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Opioid-associated central sleep apnea: a case series

Opioid-associated central sleep apnea: a case series

  1. Anonymous
    Sleep Breath (2009) 13:201–206
    M. A. Alattar & S. M. Scharf

    Introduction Subjects on methadone maintenance for drug
    addiction have been reported to have central sleep apnea
    (CSA). However, there are few reports of disordered
    breathing in patients receiving opioids for chronic pain.
    Materials and methods We report on six patients (ages 41–
    68, two females, body mass index 27–34, morphine
    equivalent doses 120–420 mg/day, Epworth Scales 7–21)
    referred to our sleep center receiving sustained release
    opioids for more than 6 months with excessive daytime
    sleepiness. CSA was defined as apnea–hypopnea index
    (AHI) more than 5 per hour with ≥50% central events.
    Bilevel (BLV) titration was done to determine settings and
    all patients were followed for at least 6 months on nocturnal
    BLV. AHI ranged 28.4–106 per hour. Time less than 90%
    O2 saturation ranged 1.8 min to 6.4 h. Four of the patients
    were treated with chronic BLV ventilation with settings
    ranging 12–16 cm H2O (inspiratory positive airway
    pressure)/4–8 cm H2O (expiratory positive airway pressure)
    with backup rate of 12–16. Among the four patients who
    used BLV treatment for at least 6 months, Epworth scores
    improved (by 4, 12, 5, and 9, respectively).
    Conclusion Treatment of opioid-associated CSA with BLV
    corrected nocturnal hypoxemia and reduced sleep fragmentation.
    Randomized controlled trials, with objective measures of
    daytime function, are recommended in opioid-induced CSA
    patients.