Chronic Opioid Use is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing

Walker, James M.; Farney, Robert J.; Rhondeau, Steven; Boyle, Kathleen M.; Valentine, Karen; Cloward, Tom V.; Shilling, Kevin C.

doi:10.5664/jcsm.26908

Cited by 370 publications

(208 citation statements)

References 23 publications

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“…27 Chronic opioid use has been shown to worsen sleep-disordered breathing, at least in part by introducing more central events. 28,29 Continuous positive airway pressure (CPAP) compliance may be limited by xerostomia and pain; oral appliance therapy compliance may be limited by by trismus, xerostomia, and dental changes. 6,9,30 Palatal and pharyngeal surgery likely are relatively contraindicated for oncologic, wound-healing and morbidity reasons.…”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea in the irradiated head and neck cancer patient

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea in the irradiated head and neck cancer patient

et al. 2017

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“…Ataxic or irregular breathing during NREM sleep was also more prevalent in patients who chronically used opioids (70% vs 5%, P < .001) and more frequent (92%) at a morphine dose equivalent of 200 mg or higher (odds ratio = 15.4, P = .017). 26 Webster et al performed polysomnography on 147 patients from a consecutive series of patients receiving COT for at least 6 months with a stable dose for at least 4 weeks. The apnea-hypopnea index was abnormal in 75%: 39% had obstructive sleep apnea, 24% had central apnea, 8% both types, and 4% with an indeterminate type.…”

Section: Other Adverse Effects Of Opioidsmentioning

confidence: 99%

A Practice Guide for Continuous Opioid Therapy for Refractory Daily Headache: Patient Selection, Physician Requirements, and Treatment Monitoring

et al. 2010

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“…High-dose opioids lead to ataxic breathing (Biot breathing) and an abnormal pattern of respiratory rate, rhythm and depth with irregular pauses and breath frequency (Nguyen, Kim, Grunstein, Thamrin, & Wang, 2016;Walker et al, 2007), which is traditionally visually scored by pattern recognition. There is no guideline in the standard scoring manual to address abnormal breathing rhythm during sleep (Berry et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

The effect of acute exposure to morphine on breathing variability and cardiopulmonary coupling in men with obstructive sleep apnea: A randomized controlled trial

Wang

Rowsell

et al. 2019

Journal of Sleep Research

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Opioid‐related deaths from respiratory depression are increasing but there is only limited information on the effect of morphine on breathing during sleep. This study aimed to detect and quantify opioid‐induced cardiorespiratory pattern changes during sleep in obstructive sleep apnea (OSA) patients using novel automated methods and correlate these with conventional polysomnography (PSG) measures. Under a randomized double‐blind placebo‐controlled crossover design, 60 male OSA patients attended two one‐night visits to the sleep laboratory, at least a week apart. Either a 40‐mg controlled‐release oral morphine dose or placebo was administered. Breathing during sleep was measured by standard in‐laboratory PSG. We analysed the inter‐breath interval (IBI) from the PSG flow channel to quantify breathing irregularity. Cardiopulmonary coupling (CPC) was analysed using the PSG electrocardiogram (ECG) channel. Following the consumption of morphine, the 60 OSA patients had fewer breaths (p = .0006), a longer inter‐breath interval (p < .0001) and more irregular breathing with increased IBI coefficient of variation (CV) (p = .0015) compared to the placebo night. A higher CPC sleep quality index was found with morphine use. The change of key IBI and CPC parameters was significantly correlated with the change of key PSG sleep‐disordered breathing parameters. In conclusion, 40 mg controlled‐release morphine resulted in a longer breathing cycle and increased breathing irregularity but generally more stable sleep in OSA patients. The significant links between the IBI and CPC techniques and a range of PSG sleep‐disordered breathing parameters may suggest a practical value as surrogate overnight cardiorespiratory measurements, because both respiratory flow and ECG can be detected by small portable devices.

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Chronic Opioid Use is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing

Abstract: Disclosure StatementThis is not an industry supported study. Drs. Walker, Farney, Rhondeau, Cloward, Shilling, Ms. Boyle and Ms. Valentine have indicated no financial conflicts of interest.

Cited by 370 publications

References 23 publications

Obstructive sleep apnea in the irradiated head and neck cancer patient

Obstructive sleep apnea in the irradiated head and neck cancer patient

A Practice Guide for Continuous Opioid Therapy for Refractory Daily Headache: Patient Selection, Physician Requirements, and Treatment Monitoring

The effect of acute exposure to morphine on breathing variability and cardiopulmonary coupling in men with obstructive sleep apnea: A randomized controlled trial

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