Sleep-Disordered Breathing Associated With Long-term Opioid Therapy*

Farney, Robert J.; Walker, James M.; Cloward, Tom V.; Rhondeau, Steven

doi:10.1378/chest.123.2.632

Cited by 195 publications

(99 citation statements)

References 17 publications

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“…It has been reported that in MMT patients, the number of central sleep apneas, apnea duration, and severity of hypoxia are higher during NREM than REM sleep. [8][9][10] Consistent with this, in the current study, we found that the mean duration of IBI in MMT patients was higher in NREM compared to REM. The significant higher AHI in methadone patients compared to healthy subjects has also been suggested to be primarily due to central sleep apneas occurring during NREM sleep.…”

Section: Relationship Between Respiratory Variability and Apnea Indicessupporting

confidence: 87%

“…Opioids also predispose patients with chronic usage to the development of ataxic breathing or Biot's respiration. 9,10 This is distinct from Cheyne-Stokes respiration and periodic breathing with central sleep apnea. 12 Ataxic breathing is characterized by irregular respiratory rate, rhythm, and depth with or without brief respiratory pauses less than 10 seconds, or a repeating pattern of several breaths.…”

Section: Introductionmentioning

confidence: 99%

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Respiratory Variability during Sleep in Methadone Maintenance Treatment Patients

Nguyen

Kim

Grunstein

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Methadone maintenance treatment (MMT) patients have a high prevalence of central sleep apnea and ataxic breathing related to damage to central respiratory rhythm control. However, the quantification of sleep apnea indices requires laborious manual scoring, and ataxic breathing pattern is subjectively judged by visual pattern recognition. This study proposes a semi-automated technique to characterize respiratory variability in MMT patients. Methods: Polysomnography, blood, and functional outcomes of sleep questionnaire (FOSQ) from 50 MMT patients and 20 healthy subjects with matched age, sex, and body mass index, were analyzed. Inter-breath intervals (IBI) were extracted from the nasal cannula pressure signal. Variability of IBI over 100 breaths was quantified by standard deviation (SD), coefficient of variation (CV), and scaling exponent (α) from detrended fluctuation analysis. The relationships between these variability measures and blood methadone concentration, central sleep apnea index (CAI), apnea-hypopnea index (AHI), and clinical outcome (FOSQ), were then examined. Results: MMT patients had significantly higher SD and CV during all sleep stages. During NREM sleep, SD and CV were correlated with blood methadone concentration (Spearman R = 0.52 and 0.56, respectively; p < 0.01). SD and CV were also correlated with CAI (R = 0.63 and 0.71, p < 0.001, respectively), and AHI (R = 0.45 and 0.58, p < 0.01, respectively). Only α showed significant correlation with FOSQ (R = −0.33, p < 0.05). Conclusions: MMT patients have a higher respiratory variability during sleep than healthy controls. Semi-automated variability measures are related to apnea indices obtained by manual scoring and may provide a new approach to quantify opioid-related sleep-disordered breathing.

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Section: Relationship Between Respiratory Variability and Apnea Indicessupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Respiratory Variability during Sleep in Methadone Maintenance Treatment Patients

Nguyen

Kim

Grunstein

et al. 2016

Journal of Clinical Sleep Medicine

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“…9 It was suggested that respiratory depression induced by opioids is a shortlived phenomenon and is experienced predominantly by opioid-naïve patients. Since then, a number of studies 7,8,[10][11][12] have demonstrated that 30-90% of patients on chronic opioid therapy have evidence of sleep apnoea with a pattern of severity in a dose-dependent manner. 7 Opioid use is associated not only with CSA but also with ataxic breathing.…”

Section: Discussionmentioning

confidence: 99%

Chronic opioid use: a risk factor for central sleep apnoea and successful therapy with adaptive pressure support servo-ventilation

Fahim

Johnson²

2012

J R Coll Physicians Edinb

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Sleep apnoea is a global health problem with significant morbidity. Obesity is a well-known risk factor for this condition, however chronic intake of opioids as a risk factor for central sleep apnoea is under-recognised. We report a case of a 47-year-old man who developed significant sleep-disordered breathing secondary to opioid use for chronic pain. A sleep study demonstrated a picture of complex sleep apnoea with a prominent central sleep apnoea component. He had no significant improvement with conventional continuous positive airway pressure therapy. However, adaptive servo-ventilation had a dramatic effect on his symptoms and compliance. This case highlights the significant risk of central sleep apnoea with opioid use and illustrates the importance of adaptive servo-ventilation in the management of sleep-disordered breathing secondary to impaired central respiratory drive.

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“…[1][2][3][4][5][6] Meanwhile, in the last decade, there has been a major change in the management of chronic pain with a marked increase in the therapeutic use of opioids. [7][8][9] Therefore, with widespread use of opioids for pain management, a large number of patients could suffer from sleep apnea.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…[1][2][3][4][5][6] In one study of 140 patients in a pain clinic, in which patients were enrolled independent of risk factors for sleep apnea, 36% had an AHI ≥ 30/h. 5 However, in our study, virtually all suffered from severe sleep apnea (average AHI = 64/h and 18 of 20 had AHI ≥ 30/h).…”

Section: Asv For Opioidsmentioning

confidence: 99%

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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Sleep-Disordered Breathing Associated With Long-term Opioid Therapy*

Cited by 195 publications

References 17 publications

Respiratory Variability during Sleep in Methadone Maintenance Treatment Patients

Respiratory Variability during Sleep in Methadone Maintenance Treatment Patients

Chronic opioid use: a risk factor for central sleep apnoea and successful therapy with adaptive pressure support servo-ventilation

Adaptive Servoventilation for Treatment of Opioid-Associated Central Sleep Apnea

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