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Review
. 2015 Oct;16 Suppl 1(0 1):S22-6.
doi: 10.1111/pme.12910.

Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies

Martin D Cheatle  1 , Lynn R Webster  2
Affiliations
Review

Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies

Martin D Cheatle et al. Pain Med. 2015 Oct.

Abstract

Objective: Patients with chronic pain frequently experience concomitant sleep disorders. There has been controversy on whether opioids have a beneficial or deleterious effect on sleep quality, duration and efficiency. There is also concern regarding the association between chronic opioid therapy (COT) and sleep disordered breathing (SDB) and the increased risk for unintentional opioid related overdose. This article provides a narrative review of the literature on the effect of opioids on sleep disorders and discusses risk assessment and mitigation strategies.

Design: A narrative review of the current literature on the effect of prescription opioids on sleep quality and efficiency, the relationship between opioids and sleep disorders and potential risk factors in patients with chronic pain.

Results: There is conflicting evidence regarding the benefit of opioids in improving sleep quality, duration and efficiency with several studies and reviews suggesting a beneficial effect of opioids on sleep and other studies demonstrating the opioids can cause sleep disturbance leading to hyperalgesia. There was credible evidence of a strong relationship between opioids and SDB with noted risk factors including use of methadone, high opioid dosing (>200 mg MED) and combining opioids with benzodiazepines.

Conclusions: Further research is required to elucidate the effect of prescription opioids on sleep quality and pain intensity and the risks associated with opioids and SDB. The risk of SDB should be routinely assessed in patients on COT.

Keywords: Chronic Pain; Methadone; Opioid Therapy; Sleep Disordered Breathing.

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Conflict of interest statement

Conflicts of Interest: MDC has received honoraria, grant support, consultant fees and/or travel expenses from the following companies: Cordant Healthcare, Campbell Alliance, Zogenix, Nektar LRW has received honoraria, consultant fees and/or travel expenses from the following companies: AcelRx Pharmaceuticals, Acura Pharmaceuticals, AstraZeneca, BioDelivery Sciences International, Boehringer Ingelheim, Bristol Myers Squibb (BMS), Cara Therapeutics, Charleston Labs, Collegium Pharmaceuticals, CVS Caremark, Depomed, Egalet, Grunenthal USA, Inspirion Pharmaceuticals, Insys Therapeutics, Jazz Pharmaceuticals, Kaleo, Mallinckrodt, Medtronic, Nektar Therapeutics, Neura Therapeutik, Nevro Corporation, Orexo Pharmaceuticals, Pfizer, Proove Biosciences, QRx Pharma, Quintiles, Shionogi, Signature Therapeutics, TEVA, Theravance, Trevena, Zogenix.

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