Yamada C, Rossi G, Sedky K, Pradhan B. Examining the Relationship Between Sleep-Disordered Breathing and Opioid Intake: Systematic Review and Meta-Analysis. In: New Jersey Psychiatric Association; March 21 2020; Princeton, NJ.
Background:
Opioids have become a mainstay in treating patients with pain and opioid use disorder. In 2015, an estimated 1 in 3 adults were using prescription opioids in the U.S. The increase in opioid use resulted in an increase in opioid-related morbidity and mortality. In 2016 and 2017, prescription opioids accounted for more than 17,000 overdoses deaths. The side effects of opioid medications are diverse. These side effects include constipation, nausea, dizziness, sedation, physical dependence, respiratory depression, and sleep-disordered breathing. Sleep-disordered breathing (SDB) has become a topic of concern as it has been linked to increased daytime sleepiness, increased rates of vehicular accidents, and hyperalgesia. Several reports have suggested there is an increased risk of SDB, particularly obstructive sleep apnea (OSA) and central sleep apnea (CSA), in patients taking opioids. This meta-analysis explores the relationship between opioids and SDB, where we hypothesized that opioid use would have particular effects on sleep apnea parameters, particularly an increase in the number of SDB events, both OSA and CSA, in all types of opioid users.
Methods:
Data regarding opioid usage and its relationship to SDB was obtained from previous studies up to 2019. Studies were found through scientific journal search engines such as PubMed, Ovid, and Google Scholar. To avoid selection bias, studies that included sleep data from various types of opioid users – healthy individuals, chronic opioid users for pain, methadone maintenance patients, and current subjects undergoing detoxification or withdrawal – were included. From these studies, certain variables were analyzed: subject demographic data, sleep parameter measures, number apneic events, and O2 desaturation percentages. These variables and their potential relationships were analyzed using Comprehensive Meta-analysis Software to find sleep apnea parameters among the different types of opioid users.
Results:
Increased apneic events, both OSA and CSA, were seen from the analysis. Prevalence of OSA in this analysis ranged from 8% to 39%, compared to the central apneas ranging from 14% to 100%. This increased SDB prevalence was found in both non-regular opioid users (one-time use) as well as chronic opioid users. On average, the time subjects spent in rapid eye movement (REM) and slow-wave sleep stages decreased, while non-REM stage 1 and 2 increased.
Conclusion:
This study supports the relationship between opioid use and SDB, with some studies suggesting a dose-dependent relationship to the apneic events. There is an established association between opioid use and interrupted sleeping patterns. In addition to compromise of sleep, SDB can lead to hyperalgesia in pain-managed patients resulting in increased opioid dosages. Thus, screening and early treatment of patients with SDB who are also using opioids may help reduce opioid-related mortality. While the results of this meta-analysis supported our initial hypothesis, certain limitations of the study should be noted. Specifically, the number of scientific articles used in the meta-analysis were limited due to an inability to gather sufficient data from certain studies. These studies were eliminated from data analysis if the data was unobtainable after attempting to contact the original authors. Also, the number of studies that looked specifically at SDB is limited. While more research is needed to better delineate this relationship, this meta-analysis suggests a need for regular monitoring of individuals prescribed opioid medications using polysomnography to detect and treat SDB.
Christopher Yamada, OMSIII-OMSIV, Rowan School of Osteopathic Medicine