Sleep disordered breathing in patients receiving therapy with buprenorphine/naloxone

Abstract

Patients using chronic opioids are at risk for exceptionally complex and potentially lethal disorders of breathing during sleep, including central and obstructive apnoeas, hypopnoeas, ataxic breathing and nonapnoeic hypoxaemia. Buprenorphine, a partial m-opioid agonist with limited respiratory toxicity, is widely used for the treatment of opioid dependency and chronic nonmalignant pain. However, its potential for causing sleep disordered breathing has not been studied.70 consecutive patients admitted for therapy with buprenorphine/naloxone were routinely evaluated with sleep medicine consultation and attended polysomnography.The majority of patients were young (mean¡SD age 31.8¡12.3 years), nonobese (mean¡SD body mass index 24.9¡5.9 kg?m -2 ) and female (60%). Based upon the apnoea/hypopnoea index (AHI), at least mild sleep disordered breathing (AHI o5 events?h -1 ) was present in 63% of the group. Moderate (AHI o15-,30 events?h -1 ) and severe (AHI o30 events?h -1 ) sleep apnoea was present in 16% and 17%, respectively. Hypoxaemia, defined as an arterial oxygen saturation measured by pulse oximetry, of ,90% for o10% of sleep time, was present in 27 (38.6%) patients.Despite the putative protective ceiling effect regarding ventilatory suppression observed during wakefulness, buprenorphine may induce significant alterations of breathing during sleep at routine therapeutic doses. @ERSpublications Buprenorphine at routine therapeutic doses may induce significant alterations of breathing during sleep

Respiratory Variability during Sleep in Methadone Maintenance Treatment Patients

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A 27-Year-Old Female on Chronic Opioid Therapy

“…[2][3][4][5][6][7][8][9] One study found that 75% of patients on chronic opioid therapy had an AHI ≥ 5 events per hour and 36% had severe sleep apnea (AHI ≥ 30 events/h). 4 Another study found that 70% of patients on chronic opioid therapy had evidence of ataxic breathing.…”