Opioids Cause Central and Complex Sleep Apnea in Humans and Reversal With Discontinuation: A Plea for Detoxification

Abstract

Central sleep apnea (CSA) and continuous positive airway pressure (CPAP) emergent CSA are common in patients for whom opioids have been prescribed for chronic pain management. It is not known if opioids are the potential cause of CSA. We report the case of a patient who underwent multiple full nights of polysomnography testing while on opioids, off opioids, and with various positive airway pressure devices. While on opioids, the patient had severe CSA that persisted during both CPAP and bilevel titration but was eliminated with adaptive servoventilation therapy. Some time later, opioid use was discontinued by the patient. Repeat polysomnography showed resolution of the sleep-disordered breathing. Later-while the patient was still off opioids-she had gained weight and become symptomatic; polysomnography showed obstructive sleep apnea without CSA. This time, therapy with CPAP showed elimination of sleep apnea without emergent CSA. These data collectively indicate that opioids were the cause of CSA as well as emergent CSA.

Keywords: adaptive servoventilation; central sleep apnea.

Figure 1. Five-minute epoch from May 2006.

Please note that with central apnea, airflow, as measured by thermocouple, from the rib cage, abdominal, and the sum excursions are all flat. ABDO = abdomen respiratory inductance plethysmography, FLOW = thermocouple, CHEST = rib cage respiratory inductance plethysmography, Chin = chin electromyogram, ECG = central electroencephalogram, LEOG = left electro-oculogram, LEMG = leg electromyogram, REOG = right electro-oculogram, SaO₂ = arterial oxyhemoglobin saturation, Sum = sum of the CHEST and ABDO. The amplitude of the signals are not proportional.

Figure 2. Five-minute epoch from February 2007 on CPAP of 8 cm H₂O.

Please note that with central apnea, airflow monitored by the pneumotach, from the rib cage, abdominal, and the sum excursions are all flat. ABDO = abdomen respiratory inductance plethysmography, CFLOW = pneumotach, CHEST = rib cage respiratory inductance plethysmography, Chin = chin electromyogram, ECG = central electroencephalogram, LEOG = left electro-oculogram, LEMG = leg electromyogram, REOG = right electro-oculogram, SaO₂ = arterial oxyhemoglobin saturation, Sum = sum of the CHEST and ABDO. The amplitude of the signals are not proportional.