Opioids and obstructive sleep apnea.

Abstract

Opioids are widely prescribed for pain management and it is estimated that 40% of adults in the US use prescription opioids every year. Opioid misuse leads to high mortality with respiratory depression as the main cause of death. Animal and human studies indicate that opioid use may lead to sleep disordered breathing. Opioids affect control of breathing and impair upper airway function causing central apneas, upper airway obstruction and hypoxemia during sleep. The presence of obstructive sleep apnea (OSA) increases the risk of opioid-induced respiratory depression. However, if relationships between opioids and central sleep apnea are firmly established, a question if opioids can aggravate OSA remains unanswered. While several reports have shown a high prevalence of OSA and nocturnal hypoxemia in patients receiving a high dose of opioids, other studies did not find correlation between opioid use and obstructive events. These differences can be attributed to considerable inter-individual variability, divergent effects of opioids on different phenotypic traits of OSA and wide-ranging methodology. This review will discuss mechanistic insights in the effects of opioids on the upper airway and hypoglossal motor activity and the association of opioid use and obstructive sleep apnea.