A narrative review: The effects of opioids on sleep disordered breathing in chronic pain patients and methadone maintained patients

Hassamal, Sameer; Miotto, Karen; Wang, Tisha; Saxon, Andrew J.

doi:10.1111/ajad.12424

Cited by 45 publications

(32 citation statements)

References 70 publications

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“…Among patients with chronic opioid therapy (i.e., > 90 days), as many as 85% may have central, obstructive or mixed-type sleep apnea, as verified by polysomnography ( Mogri et al, 2009 ). In addition, higher chronic benzodiazepine doses are associated with greater incidence of central sleep apnea among patients with chronic opioid therapy ( Hassamal et al, 2016 ). Therefore, physicians treating patients with chronic opioid therapy and concomitant benzodiazepines should consider referral for home- or laboratory-based polysomnography, especially in the presence of other risk factors for obstructive sleep apnea (e.g., elevated body-mass index, thick neck circumference, smoking, male sex) and central sleep apnea (e.g., history of stroke, cardiovascular disease) ( Cheatle and Webster, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Outpatient, combined use of opioid and benzodiazepine medications in the United States, 1993–2014

Hirschtritt

Delucchi

Olfson

2018

Preventive Medicine Reports

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The combined use of opioid and benzodiazepine medications increases the risk of hazardous effects, such as respiratory depression. Although recent increases in outpatient use of opioid prescriptions have been documented, there are limited data regarding rates and correlates of combined opioid and benzodiazepines among adults in outpatient settings. Our objective was to examine annual trends in outpatient visits including opioids, benzodiazepines, and their combination among adults as well as clinical and demographic correlates. We used data from the 1993–2014 National Ambulatory Medical Care Survey (NAMCS) among non-elderly (i.e., ages 18–64 years) adults to examine the probability of a visit including an opioid, benzodiazepine, or their combination, in addition to clinical and demographic correlates. From 1993 to 2014, benzodiazepines-with-opioids visits increased from 9.8 to 62.5 (OR = 9.23, 95% CI = 5.45–15.65) per 10,000 visits. Highest-represented groups among benzodiazepines-with-opioids visits were older (50–64 years) (49.1%), white (88.8%), commercially insured (58.0%) patients during their first visit (87.6%) to a primary-care physician (41.9%). We identified a significant increase in the outpatient co-prescription of opioids and benzodiazepines, notably among adults aged 50–64 years during primary-care visits. Educational and policy changes to provide alternatives to benzodiazepine-with-opioid co-prescription and limiting opioid prescription to pain specialists may reduce rates of this potentially hazardous combination.

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Section: Discussionmentioning

confidence: 99%

Outpatient, combined use of opioid and benzodiazepine medications in the United States, 1993–2014

Hirschtritt

Delucchi

Olfson

2018

Preventive Medicine Reports

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“…Assessment of sleep disturbances is important in patients with chronic pain problems, specifically in the elderly. Furthermore, opioid therapy, along with other psychoactive drug therapy, may induce or exacerbate multiple sleep disturbances (571)(572)(573)(574)(575)(576)(577). Thus, conditions related to sleep disturbances, including that of obstructive sleep apnea syndrome, are crucial in assessing the patient condition prior to initiation of opioid therapy (571-577).…”

Section: Sleep Patternsmentioning

confidence: 99%

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Kaye²,

et al. 2017

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Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ).

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“…Studies indicate that the overall prevalence of CSA in patients taking chronic opioids is about 24% [ 26 ]. Older age, lower BMI, male gender, higher pain levels, higher benzodiazepine doses, and higher opioid doses were all predictors for CSA [ 27 ].…”

Section: Pharmacologic Agentsmentioning

confidence: 99%

Neuropathic Pain and Sleep: A Review

Ferini‐Strambi

2017

Pain Ther

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Neuropathic pain is associated with sleep disturbances, and in turn poor sleep quality leads to increased pain sensitivity, so it is essential to assess sleep alongside neuropathic pain. Responses to drugs are inconsistent and identifying the best treatment option that will reduce pain and improve sleep quality remains challenging for clinicians. Anticonvulsants such as pregabalin and gabapentin improve neuropathic pain and have a positive effect on comorbid sleep disturbances. Opioids and antidepressants are effective in reducing pain but can exacerbate sleep disturbances. Funding: Pfizer, Italy.

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A narrative review: The effects of opioids on sleep disordered breathing in chronic pain patients and methadone maintained patients

Cited by 45 publications

References 70 publications

Outpatient, combined use of opioid and benzodiazepine medications in the United States, 1993–2014

Outpatient, combined use of opioid and benzodiazepine medications in the United States, 1993–2014

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Neuropathic Pain and Sleep: A Review

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