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Date: Sep 21 2007

Sleep apnea often seen with chronic opioid use
Sleep apnea often seen with chronic opioid use
by Anthony J. Brown, MD


NEW YORK (Reuters Health) - Sleep-disordered breathing is very common in patients who use opioids for chronic pain conditions, according to a report issued online September 6th by the journal Pain Medicine.

"Sleep disturbances are common in people with chronic pain, but relatively little research has been performed to investigate the effects of long-term opioid therapy on sleep," lead author Dr. Lynn R. Webster, from Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah, told Reuters Health.

For their study, Dr. Webster and colleagues offered polysomnographic testing to 392 consecutive patients who were visiting a private clinic for control of chronic pain. The subjects had been receiving around-the-clock opioids for 6 months or longer with no change in the dose for at least 4 weeks.

Of the 147 patients who agreed to undergo testing, 140 had data available for analysis, the report indicates.

The median daily dosage of all opioids was 266 mg of morphine equivalents, and "in the 36% of patients taking benzodiazepines, the median daily dosage in diazepam equivalents was 15 mg," the team reports.

"The biggest finding was an extraordinarily high prevalence of sleep-disordered breathing in opioid-treated chronic pain patients," Dr. Webster noted. "Obstructive and central sleep apnea syndromes occurred in the studied population at a far greater rate (75%) than is observed in the general population."

The most common type of sleep apnea, seen in 39% of all patients, was the obstructive type, followed by central sleep apnea in 24%, central and obstructive sleep apnea in 8%, and indeterminate type in 4%.

The apnea-hypopnea index was directly related to the daily dosage of methadone, but not to that of other opioids (p = 0.002). The central apnea index was directly linked to the daily dosage of both methadone (p = 0.008) and benzodiazepines (p = 0.004).

"Tolerance to the respiratory effects of opioids is often assumed to be complete in patients on long-term opioid therapy. This research adds to a growing body of literature suggesting this may not be true for all patients," Dr. Webster pointed out.

She said that further studies are needed to clarify how various opioids influence the risk of sleep apnea and why methadone, in particular, may have a greater effect.
Meanwhile, Dr. Webster and colleagues conclude: "The challenge is to monitor and adjust medications for maximum safety, not to eliminate them at the expense of pain management."

Pain Medicine 2007.

Copyright Reuters 2007.