A new review of studies has documented high rates of sleep-disordered breathing in patients who use opioids.

Frances Chung, MBBS, and her co-authors found that the overall prevalence of central sleep apnea (CSA) was 24% among people using opioids chronically. The overall rate of sleep-disordered breathing (SDB) was as high as 85%, and morphine-equivalent daily doses of 200 mg per day or higher were associated with a 92% rate of ataxic periodic breathing.

“Pain physicians and family doctors need to be more aware of the potential for serious adverse respiratory effects of opioid therapy for chronic pain, specifically during sleep,” Dr Chung, president of the Society of Anesthesia and Sleep Medicine, and professor, Department of Anesthesiology, University of Toronto, Toronto Western Hospital and the University Health Network, told Pain Medicine News. “When opioids are prescribed in large doses for chronic pain, it may precipitate central apnea, obstructive apnea or ataxic periodic breathing.”

Peter Gay, MD, a consultant and professor of medicine in the Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, in Rochester, Minn, said the paper was helpful. He was not involved in the review.

“The paper by Dr. Chung’s group has done a nice job reviewing the current literature with respect to chronic opioid use and its effect on respiration, most importantly the central apnea component,” said Dr Gay. “Body mass index was noted to be inversely related to the severity of sleep-disordered breathing. [But] not surprisingly, little could be said about the issues surrounding perioperative considerations … but there is just very little written in this regard.”

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