Impact of Opioid Therapy on Sleep and Respiratory Patterns in Adults With Advanced Cancer Receiving Palliative Care

Abstract

Context. In advanced cancer, abnormal sleep patterns may contribute to poor quality of life, but the impact of opioidrelated sleep disorders has not been explored in detail in these patients. Objective. To document sleep and respiratory patterns in patients with cancer, receiving a range of opioids, determine factors that contribute to severity of central or obstructive apnea, and to what extent these contribute to sleep disturbance. Methods. Adults with advanced cancer admitted to a palliative care service underwent a sleep analysis by an unattended polysomnography. Total sleep time, apnea hypopnea index, central apnea index, obstructive apnea hypopnea index, arousal index, and oxygen desaturation were measured. Baseline assessment included body habitus, Mallampati score, comorbidity indices, concomitant medications, and the Berlin questionnaire. Epworth Sleepiness Scale, Stanford Sleepiness Scale, and Wu cancer fatigue scales were documented. Results. Twenty-eight patients were studied, including 25 receiving opioids. In the latter group, the apnea hypopnea index was mildly abnormal in six patients and severely abnormal in 10 patients. Central apnea index and obstructive apnea hypopnea index were abnormal in nine and 17 patients, respectively. There was no significant correlation between opioid dose and polysomnographic results. Conclusion. In patients with advanced cancer receiving opioid analgesia, there was a high prevalence of respiratory disturbance, both central and obstructive, and deranged sleep patterns. Addressing sleep-disordered breathing in cancer patients has the potential to improve daytime drowsiness and quality of life.

Comparison of Sleep Quality before and after Chemotherapy in Locally Advanced Nonsmall Cell Lung Cancer Patients: A Prospective Study

“…Our methodology was to exclude patients with great pain levels, patients with poor general health, and patients on specific treatment interacting with sleep quality. That allowed us to select a coherent cohort of patients to evaluate the quality of life and its correlation with sleep quality independently from the influence of pain or general health [5]. Questionnaires are a validated tool to assess global health or symptom severity [12,13].…”

“…Chemotherapy is proposed in stage IV of the disease if there are no contraindications. Its impact on the general status, quality of life, and sleep quality is scarcely reported [4][5][6]. These interactions between burdensome therapeutic protocols and quality of life or sleep were reported in other cancer types [7][8][9].…”

Less Well-Known Consequences of the Long-Term Use of Opioid Analgesics: A Comprehensive Literature Review

“… 17 , 146 , 148 Significant sleep disturbances were also demonstrated in an observational investigation in patients with advanced cancer (84%). 147 Sleep apnea may contribute to arrhythmias, myocardial infarction, stroke and increased mortality. 17 , 26 , 146 , 150–152 …”

“…Opioid use may induce sleep-disordered breathing (SDB), mostly of the central type, because of the influence of opioids on breathing rhythm and control of ventilation. 17,18,[146][147][148][149] Opioids can also trigger or exacerbate obstructive sleep apnea in predisposed individuals by causing relaxation of pharyngeal tone and increasing the collapsibility of the airways. 17,146,147 Studies included in two systematic reviews demonstrated high prevalence of SDB and central sleep apnea (CSA) in patients using opioids for chronic pain, ranging from 75% to 91%, and 18% to 33%, respectively.…”

“…17,18,[146][147][148][149] Opioids can also trigger or exacerbate obstructive sleep apnea in predisposed individuals by causing relaxation of pharyngeal tone and increasing the collapsibility of the airways. 17,146,147 Studies included in two systematic reviews demonstrated high prevalence of SDB and central sleep apnea (CSA) in patients using opioids for chronic pain, ranging from 75% to 91%, and 18% to 33%, respectively. 18,146 The risk of CSA was demonstrated to be higher in patients with lower body mass, when the dose of oral opioid ≥200 MEDD and opioids were combined with benzodiazepines or other CNS depressant agents.…”