Cited by 419Obstructive Sleep Apnea ResearchNeuroscience of respiration and sleepOpioid Use Disorder Treatment

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Chronic Opioid Use is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing

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Walker, James M., Farney, Robert J., Rhondeau, Steven M., Boyle, Kathleen M, Valentine, Karen, Cloward, Tom V., Shilling, Kevin C.·2007·Journal of Clinical Sleep Medicine

DOI 10.5664/jcsm.26908PMC PMC1978331

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Abstract

Background Chronic opioid therapy for pain management has increased dramatically without adequate study of potential deleterious effects on breathing during sleep.Methods A retrospective cohort study comparing 60 patients taking chronic opioids matched for age, sex, and body mass index with 60 patients not taking opioids was conducted to determine the effect of morphine dose equivalent on breathing patterns during sleep.Results The apnea-hypopnea index was greater in the opioid group (43.5/h vs 30.2/h, p < .05) due to increased central apneas (12.8/h vs 2.1/h; p < .001). Arterial oxygen saturation (SpO2) in the opioid group was significantly lower during both wakefulness (difference 2.1%, p < .001) and non-rapid eye movement (NREM) sleep (difference 2.2%, p < .001) but not during rapid eye movement (REM) sleep (difference 1.2%) than in the nonopioid group. Within the opioid group, and after controlling for body mass index, age, and sex, there was a dose-response relationship between morphine dose equivalent and apnea-hypopnea (p < .001), obstructive apnea (p < .001), hypopnea (p < .001), and central apnea indexes (p < .001). Body mass index was inversely related to apnea-hypopnea index severity in the opioid group. Ataxic or irregular breathing during NREM sleep was also more prevalent in patients who chronically used opioids (70% vs 5.0%, p < .001) and more frequent (92%) at a morphine dose equivalent of 200 mg or higher (odds ratio = 15.4, p = .017).Conclusions There is a dose-dependent relationship between chronic opioid use and the development of a peculiar pattern of respiration consisting of central sleep apneas and ataxic breathing. Although potentially significant, the clinical relevance of these observations remains to be established.

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Authors: Walker, J. M., Farney, R. J., Rhondeau, S. M., Boyle, K. M., Valentine, K., Cloward, T. V., & Shilling, K. C.
Affiliations: Intermountain Healthcare (US)
Corresponding author: Walker, James M.
Venue: Journal of Clinical Sleep Medicine
Publisher: Springer Science and Business Media LLC
Published: 2007-08-15
Volume: 3
Issue: 5
Pages: 455-461
ISSN: 1550-9389 (ISSN-L)
1550-9397
DOI: 10.5664/jcsm.26908
PMC: PMC1978331
OpenAlex: W159756581
Cited by: 419
References: 35
Citations by year: 2026: 7 · 2025: 18 · 2024: 17 · 2023: 14 · 2022: 15 · 2021: 23 · 2020: 25 · 2019: 18 · 2018: 19 · 2017: 25 · 2016: 33 · 2015: 37 · 2014: 34 · 2013: 20 · 2012: 27
FWCI: 13.36
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Journal of Clinical Sleep Medicine (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords: chronic opioid use, central sleep apnea, apnea-hypopnea index, arterial oxygen saturation, body mass index, obstructive apnea, hypopnea, sleep-disordered breathing, opioid side effects
MeSH terms: Adult, Analgesics, Opioid, Dose-Response Relationship, Drug, Female, Humans, Male, Middle Aged, Pain, Respiration, Retrospective Studies, Severity of Illness Index, Cohort Studies, Body Mass Index, Polysomnography, Sleep Apnea, Obstructive, Sleep Apnea, Central

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Chronic Opioid Use is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing

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