Effect of Opioids on Sleep and Breathing in Chronic Pain Patients

Mador, M. Jeffery; Henderson, Jennifer

doi:10.5664/jcsm.3952

Cited by 4 publications

(3 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In those studies where daily opioid dosing for pain management was present, 50–71% of patients were found to suffer from OSA and 37% of patients were found to be compliant to CPAP. [ 14 , 30 ] The data range for previous studies in regard to OSA incidence is consistent with this study in which 61.7% of participants were either diagnosed with OSA on CPAP or were at high risk for OSA (STOP-Bang ≥ 3 not completing polysomnography or not compliant with CPAP). This study was significantly higher with regards to the percentage of remaining on CPAP (65%) suggesting that diligence in repetitive diagnosis attempts and continued follow with motivational techniques may improve care in this type of patient.…”

Section: Discussionsupporting

confidence: 89%

Identiﬁcation and treatment of obstructive sleep apnea by a primary care team with a subset focus on chronic pain management

et al. 2020

View full text Add to dashboard Cite

Background Patients diagnosed with obstructive sleep apnea (OSA), who also consume prescription opioids, have a greater likelihood of morbidity and mortality. This study evaluated whether a primary care team, focused on chronic pain care management, could use a validated questionnaire (STOP-Bang) and motivational follow-up, to increase identification and treatment of OSA. Methods This study was a retrospective, dual arm, pre/post controlled study. Participants of this study included the complete chronic pain management sub group treated by this primary care team. Participants were ≥ 18 years old and prescribed daily opioids for treatment of chronic pain. All participants had a multifaceted, individualized, educational meeting that included completing a STOP-Bang questionnaire. Participants who received a score ≥ three were advised to follow up with their primary care physician. Participants were seen quarterly throughout the study. Results The primary outcome of this study was that 65% of participants with likely OSA were using CPAP for a minimum of 12 months (range of 12–25 months, 18-month average) post-intervention vs. 37% CPAP-use in the control group (12 months of observation), both groups were chronic opioid users with OSA. This was a 28% relative improvement (p = 0.0034). A secondary outcome was that 8.9% of non-prior CPAP users obtained CPAP post- intervention; a 56.7% pre-post improvement (p = 0.0064, x 2 = 10.08 with 1 degree of freedom). Also, participants who were likely to have OSA (STOP-Bang score ≥ 3 or had a positive polysomnography (AHI >5 with comorbidities)) compared to those unlikely to have OSA (STOP-Bang score <3 or had a negative polysomnography (AHI <5)) in this study were more likely to be male, have a higher BMI, have hypertension, have cardiovascular disease and/or have diabetes (all types). Conclusion Team based care management for participants taking prescription opioids, where STOP-Bang questionnaires were completed, were associated with an increase in the identification and treatment of OSA.

show abstract

Section: Discussionsupporting

confidence: 89%

Identiﬁcation and treatment of obstructive sleep apnea by a primary care team with a subset focus on chronic pain management

et al. 2020

View full text Add to dashboard Cite

show abstract

“…26 Although the mean PCO 2 was at the high end of the normal range, nine of the participants were reported to have hypercapnia (defined as PCO 2 $ 45 mg) on daytime arterial blood gas (ABG) measurement, whereas two had even more pronounced hypercapnia. 26,27 These findings are concerning given that the participants had normal lung function (measured by using spirometry) and were previously unaware of their hypercapnia. Furthermore, there is no current way of predicting who is at risk of this kind of borderline respiratory failure and at what dose of opioids.…”

Section: Opioids: Effects On Respirationmentioning

confidence: 98%

Opioids and Sleep-Disordered Breathing

Ryswyk

Antic

2016

Chest

View full text Add to dashboard Cite

“…However, the majority of prior studies in this area have been cross‐sectional. This is problematic as many patients who are prescribed morphine are taking other centrally acting medications, and their comorbid conditions may also contribute to sleep disruption . As such, there have been very few appropriately designed studies to systematically examine the effect of morphine on sleep quality, particularly at relatively low doses in steady state and in clinically relevant populations such as people with increased respiratory drive due to pain or chronic refractory breathlessness …”

Section: Introductionmentioning

confidence: 99%

Effects of low‐dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study

et al. 2015

View full text Add to dashboard Cite

Background and objective: The management of chronic refractory breathlessness is one of the indications for regular low-dose (≤30 mg/24 h) oral sustained release morphine. Morphine may disrupt sleep in some conditions and improve sleep quality in others. This study aimed to determine any signal of regular, lowdose morphine on perceived sleep disruption due to breathlessness and perceived sleep quality. Methods: This is a secondary analysis of data from 38 participants with refractory breathlessness (30 male; 33 with COPD) aged 76 ± 0.9 years who completed a double-blind, randomized, placebo-controlled, crossover study in which they received 20 mg oral sustained release morphine daily and placebo for 4 days each. Participant ratings of sleep disruption due to breathlessness and perceived sleep quality were obtained daily throughout the 8-day trial. Results: Perceived sleep disruption due to breathlessness over the 4-day period ranged between 13% and 32% of participants for placebo and 13% and 26% for morphine, decreasing by each day of the study during

show abstract

Effect of Opioids on Sleep and Breathing in Chronic Pain Patients

Cited by 4 publications

References 8 publications

Identiﬁcation and treatment of obstructive sleep apnea by a primary care team with a subset focus on chronic pain management

Identiﬁcation and treatment of obstructive sleep apnea by a primary care team with a subset focus on chronic pain management

Opioids and Sleep-Disordered Breathing

Effects of low‐dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study

Contact Info

Product

Resources

About