; Sleep quality; Sleepiness; Empathy (EQ60)