TY - JOUR
T1 - Looking both ways before crossing the street
T2 - Assessing the benefits and risk of opioids in treating patients at risk of sleep disordered breathing for pain and dyspnea
AU - Davis, Mellar P.
AU - Behm, Bertrand
AU - Balachandran, Diwakar
N1 - Publisher Copyright:
© 2017 Journal of Opioid Management, All Rights Reserved.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Opioids adversely influence respiration in five distinct ways. Opioids reduce the respiratory rate, tidal volume, amplitude, reflex responses to hypercapnia and hypoxia, and arousability related necessary for respiratory adaptive responses. Opioids cause impairment of upper pharyngeal dilator muscles leading to obstructive apnea. Opioids cause complex sleep disordered breathing (SDB) consisting of central sleep apnea and obstructive sleep apnea. Clinically opioids worsen preexisting SDB. Recent studies have shown increased morbidity and mortality in patients receiving opioids for chronic noncancer pain and chronic obstructive pulmonary disease, which appear to be related to cardiovascular events, not overdose. Both patient populations are at risk for sleep disordered breathing and increased risk for adverse cardiovascular events on opioids for dyspnea or pain. This review discusses the influence of opioids on respiration and SDB and will review the adverse respiratory and cardiovascular effects of opioid use in at risk populations. Recommendations regarding management will follow as a summary.
AB - Opioids adversely influence respiration in five distinct ways. Opioids reduce the respiratory rate, tidal volume, amplitude, reflex responses to hypercapnia and hypoxia, and arousability related necessary for respiratory adaptive responses. Opioids cause impairment of upper pharyngeal dilator muscles leading to obstructive apnea. Opioids cause complex sleep disordered breathing (SDB) consisting of central sleep apnea and obstructive sleep apnea. Clinically opioids worsen preexisting SDB. Recent studies have shown increased morbidity and mortality in patients receiving opioids for chronic noncancer pain and chronic obstructive pulmonary disease, which appear to be related to cardiovascular events, not overdose. Both patient populations are at risk for sleep disordered breathing and increased risk for adverse cardiovascular events on opioids for dyspnea or pain. This review discusses the influence of opioids on respiration and SDB and will review the adverse respiratory and cardiovascular effects of opioid use in at risk populations. Recommendations regarding management will follow as a summary.
KW - Apnea
KW - Central sleep apnea
KW - Obstructive sleep apnea
KW - Opioid
KW - Sleep
KW - Sleep disordered breathing
UR - http://www.scopus.com/inward/record.url?scp=85026315654&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85026315654&partnerID=8YFLogxK
U2 - 10.5055/jom.2017.0385
DO - 10.5055/jom.2017.0385
M3 - Review article
C2 - 28829519
AN - SCOPUS:85026315654
SN - 1551-7489
VL - 13
SP - 183
EP - 196
JO - Journal of Opioid Management
JF - Journal of Opioid Management
IS - 3
ER -