Prevalence of sleep-disordered breathing in opioid users with chronic pain: a systematic review and meta-analysis

Abstract

Study Objectives: Opioids have been reported to increase the risk for sleep-disordered breathing (SDB) in patients with noncancer chronic pain on opioid therapy. This study aims to determine the pooled prevalence of SDB in opioid users with chronic pain and compare it with patients with pain:no opioids and no pain:no opioids. Methods: A literature search of PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials was conducted. We included all observational studies that reported the prevalence of SDB in patients with chronic pain on long-term opioid therapy (≥3 months). The primary outcome was the pooled prevalence of SDB in opioid users with chronic pain (pain:opioids group) and a comparison with pain:no opioids and no pain:no opioids groups. The meta-analysis was performed using a random-effects model. Results: After screening 1,404 studies, 9 studies with 3,791 patients were included in the meta-analysis (pain:opioids group, n = 3181 [84%]; pain:no opioids group, n = 359 [9.4%]; no pain:no opioids group, n = 251 [6.6%]). The pooled prevalence of SDB in the pain:opioids, pain:no opioids, and no pain:no opioids groups were 91%, 83%, and 72% in sleep clinics and 63%, 10%, and 75% in pain clinics, respectively. Furthermore, in the pain: opioids group, central sleep apnea prevalence in sleep and pain clinics was 33% and 20%, respectively. Conclusions: The pooled prevalence of SDB in patients with chronic pain on opioid therapy is not significantly different compared with pain:no opioids and no pain:no opioids groups and varies considerably depending on the site of patient recruitment (ie, sleep vs pain clinics). The prevalence of central sleep apnea is high in sleep and pain clinics in the pain:opioids group. Clinical Trial Registration: Registry: PROSPERO: International prospective register of systematic reviews; Name: Prevalence of sleep disordered breathing, hypoxemia and hypercapnia in patients on oral opioid therapy for chronic pain management; URL: https://www.crd.york.ac.uk/prospero/display_record.php?

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

“… 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. 17 , 146 , 148 Significant sleep disturbances were also demonstrated in an observational investigation in patients with advanced cancer (84%).…”

“…Opioids have significant effects on the endocrine, immune, cardiovascular, respiratory, gastrointestinal and neural systems. [10][11][12][13][14][15][16][17][18][19][20] They increase the risk of fractures, infections, cardiovascular complications (including myocardial infarction), sleep disturbances and sleep-disordered breathing, bowel dysfunction, overdose and mortality due to opioid overdose or other causes. [15][16][17][18][21][22][23][24][25][26][27] Opioids may potentially affect cancer development.…”

Might chronic opioid use impact sleep-disordered breathing and vice versa?

“…1. Although the study of Mubashir et al 11 13 whereas plant gain (efficiency of CO 2 excretion) may be increased. 14 Patients with chronic pain may be sedentary, contributing to increased body weight, and opioids seem to have vasodilatory properties that could contribute to fluid accumulation and rostral shifts.…”

“…In this issue of the Journal of Clinical Sleep Medicine, Mubashir et al 11 report the results of a systematic review and meta-analysis of the prevalence of SDB among those using opioids for chronic pain. Their findings were based on 9 studies, in which they found an estimated prevalence of SDB of 91% among opioid users in sleep clinics and 63% in pain clinics, although the overall prevalence of SDB did not differ from those not using opioids.…”

No Zero Sum in Opioids for Chronic Pain: Neurostimulation and the Goal of Opioid Sparing, Not Opioid Eradication

“…[24][25][26][27][28] Additionally, systematic reviews point to issues of tolerability, 29 and adverse effects including, but not limited to, constipation, 30 cognitive dysfunction, 31 endocrinopathy, 32 mood disturbance, 33 and sleep apnea. 34 Although some studies have attempted to demonstrate a causative relationship between opioid use and substance use disorders in chronic pain patients, variance in definitions and a prevalence of methodologically flawed studies based upon investigator bias make such a conclusion tenuous.…”