Features  |   July 2017
Opioids and Sleep-Disordered Breathing
Article Information
Central and Peripheral Nervous Systems / Pain Medicine / Pharmacology / Respiratory System / Sleep Medicine / Features
Features   |   July 2017
Opioids and Sleep-Disordered Breathing
ASA Monitor 07 2017, Vol.81, 24-26.
ASA Monitor 07 2017, Vol.81, 24-26.
Large, retrospective clinical cohorts suggest that preoperative diagnosis of obstructive sleep apnea (OSA) is associated with more than a two-fold increase in the risk for respiratory complications in the immediate postoperative period (i.e., the first 12 hours after surgery).1 -6  The contribution of OSA to the causal nature of these complications remains unclear; however, an increased vulnerability of OSA patients to anesthesia- and opioid-induced ventilatory compromise has been proposed as a likely mechanism.7,8 
This hypothesis is supported by experimental and clinical evidence suggesting that chronic intermittent hypoxia, a hallmark phenotype of OSA, may enhance the sensitivity to the analgesic and respiratory-depressant effects of opioids.9 -15  Furthermore, retrospective analyses of life-threatening opioid-related respiratory events in the context of postoperative analgesia have shown that obesity, somnolence and OSA diagnosis were common among afflicted patients.6,7,16,17  Although hypoxemia due to opioid use in the immediate and short-term postoperative period is common and persistent,18 -20  the incidence of life-threatening opioid-induced respiratory depression (OIRD) is very low,21  suggesting that if OSA, a common and highly heterogeneous condition,22 -24  is a risk factor for OIRD, then certain OSA patients might be at relatively greater risk than others for this potentially lethal complication.
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