Medium Increased Risk for Central Sleep Apnea but Not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis

Filiatrault, Marie-Lou; Chauny, Jean‐Marc; Daoust, Raoul; Roy, Marie-Pier; Denis, Ronald; Lavigne, Gilles

doi:10.5664/jcsm.5704

Cited by 35 publications

(20 citation statements)

References 41 publications

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“…We believe this is the first report of the negative effects of an anticonvulsant drug on respiratory parameters during sleep. The effect sizes for the primary outcomes were greater than those observed in a trial for flurazepam and a meta‐analysis for opioids (Dolly and Block, ; Filiatrault et al ., ). A smaller effect size was also found in a previous study investigating the effects of antipsychotics on AHI (Rishi et al ., ).…”

Section: Discussionmentioning

confidence: 97%

Gabapentin acutely increases the apnea–hypopnea index in older men: data from a randomized, double‐blind, placebo‐controlled study

Piovezan

Kase

Moizinho

et al. 2017

Journal of Sleep Research

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Although drugs with sedative properties may increase the risk of airway collapse during sleep, their acute effects on the apnea-hypopnea index in older adults are under-reported. We investigated the acute effects of gabapentin (GABA) on sleep breathing in older men without sleep apnea. A double-blind, randomized, placebo-controlled cross-over pilot study using a bedtime dose of gabapentin 300 mg was conducted in eight non-obese older men. Polysomnography measured the effects of the intervention. The apnea-hypopnea index was higher in the gabapentin arm than in the placebo arm (22.4 ± 6.1 versus 12.2 ± 4.3, P ≤ 0.05, d: 0.67), as was the oxygen desaturation index (20.6 ± 5.8 versus 10.8 ± 3.9, P ≤ 0.05, d: 0.68). The number needed to harm was four. A subset analysis demonstrated that differences in sleep respiratory parameters were present only during non-rapid eye movement sleep, as well as only in the supine position. No adverse events were reported. Hence, gabapentin worsened sleep breathing acutely compared with placebo. Long-term clinical trials are warranted to elucidate the clinical relevance of these findings for the safety profile of GABAergic agents.

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Section: Discussionmentioning

confidence: 97%

Gabapentin acutely increases the apnea–hypopnea index in older men: data from a randomized, double‐blind, placebo‐controlled study

Piovezan

Kase

Moizinho

et al. 2017

Journal of Sleep Research

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“…SDB associated with long-term opioid therapy in adults without cancer has also been widely reported 11,13 although the precise nature of such disorders has not been clearly defined. A recent systematic review 31 suggested that opioids were associated with a moderately increased risk of central, but not obstructive, apnea. In contrast, a study in adults receiving methadone observed obstructive apnea to be the dominant abnormality.…”

Section: Discussionmentioning

confidence: 99%

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

Good

Pinkerton²,

Bowler

et al. 2018

Journal of Pain and Symptom Management

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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.

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“…[11][12][13] There is moderate to strong evidence that opioids, in either acute or chronic cases, can affect both sleep breathing and sleep quality. 3,[14][15][16][17][18][19] However, although the risk of opioids for sleepdisordered breathing is recognized, so far we have failed to identify exactly who is at risk. A 2015 review concludes that CSA is present in 24% of opioid users.…”

Section: Opioid Use and Comedicationsmentioning

confidence: 99%

Thoughts on the 2019 American Academy of Sleep Medicine position statement on chronic opioid therapy and sleep

Lavigne

Babiloni

Mayer

et al. 2020

Journal of Clinical Sleep Medicine

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Medium Increased Risk for Central Sleep Apnea but Not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis

Abstract: The meta-analysis results suggest that long-term opioid use in OSA patients has a medium effect on central sleep apnea.

Cited by 35 publications

References 41 publications

Gabapentin acutely increases the apnea–hypopnea index in older men: data from a randomized, double‐blind, placebo‐controlled study

Gabapentin acutely increases the apnea–hypopnea index in older men: data from a randomized, double‐blind, placebo‐controlled study

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

Thoughts on the 2019 American Academy of Sleep Medicine position statement on chronic opioid therapy and sleep

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