Obstructive sleep apnea, pain, and opioids

Lam, K K; Kunder, Samuel; Wong, Jean; Doufas, Anthony G.; Chung, Frances

doi:10.1097/aco.0000000000000265

Cited by 125 publications

(72 citation statements)

References 79 publications

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“…Be aware of increased sensitivity to the effects of opioids in patients with obstructive sleep apnea (OSA) and markedly increased risk of opioid‐induced ventilatory impairment (OIVI) in the postoperative period . It is recommended that opioids should be avoided in the postoperative period in this population if possible or if needed, minimize opioid dosage (25%‐50% of usual dosage), and titrate dose to effect with enhanced postoperative monitoring and longer hospital stay …”

Section: Recommendationsmentioning

confidence: 99%

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Vittinghoff

Lönnqvist

Mossetti

et al. 2018

Pediatric Anesthesia

117

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The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice.

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Section: Recommendationsmentioning

confidence: 99%

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Vittinghoff

Lönnqvist

Mossetti

et al. 2018

Pediatric Anesthesia

117

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“…46 The opioid-induced reduced respiratory drive to hypoxia and hypercapnia could decrease the neural output to upper airway dilating muscles resulting in upper airway collapsibility. In addition, opioids may impair the arousal mechanisms that occur in response to hypoxia in the perioperative period.…”

Section: Endotypes and Phenotypes Of Osamentioning

confidence: 99%

“…46 Regional anesthesia, by an opioid-sparing effect, decreases airway collapsibility and respiratory depression and is beneficial in these patients. 121 These patients may require prolonged continuous postoperative monitoring with high-resolution pulse oximetry 44 and capnography.…”

Section: Osa In Surgical Patientsmentioning

confidence: 99%

Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

Subramani¹,

Singh²,

Wong

et al. 2017

Anesthesia &Amp; Analgesia

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124

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Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing with potential long-term major neurocognitive and cardiovascular sequelae. The pathophysiology of OSA varies between individuals and is composed of different underlying mechanisms. Several components including the upper airway anatomy, effectiveness of the upper airway dilator muscles such as the genioglossus, arousal threshold of the individual, and inherent stability of the respiratory control system determine the pathogenesis of OSA. Their recognition may have implications for the perioperative health care team. For example, OSA patients with a high arousal threshold are likely to be sensitive to sedatives and narcotics with a higher risk of respiratory arrest in the perioperative period. Supplemental oxygen therapy can help to stabilize breathing in OSA patients with inherent respiratory instability. Avoidance of supine position can minimize airway obstruction in patients with a predisposition to upper airway collapse in this posture. In this review, the clinically relevant endotypes and phenotypes of OSA are described. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for most patients with OSA but tolerance and adherence can be a problem. Patient-centered individualized approaches to OSA management will be the focus of future research into developing potential treatment options that will help decrease the disease burden and improve treatment effectiveness.

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“…The interaction of OSA, sleep fragmentation, pain, and opioids requirement is an area that requires more research [43]. There is preliminary evidence that shows support for perioperative continuous positive airway pressure for patients with OSA [44 ▪▪ ,45 ▪▪ ].…”

Section: Challenges In Use Of Stop-bangmentioning

confidence: 99%

An update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine

Nagappa

Wong

Singh

et al. 2017

Current Opinion in Anaesthesiology

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Purpose of reviewThe present review aims to provide an update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine.Recent findingsThe STOP-Bang questionnaire was originally validated as a screening tool to identify surgical patients who are at high-risk of obstructive sleep apnea (OSA). A recent meta-analysis confirmed that STOP-Bang is validated for use in the sleep clinic, surgical, and general population. Patients with a STOP-Bang score of 0--2 can be classified as low-risk for moderate-to-severe OSA. Those with a score of 5--8 can be classified as high-risk for moderate-to-severe OSA. In patients with a score of 3 or 4, a specific combination of a STOP score at least 2 + BMI more than 35 kg/m2 or STOP score at least 2 + male or STOP score at least 2 + neck circumference more than 40 cm indicates higher risk for moderate-to-severe OSA. Further, patients with a STOP-Bang score at least 3 can be classified as high risk for moderate-to-severe OSA if the serum HCO3- at least 28 mmol/l. STOP-Bang can be used as a novel tool for perioperative risk stratification because it easily identifies patients who are at increased risk of perioperative complications.SummarySTOP-Bang at least 3 was recommended previously to identify the suspected or undiagnosed OSA. To reduce the false positive cases and to improve its specificity, a stepwise stratification is recommended to identify the patients at high risk of moderate-to-severe OSA. Because of its practical application, STOP-Bang is a useful screening tool for patients with suspected or undiagnosed OSA.

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Obstructive sleep apnea, pain, and opioids

Cited by 125 publications

References 79 publications

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

An update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine

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