PURPOSE: To study the effects of long term opioids on breathing patterns in sleep. There have been few studies showing the effect of opioids on respiration during sleep. Teichtahl et. al. (Addiction 2001, 96:, 395-403) reported that stable methadone maintenance patients (MMP) had a higher prevelance of central sleep apnea(CSA). Wang et. al. ( CHEST 2005 Sep;128(3):1348-56) showed that 30% of stable MMP patients had CSA, a minority of which could be explained by blood methadone concentration; further research was recommended.
METHODS: Four patient on cnronic narcotics with symptoms suggestive of sleep apnea, evaluated with a diagnostic Polysomnogram (PSG).
RESULTS: Patient A: 38 year old man, on Oxycodone 30 mg daily for chronic low back pain. Polysomnogram (PSG )showed severe sleep apnea with an apnea-hypopnea index (AHI) of 112.6 per hour including obstructive, mixed and central apneas. Patient B: 44 year old woman abusing Methadone and had a PSG study that showed predominantly CSA with an AHI of 20.2/hour. Short cycle central sleep apneas were seen, worse in supine sleep, and worse towards the end of the night in NREM sleep. The patient had no history of heart disease and a negative cardiac workup.Patient C: 42 year old man with history of traumatic brain injury, on Methadone 200 mg/day for a history of i.v drug abuse, since 2001. His PSG showed mixed obstructive and primarily central sleep apnea, severe in REM (AHI of 49.4 /hour during REM). Patient D: 68 year old woman on Oxycontin 260 mg/day and Roxycodone 45 mg/day for chronic radicular pain. Her PSG showed central sleep apneas (AHI 109/hr). At times, the breathing resembled an ataxic ( Biot’s ) breathing.
CONCLUSION: Patients on long term opioids should be periodically assessed for sleep disordered breathing through serial PSGs in order to avoid long-term serious consequences.
CLINICAL IMPLICATIONS: The clinical consequences of opioids induced CSA are unknown in distinction from CSA due to other reasons, Therefore further studies and serial follow up PSG are recommended.
DISCLOSURE: Peter Polos, No Financial Disclosure Information; No Product/Research Disclosure Information