2009
DOI: 10.1097/aln.0b013e31819c480a View full text |Buy / Rent full text
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Abstract: Intermittent hypoxia, a powerful and unique stimulus, leads to physiologic changes that are distinct from those associated with either single or continuous hypoxic exposure. There is an accumulating body of evidence that the neurocognitive, inflammatory and cardiovascular symptoms that characterize the syndrome of obstructive sleep apnea are linked to the stimulus of intermittent hypoxia. In addition, altered sensitivities to opiates in children with obstructive sleep apnea have been linked to recurrent hypoxi… Show more

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“…Furthermore, both children suffering from OSA [63] and rats treated during development with chronic intermittent hypoxia [64] were more sensitive to the respiratory depressant effect of fentanyl. Although the mechanism for this effect of recurrent hypoxia on pain and analgesia systems is vague, in vivo evidence suggests that an up-regulation of μ-opioid receptors might be responsible for the observed increase in the potency of opioids [65][67].…”
Section: Discussionmentioning
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“…Furthermore, both children suffering from OSA [63] and rats treated during development with chronic intermittent hypoxia [64] were more sensitive to the respiratory depressant effect of fentanyl. Although the mechanism for this effect of recurrent hypoxia on pain and analgesia systems is vague, in vivo evidence suggests that an up-regulation of μ-opioid receptors might be responsible for the observed increase in the potency of opioids [65][67].…”
Section: Discussionmentioning
“…Arousal threshold changes were not observed in OSA patients exposed to only a hypoxic environment (3,(5)(6)(7)(8)11,18,25). Measures of SDB severity, including nocturnal oxygen desaturation (1,2,(6)(7)(8)11,15,16,18,24) and RDI (7,11,26,27), have been shown to predict postoperative respiratory complications. Therefore, nocturnal hypercapnia and hypoxia, when combined with an immature and/or dysfunctional respiratory center, may suggest blunted upper airway and ventilatory responses and predispose the patient to respiratory compromise in the postoperative setting.…”
Section: Discussionmentioning
“…More specifically, in children having adenotonsillectomy, the morphine requirement for postoperative analgesia was inversely related to the amount of preoperative nocturnal arterial desaturation [ 4 , 26 ]. Although Brown et al, [ 4 , 26 ] used nocturnal continuous oximetry monitoring rather than polysomnography, their findings were supported by independent experiments showing that intermittent hypoxia up-regulates μ-opioid receptors in developing rats [ 27 , 28 ] and may thus be responsible for increased sensitivity to the analgesic and respiratory effects of opioids [ 29 31 ]. Consistent with these findings, we have also shown that nocturnal hypoxemia (expressed by minimum nocturnal SaO 2 in polysomnography) in adults suffering from OSA, is associated with an increased analgesic sensitivity to short-acting opioids [ 5 ].…”
Section: Discussionmentioning