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Chronic Opioid Use is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing
Open accessAbstract
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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“By contrast, opioid analgesics produce deleterious effects on sleep architecture, including reductions in slow wave sleep and promotion of sleep apnea.157, 158”
From Cannabinoids as Pharmacotherapies for Neuropathic Pain: From the Bench to the Bedside (2009) · cites this paper as [157]
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Macrea, M. M., Katz, E. S., & Malhotra, A. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00109-4 · Cited by 3
Whittington, K., Simpson, L., Clay, M., Tierney, J., & Harris, D. (2020) · PLoS ONE · doi:10.1371/journal.pone.0237359 · Cited by 3
Central Sleep Apnea Due to Drug or Substance
Farney, R. J., & Walker, J. M. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-378610-4.00318-1 · Cited by 3
Self-citationA 27-Year-Old Female on Chronic Opioid Therapy
Kapoor, M., & Herrick, D. (2015) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.4786 · Cited by 2
Central Sleep Apnea, Hypoventilation Syndrome, and Sleep in High Altitude
Selim, B. J., Somers, V. K., & Caples, S. M. (2017) · Springer eBooks · doi:10.1007/978-1-4939-6578-6_33 · Cited by 2
Guillet, C., Endomba, F. T., Aravantinos, D., Hussami, A., Beye, F., Girod, J. C., & Aho, S. (2023) · Addiction and Health · doi:10.34172/ahj.2023.1455 · Cited by 2
Metadata
- 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
- Published
- 2007-08-15
- Volume
- 3
- Issue
- 5
- Pages
- 455-461
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- 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
- 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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