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Meta-Analysis
. 2020 Jun 15;16(6):961-969.
doi: 10.5664/jcsm.8392.

Prevalence of sleep-disordered breathing in opioid users with chronic pain: a systematic review and meta-analysis

Talha Mubashir  1 , Mahesh Nagappa  2 , Nilufar Esfahanian  1 , Joseph Botros  1 , Abdul A Arif  1 , Colin Suen  1 , Jean Wong  1   3 , Clodagh M Ryan  4 , Frances Chung  1
Affiliations
Meta-Analysis

Prevalence of sleep-disordered breathing in opioid users with chronic pain: a systematic review and meta-analysis

Talha Mubashir et al. J Clin Sleep Med. .

Abstract

Study objectives: Opioids have been reported to increase the risk for sleep-disordered breathing (SDB) in patients with noncancer chronic pain on opioid therapy. This study aims to determine the pooled prevalence of SDB in opioid users with chronic pain and compare it with patients with pain:no opioids and no pain:no opioids.

Methods: A literature search of PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials was conducted. We included all observational studies that reported the prevalence of SDB in patients with chronic pain on long-term opioid therapy (≥3 months). The primary outcome was the pooled prevalence of SDB in opioid users with chronic pain (pain:opioids group) and a comparison with pain:no opioids and no pain:no opioids groups. The meta-analysis was performed using a random-effects model.

Results: After screening 1,404 studies, 9 studies with 3,791 patients were included in the meta-analysis (pain:opioids group, n = 3181 [84%]; pain:no opioids group, n = 359 [9.4%]; no pain:no opioids group, n = 251 [6.6%]). The pooled prevalence of SDB in the pain:opioids, pain:no opioids, and no pain:no opioids groups were 91%, 83%, and 72% in sleep clinics and 63%, 10%, and 75% in pain clinics, respectively. Furthermore, in the pain: opioids group, central sleep apnea prevalence in sleep and pain clinics was 33% and 20%, respectively.

Conclusions: The pooled prevalence of SDB in patients with chronic pain on opioid therapy is not significantly different compared with pain:no opioids and no pain:no opioids groups and varies considerably depending on the site of patient recruitment (ie, sleep vs pain clinics). The prevalence of central sleep apnea is high in sleep and pain clinics in the pain:opioids group. Clinical Trial Registration: Registry: PROSPERO: International prospective register of systematic reviews; Name: Prevalence of sleep disordered breathing, hypoxemia and hypercapnia in patients on oral opioid therapy for chronic pain management; URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018103298; Identifier: CRD42018103298.

Keywords: opioids; prevalence; sleep-disordered breathing.

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Conflict of interest statement

All authors have seen and approved the manuscript. This study was supported by the University Health Network Foundation and the Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto. Financial disclosures: Talha Mubashir, none; Mahesh Nagappa, none; Nilufar Esfahanian, none; Joseph Botros, none; Abdul A. Arif, none; Colin Suen, none; Jean Wong, reports grants from the Ontario Ministry of Health and Long-Term Care, Anesthesia Patient Safety Foundation, and Acacia Pharma, outside of the submitted work; Clodagh M. Ryan, none; Frances Chung, reports research support from the Ontario Ministry of Health and Long-Term Care, University Health Network Foundation, Up-to-Date royalties, and STOP-Bang proprietary to University Health Network. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Flow diagram of included studies.
See this image and copyright information in PMC

Comment in

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