Obstructive sleep apnea is more common than central sleep apnea in methadone maintenance patients with subjective sleep complaints

Abstract

Objectives: Opioid-dependent patients treated with methadone have subjective sleep complaints and disrupted sleep on polysomnography (PSG). Previous studies of sleep-disordered breathing (SDB) in this population have focused on central sleep apnea (CSA). Our objectives were to: (1) characterize obstructive sleep apnea (OSA) and CSA in patients in methadone maintenance treatment (MMT) for opioid dependence; (2) examine factors associated with SDB in this population; and (3) investigate whether SDB was related to severity of subjective sleep complaints in MMT patients with subjective sleep disturbances.

Methods: We analyzed OSA and CSA from one night of home PSG in 71 patients who were in MMT for at least 3 months and had a Pittsburgh Sleep Quality Inventory (PSQI) score >5.

Results: OSA (defined as obstructive apnea-hypopnea index (OAHI) > or = 5) was observed in 35.2% of our sample. OSA was associated with higher body mass index, longer duration in MMT, and non-Caucasian race. CSA (defined as central apnea index (CAI) > or = 5) was observed in 14.1% of the sample. CSA was not associated with methadone dose or concomitant drug use. Subjective sleep disturbance measured with the PSQI was not related to OSA or CSA.

Conclusions: SDB was common in this sample of MMT patients and OSA was more common than CSA. Given the lack of association between presence of SDB and severity of subjective sleep difficulties, factors other than sleep apnea must account for complaints of disturbed sleep in this population.

Figure 1. Participant Outcomes

Figure 2. Distribution of Apnea by Severity

Percentage of MMT patients with no sleep-disordered breathing (SDB; OAHI < 5 and CAI < 5) or mild (5 ≤ OAHI < 15 or 5 ≤ CAI < 15), moderate (15 ≤ OAHI < 30 or 15 ≤ CAI < 30), or severe (OAHI ≥ 30 or CAI ≥ 30) sleep apnea. N=71.