The past two decades has seen a substantial rise in the use of opioids for chronic pain, along with opioid-related mortality and adverse effects. A contributor to opioid-associated mortality is the high prevalence of moderate/severe sleep-disordered breathing, including central sleep apnea and obstructive sleep apnea, in patients with chronic pain. Although evidence-based treatments are available for sleep-disordered breathing, patients are not frequently assessed for sleep-disordered breathing in pain clinics. To aid healthcare providers in this area of clinical uncertainty, we present evidence on the interaction between opioids and sleep-disordered breathing, and the prevalence and predictive factors for sleep-disordered breathing in patients on opioids for chronic pain. We provide recommendations on how to evaluate patients on opioids for risk of moderate/severe sleep-disordered breathing in clinical care, which could lead to earlier use of therapeutic interventions for opioid-associated sleep-disordered breathing, such as opioid cessation or positive airway pressure therapy. This would improve quality of life and well-being of patients with chronic pain.
- chronic pain
- analgesics, opioid
- drug-related side effects and adverse reactions
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Contributors JS, PWHP, and FC discussed potential contents for the manuscript. JS wrote the manuscript. PWHP, JW, CMR, and FC helped write the manuscript.
Funding This study was funded by University Health Network Foundation; Department of Anesthesia and Pain Medicine, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Competing interests JW reports grants from the Ontario Ministry of Health and Long-Term Care, Anesthesia Patient Safety Foundation, and University of Toronto Merit Research Award. FC reports research support from the Ontario Ministry of Health and Long-Term Care, University Health Network Foundation, and UpToDate royalties. STOP-Bang questionnaire: proprietary to University Health Network.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.