Mortality and Return to Work of Drug Abusers From Therapeutic Community Treatment 3 Years After Entry

Berg, John W.

doi:10.4088/pcc.v05n0404

Prim. Care Companion CNS Disord.

2003

DOI: 10.4088/pcc.v05n0404

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Mortality and Return to Work of Drug Abusers From Therapeutic Community Treatment 3 Years After Entry

John W. Berg

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Cited by 3 publications

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Reversal of Sleep‐Disordered Breathing with Opioid Withdrawal

Ramar

2009

Pain Practice

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Obstructive sleep apnea, central sleep apnea, sleep related hypoventilation, Biot's or ataxic breathing, and cluster breathing are some of the commonly described sleep disorders in patients who are on long-term opioids. Continuous positive airway pressure that is commonly used to treat obstructive sleep apnea may not be effective in treating sleep-disordered breathing in long-term opioid users, and an adaptive servoventilator (ASV) may be needed. We present a 30-year-old woman with excessive daytime sleepiness and sleep-disordered breathing for the past 4 years. Medical history was complicated by chronic osteomyelitis, periorbital abscess, and chronic facial pain requiring methadone for pain control for the last 4 years. In this case, ASV, though effective, was not tolerable due to chronic facial pain, and successful withdrawal of methadone at our pain rehabilitation center resolved the sleep-disordered breathing and improved daytime sleepiness. This is to our knowledge the first case report of resolution of sleep-disordered breathing and improvement in daytime sleepiness after withdrawal of long-term opioid use.

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Reversal of Sleep‐Disordered Breathing with Opioid Withdrawal

Ramar

2009

Pain Practice

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Adaptive Pressure Support Servoventilation: a Novel Treatment for Sleep Apnea Associated with Use of Opioids

Javaheri

Malik

Smith

et al. 2008

Journal of Clinical Sleep Medicine

111

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Rationale: Opioids have become part of contemporary treatment in the management of chronic pain. However, chronic use of opioids has been associated with high prevalence of sleep apnea which could contribute to morbidity and mortality of such patients. Objectives: The main aim of this study was to treat sleep apnea in patients on chronic opioids. Methods: Five consecutive patients who were referred for evaluation of obstructive sleep apnea underwent polysomnography followed by a second night therapy with continuous positive airway pressure (CPAP) device. Because CPAP proved ineffective, patients underwent a third night therapy with adaptive pressure support servoventilation. Main Results: The average age of the patients was 51 years. They were habitual snorers with excessive daytime sleepiness. Four suffered from chronic low back pain and one had trigeminal neuralgia. They were on opioids for 2 to 5 years before sleep apnea was diagnosed. The average apnea-hypopnea index was 70/hr. With CPAP therapy, the apnea-hypopnea index decreased to 55/hr, while the cen-tral apnea index increased from 26 to 37/hr. The patients then underwent titration with adaptive pressure support servoventilation. At final pressure, the hypopnea index was 13/hr, with central and obstructive apnea index of 0 per hour. conclusions: Opioids may cause severe sleep apnea syndrome. Acute treatment with CPAP eliminates obstructive apneas but increases central apneas. Adaptive pressure support servoventilation proves to be effective in the treatment of sleep related breathing disorders in patients on chronic opioids. Long-term studies on a large number of patients are necessary to determine if treatment of sleep apnea improves quality of life, decreases daytime sleepiness, and ultimately decreases the likelihood of unexpected death of patients on opioids.

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Adaptive Servoventilation for Treatment of Opioid-Associated Central Sleep Apnea

Javaheri

Harris

Howard

et al. 2014

Journal of Clinical Sleep Medicine

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Mortality and Return to Work of Drug Abusers From Therapeutic Community Treatment 3 Years After Entry

Cited by 3 publications

References 15 publications

Reversal of Sleep‐Disordered Breathing with Opioid Withdrawal

Reversal of Sleep‐Disordered Breathing with Opioid Withdrawal

Adaptive Pressure Support Servoventilation: a Novel Treatment for Sleep Apnea Associated with Use of Opioids

Adaptive Servoventilation for Treatment of Opioid-Associated Central Sleep Apnea

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