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Contemporary Reviews in Sleep Medicine |

Opioids and Sleep Disordered Breathing

Emer Van Ryswyk, Dr; Nick Antic, Professor
Author and Funding Information

Conflict of interest: Dr Van Ryswyk has declared that she has no conflict of interest. Professor Antic has received research funding from the National Health and Medical Research Council of Australia, Philips Respironics™ and Fisher and Paykel™, equipment donations from ResMed™, Philips Respironics™ and SomnoMed Limited, and lecture fees and payment for development of educational presentations from ResMed™, Astra Zeneca™ and GSK™.

Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Faculty of Medicine, Nursing and Health Sciences, The Flinders University of South Australia, Postal Address: c/- Adelaide Sleep Health, SALHN, Repatriation General Hospital, C-Block, Daws Road, Daw Park, SA, 5041, Australia

Correspondence to: Professor Nick Antic, Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Faculty of Medicine, Nursing and Health Sciences, The Flinders University of South Australia, Postal Address: c/- Adelaide Sleep Health, SALHN, Repatriation General Hospital, C-Block, Daws Road, Daw Park, SA, 5041, AUSTRALIA


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.05.022
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Published online

Abstract

Opioid use for chronic pain analgesia, particularly chronic non-cancer pain (CNCP), has increased greatly since the late 1990s, resulting in an increase in opioid-associated morbidity and mortality. A clear link between opioid use and sleep disordered breathing (SDB) has been established, with the majority of chronic opioid users being affected by the condition, and dose dependent severity apparent for some opioids. More evidence is currently needed on how to effectively manage opioid-induced SDB. This review summarizes the current state of knowledge relating to management of patients on chronic opioid therapy who have SDB. Initial management of the patient on chronic opioid therapy with SDB requires thorough biopsychosocial assessment of their need for opioid therapy, consideration of reduction, or cessation of the opioid if possible and alternative therapies for treatment of their pain. If opioid therapy must be continued, then management of the associated SDB may be important. Several small-medium scale studies have examined the efficacy of non-invasive ventilation, particularly adaptive servo ventilation (ASV) for treatment of opioid-associated SDB. This is particularly because opioids predispose predominantly to central sleep apnoea (CSA), and also, to a lesser extent, to obstructive sleep apnoea (OSA). Generally, these studies have found positive results in treating opioid-associated SDB with ASV in terms of improving outcome measures such as central apnoea index and apnoea hypopnoea index. However, larger studies that measure longer term health outcomes, patient sleepiness and compliance are needed. Registries of health outcomes of ASV treated patients may assist with future treatment planning.


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