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Are opioids associated with sleep apnea? A review of the evidence

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Abstract

Chronic opioid use for nonmalignant pain has increased dramatically; nonillicit unintentional deaths have also increased. This article reviews the physiology of breathing, effects of sleep on respiration, effects of opioids on respiration, potential interactions between sleep and opioids on respiration, and current evidence that chronic opioid use is associated with sleep-disordered breathing.

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References and Recommended Reading

  1. ARCOS, US Department of Justice, Drug Enforcement Administration, Office of Diversion Control: Retail Drug Summary. Available at http://www.deadiversion.usdoj.gov/arcos/retail_drug_summary. Accessed October 2008.

  2. Moore TJ, Cohen MR, Furberg CD: Serious adverse drug events reported to the Food and Drug Administration, 1998–2005. Arch Intern Med 2007, 167:1752–1759.

    Article  PubMed  Google Scholar 

  3. Joranson DE, Gilson AM: Drug crime is a source of abused pain medication in the United States. J Pain Symptom Manage 2005, 30:299–301.

    Article  PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention (CDC): Increase in poisoning deaths caused by non-illicit drugs: Utah, 1991–2003. MMWR Morb Mortal Wkly Rep 2005, 54:33–36.

    Google Scholar 

  5. Young T, Peppard PE, Gottlieb DJ: Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002, 165:1217–1239.

    Article  PubMed  Google Scholar 

  6. Strohl KP, Redline S: Recognition of obstructive sleep apnea. Am J Respir Crit Care Med 1996, 154:279–289.

    PubMed  CAS  Google Scholar 

  7. Strohl KP, Saunders NA, Sullivan CE: Sleep apnea syndromes. In: Sleep and Breathing. Edited by Saunders NA, Sullivan CE. New York: Marcel Dekker, Inc.; 1984:365–402.

    Google Scholar 

  8. Young T, Evans L, Finn L, et al.: Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997, 20:705–706.

    PubMed  CAS  Google Scholar 

  9. Farney RJ, Walker JM, Cloward TV, et al.: Sleep-disordered breathing associated with long-term opioid therapy. Chest 2003, 123:632–639.

    Article  PubMed  Google Scholar 

  10. Rennotte MT, Baele P, Aubert G, et al.: Nasal continuous positive airway pressure in the management of patients with obstructive sleep apnea submitted to surgery. Chest 1995, 107:367–374.

    Article  PubMed  CAS  Google Scholar 

  11. Teichtahl H, Promdiomidis A, Miller B, et al.: Sleep-disordered breathing in stable methadone programme patients: a pilot program. Addiction 2001, 96:395–403.

    Article  PubMed  CAS  Google Scholar 

  12. Walker JM, Farney RJ, Rhondeau SM, et al.: Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing. J Clin Sleep Med 2007, 3:455–462.

    PubMed  Google Scholar 

  13. Wang D, Teichtahl H, Drummer O, et al.: Central sleep apnea in stable methadone maintenance treatment patients. Chest 2005, 128:1348–1356.

    Article  PubMed  Google Scholar 

  14. Webster LR, Youngmi C, Himanshu D, et al.: Sleep-disordered breathing and chronic opioid therapy. Pain Med 2008, 9:425–432.

    Article  PubMed  Google Scholar 

  15. Meoli AL, Rosen CL, Kristo D, et al.; Clinical Practice Review Committee, American Academy of Sleep Medicine: Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period-avoiding complications. Sleep 2003, 26:1060–1065.

    PubMed  Google Scholar 

  16. Caruana-Montaldo B, Gleeson K, Zwillich CW: The control of breathing in clinical practice. Chest 2000, 117:205–225.

    Article  PubMed  CAS  Google Scholar 

  17. Dempsey JA, Smith CA, Harms CA, et al.: Sleep-induced breathing instability. Sleep 1996, 236–247.

  18. Krimsky WR, Leiter JC: Physiology of breathing and respiratory control during sleep. In: Seminars in Respiratory and Critical Care Medicine. Edited by Lynch JP III. New York: Theime Medical Publishers; 2005:5–12.

    Google Scholar 

  19. Phillipson EA: Control of breathing during sleep. Am Rev Respir Dis 1978, 118:909–939.

    PubMed  CAS  Google Scholar 

  20. Sullivan CE: Breathing in sleep. In: Physiology in Sleep. Edited by Orem J, Barnes CD. New York: Academic Press; 1980:214–272.

    Google Scholar 

  21. Pattinson KTS: Opioids and the control of respiration. Br J Anaesth 2008, 100:747–758.

    Article  PubMed  CAS  Google Scholar 

  22. Santiago TV, Edelman NH: Opioids and breathing. J Appl Physiol 1985, 59:1675–1685.

    PubMed  CAS  Google Scholar 

  23. Shook JE, Watkins WD, Camporesi EM: Differential roles of opioid receptors in respiration, respiratory disease, and opiate-induced respiratory depression. Am Rev Respir Dis 1990, 142:895–909.

    PubMed  CAS  Google Scholar 

  24. Feldman JL, Mitchell GS, Nattie EE: Breathing: rhythmicity, plasticity, chemosensitivity. Annu Rev Neurosci 2003, 26:239–266.

    Article  PubMed  CAS  Google Scholar 

  25. Nattie E: Multiple sites for central chemoreception: their roles in response sensitivity and in sleep and wakefulness. Respir Physiol 2000, 122:223–225.

    Article  PubMed  CAS  Google Scholar 

  26. Takakura AC, Moreira TS, Colombari E, et al.: Peripheral chemoreceptor inputs to retrotrapezoid nucleus (RTN) CO2-sensitive neurons in rats. J Physiol 2006, 572:503–523.

