Opioid Therapy and Sleep Apnea
Summary by Ariana Selby, PA-C, MPH
Opioid therapy for chronic non-cancer pain continues to be prevalent despite known opioid related risks. One risk of opioid use is respiratory ataxia, particularly central sleep apnea. Untreated sleep disordered breathing (SBD) is associated with health problems such as obesity, cardiovascular, metabolic and neurocognitive diseases. Yet, American guidelines for the safe use of opioids do not clarify the relationship between SDB and opioid therapy.
A recent systematic review and meta-analysis was performed to assess the influence of long term opioid use on the apnea-hypopnea index and central apnea indices (AHI and CAI, respectively). In this study, principal investigators reviewed major bibliographic databases, including Medline and Cochrane Database, finding seven studies meeting inclusion criteria. A total of 803 patients with existing OSA were compared with respect to two outcomes: AHI (320 opioid users and 483 non-users) and 790 patients with CAI (315 opioid users and 475 non-users), finding an interesting variation in AHI and CAI in opioid users and non-users. Opioid use was shown to have a significant but small increase in apnea measured by AHI and a medium increase for CAI.
As a result of this analysis, researchers have concluded that long term opioid use in patients with OSA may aggravate sleep disordered breathing by increasing central sleep apnea. However, it remains unclear what degree of risk is observed in opioid users without OSA. Both central and obstructive sleep apnea is correlated with higher risk of morbidity and mortality due to cardiac arrhythmia, myocardial ischemia/ infarction, and stroke. Treatment guidelines have not been clearly established; however, research suggests the use of a breathing device such as positive airway pressure is probably safer. These findings are of important clinical relevance as the prevalence of opioid induced sleep apnea is growing rapidly. Clinicians should continue to carefully weigh the risks and benefits of chronic opioid treatment in patients with SDB.
Marie-Lou Filiatrault, RDN, MSc, et al. Medium Increased Risk for Central Sleep Apnea but not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis. Journal of Clinical Sleep Medicine, Vol. 12, No.4, 2016.
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