The effect of acute morphine on obstructive sleep apnoea: a randomised double-blind placebo-controlled crossover trial

Rowsell, Luke; Wong, Keith; Yee, Brendon J.; Eckert, Danny J.; Somogyi, Andrew A.; Duffin, James; Grunstein, Ronald R.; Wang, David

doi:10.1136/thoraxjnl-2018-211675

Cited by 30 publications

(63 citation statements)

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“…There was a 10% increase in percentage of sleep time spent below 95% oxygen saturation (T95%) with morphine intake ( p = .003), suggesting mild respiratory depression. In addition, there was a mild but statistically significant worsening in mean SpO 2 nadir (87.2 ± 5.7 vs. 86 ± 5.7%, p = .036) and mean PtcCO 2 (43.7 ± 4.1 vs. 45.9 ± 4.1 mmHg, p < .001) (Rowsell et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…The sixty patients had an average age of 44.4 ( SD 11.7) years and BMI of 29.3 ( SD 3.9) kg/m 2 . Key PSG changes postmorphine have been described elsewhere (Rowsell et al, ). In general, 40 mg of controlled‐release morphine did not change key respiratory outcomes in AHI (placebo vs. morphine: 19.1 ± 17.7 vs. 20.7 ± 19.1/hr, p = .36), T90% (1.2 ± 3.1 vs. 1.6 ± 4.6%, p = .46) and ODI (14.3 ± 16 vs. 15.6 ± 15.6/hr, p = .36).…”

Section: Resultsmentioning

confidence: 99%

“…All patients provided written consent. The main study of the project that investigated the effect of morphine on OSA and ventilatory control was published elsewhere (Rowsell et al, ).…”

Section: Methodsmentioning

confidence: 99%

“…Sixty‐eight mild to severe OSA men were recruited, with ages between 18 and 65 years, BMI ≤ 40kg/m 2 , awake SpO 2 > 90%, overnight PSG SpO 2 nadir ≥ 60% and apnea–hypopnea index (AHI) ≥5. They were not shift workers and did not have any other significant sleep disorders such as periodic leg movement syndrome (PLMS), nor any severe medical and/or psychiatric diseases other than OSA (Rowsell et al, ).…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, this study aimed to detect and quantify relatively subtle opioid-induced cardiorespiratory pattern changes during sleep in patients with OSA using IBI, CPC and CVHR, and compare these with conventional PSG measures. (Rowsell et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…All patients provided written consent. The main study of the project that investigated the effect of morphine on OSA and ventilatory control was published elsewhere (Rowsell et al, ).…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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