    Article  PubMed  CAS  Google Scholar 

  27. Li A, Zhou S, Nattie E: Simultaneous inhibition of caudal medullary raphe and retrotrapezoid nucleus decreases breathing and the CO2 response in conscious rats. J Physiol 2006, 307–318.

  28. Gonzalez C, Dinger BG, Fidone SJ: Mechanisms of carotid body chemoreception. In: Regulation of Breathing. Edited by Dempsey JA, Pack AI. New York: Marcel Dekker, Inc.; 1995:391–471.

    Google Scholar 

  29. Sullivan CE, Issa FG, Berthon-Jones M, et al.: Pathophysiology of sleep apnea. In: Sleep and Breathing. Edited by Saunders NA, Sullivan CE. New York: Marcel Dekker, Inc.; 1984:299–363.

    Google Scholar 

  30. Janczewski WA, Feldman JL: Distinct rhythm generators for inspiration and expiration in the juvenile rat. J Physiol 2006, 570:407–420.

    PubMed  CAS  Google Scholar 

  31. Lalley PM: Opioidergic and dopaminergic modulation of respiration. Respir Physiol Neurobiol 2008 Mar 10 (Epub ahead of print).

  32. Rekling JC, Feldman JL: PreBötzinger complex and pacemaker neurons: hypothesized site and kernel for respiratory rhythm generation. Annu Rev Physiol 1998, 60:385–405.

    Article  PubMed  CAS  Google Scholar 

  33. Smith JC, Ellenberger HH, Ballanyi K, et al.: PreBötzinger complex: a brainstem region that may generate respiratory rhythm in mammals. Science 1991, 254:726–729.

    Article  PubMed  CAS  Google Scholar 

  34. McKay LC, Janczewski WA, Feldman JL: Sleep-disordered breathing after targeted ablation of preBötzinger complex neurons. Nature Neurosci 2005, 8:1142–1144.

    Article  PubMed  CAS  Google Scholar 

  35. McKay LC, Feldman JL: Unilateral ablation of pre-Bötzinger complex disrupts breathing during sleep but not wakefulness. Am J Respir Crit Care Med 2008, 178:89–95.

    Article  PubMed  Google Scholar 

  36. Leino K, Mildh L, Lertola K, et al.: Time course of changes in breathing pattern in morphine- and oxycodone-induced respiratory depression. Anaesthesia 1999, 54:835–840.

    Article  PubMed  CAS  Google Scholar 

  37. Barnes BJ, Tuong CM, Mellen MN: Functional imaging reveals respiratory network activity during hypoxic and opioid challenge in the neonate rat tilted sagittal slap preparation. J Neurophysiol 2007, 97:2283–2292.

    Article  PubMed  Google Scholar 

  38. Badr MS: Central sleep apnea. Prim Care 2005, 32:361–374.

    PubMed  Google Scholar 

  39. Eckert DJ, Jordan AS, Merchia P, et al.: Central sleep apnea: pathophysiology and treatment. Chest 2007, 131:595–607.

    Article  PubMed  Google Scholar 

  40. Flemons WW, Buysee D, Redline S, et al.: Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999, 22:667–689.

    Google Scholar 

  41. White DP: Central sleep apnea. In: Principles and Practice of Sleep Medicine. Edited by Kryer MH, Roth T, Dement WC. Philadelphia: Elsevier Saunders; 2005:969–982.

    Google Scholar 

  42. Bowes G, Phillipson EA: Arousal responses to respiratory stimuli during sleep. In: Sleep and Breathing. Edited by Saunders NA, Sullivan CE. New York: Marcel Dekker; 1984:137–161.

    Google Scholar 

  43. Mellen MN, Janczewski WA, Bocchiaro CM: Opioid-induced quantal slowing reveals dual networks for respiratory rhythm generation. Neuron 2003, 37:821–826.

    Article  PubMed  CAS  Google Scholar 

  44. Mogri M, Khan MIA, Grant BJB, et al.: Central sleep apnea induced by acute ingestion of opioids. Chest 2008, 133:1484–1488.

    Article  PubMed  Google Scholar 

  45. Mogri M, Desai H, Webster L, et al.: Hypoxemia in patients on chronic opiate therapy with and without sleep apnea. Sleep Breath 2008 Aug 6 (Epub ahead of print).

  46. Lu B, Budhiraja R, Parthasarathy S: Sedating medications and undiagnosed obstructive sleep apnea: physician determinants and patient consequences. J Clin Sleep Med 2005, 1:367–371.

    PubMed  Google Scholar 

  47. Biot MC: Contribution a l’ètude de phènomène respiratoire de Cheyne-Stokes. Lyon Mèd 1876, 23:517–528.

    Google Scholar 

  48. Farney RJ, Walker JM, Boyle KM, et al.: Adaptive servoventilation (ASV) in patients with sleep disordered breathing associated with chronic opioid medications for non-malignant pain. J Clin Sleep Med 2008, 4:311–319.

    PubMed  Google Scholar 

  49. Bouillon T, Bruhn J, Roepcke H, et al.: Opioid-induced respiratory depression is associated with increased tidal volume variability. Eur J Anaesthesiol 2003, 20:127–133.

    Article  PubMed  CAS  Google Scholar 

  50. Barbour SJ, Vandebeek CA, Ansermino JM: Increased tidal volume variability in children is a better marker of opioid induced respiratory depression than decreased respiratory rate. J Clin Monit Comput 2004, 18:171–178.

    Article  PubMed  Google Scholar 

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Correspondence to James M. Walker.

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Walker, J.M., Farney, R.J. Are opioids associated with sleep apnea? A review of the evidence. Current Science Inc 13, 120–126 (2009). https://doi.org/10.1007/s11916-009-0021-1

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