Background There is an increased risk of sleep apnea in patients using opioids for chronic pain. We hypothesized that a simple model comprizing of: (1) STOP-Bang questionnaire and resting daytime oxyhemoglobin saturation (SpO2); and (2) overnight oximetry will identify those at risk of moderate-to-severe sleep apnea in patients with chronic pain.
Method Adults on opioids for chronic pain were recruited from pain clinics. Participants completed the STOP-Bang questionnaire, resting daytime SpO2, and in-laboratory polysomnography. Overnight oximetry was performed at home to derive the Oxygen Desaturation Index. A STOP-Bang score ≥3 or resting daytime SpO2 ≤95% were used as thresholds for the first step, and for those identified at risk, overnight oximetry was used for further screening. The Oxygen Desaturation Index from overnight oximetry was validated against the Apnea-Hypopnea Index (≥15 events/hour) from polysomnography.
Results Of 199 participants (52.5±12.8 years, 58% women), 159 (79.9%) had a STOP-Bang score ≥3 or resting SpO2 ≤95% and entered the second step (overnight oximetry). Using an Oxygen Desaturation Index ≥5 events/hour, the model had a sensitivity of 86.4% and specificity of 52% for identifying moderate-to-severe sleep apnea. The number of participants who would require diagnostic sleep studies was decreased by 38% from Step 1 to Step 2 of the model.
Conclusion A simple model using STOP-Bang questionnaire and resting daytime SpO2, followed by overnight oximetry, can identify those at high risk of moderate-to-severe sleep apnea in patients using opioids for chronic pain.
Trial registration number NCT02513836.
- chronic pain
- diagnostic techniques and procedures
Data availability statement
Data are available upon reasonable request.
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Contributors JS, RW, and FC contributed substantially to the study concept, design, analysis, or interpretation of data for the manuscript. JW, CMR, and FC obtained funding and acquisition of data. JS and FC contributed substantially to the drafting of the manuscript. JS, RW, PP, JW, CMR, and FC contributed to the critical revision of the manuscript for important intellectual content and final approval of the version to be published. FC had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding Funded by Ontario Ministry of Health and Long-Term Care Innovation Fund; Department of Anesthesia and Pain Medicine, University Health Network-Mount Sinai Hospital, University of Toronto; and University Health Network Foundation.
Competing interests JS, RW, PP, and CMR did not report conflicts of interest. JW reports grants from the Ontario Ministry of Health and Long-Term Care, Merck Inc, and University of Toronto Merit Research Award. FC reports grants 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.
Provenance and peer review Not commissioned; externally peer reviewed.