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Review
. 2022 Feb 1;18(2):647-652.
doi: 10.5664/jcsm.9730.

Opioids and obstructive sleep apnea

Carla Freire  1   2 , Luiz U Sennes  2 , Vsevolod Y Polotsky  1
Affiliations
Review

Opioids and obstructive sleep apnea

Carla Freire et al. J Clin Sleep Med. .

Abstract

Opioids are widely prescribed for pain management, and it is estimated that 40% of adults in the United States use prescription opioids every year. Opioid misuse leads to high mortality, with respiratory depression as the main cause of death. Animal and human studies indicate that opioid use may lead to sleep-disordered breathing. Opioids affect control of breathing and impair upper airway function, causing central apneas, upper airway obstruction, and hypoxemia during sleep. The presence of obstructive sleep apnea (OSA) increases the risk of opioid-induced respiratory depression. However, even if the relationship between opioids and central sleep apnea is firmly established, the question of whether opioids can aggravate OSA remains unanswered. While several reports have shown a high prevalence of OSA and nocturnal hypoxemia in patients receiving a high dose of opioids, other studies did not find a correlation between opioid use and obstructive events. These differences can be attributed to considerable interindividual variability, divergent effects of opioids on different phenotypic traits of OSA, and wide-ranging methodology. This review will discuss mechanistic insights into the effects of opioids on the upper airway and hypoglossal motor activity and the association of opioid use and obstructive sleep apnea.

Citation: Freire C, Sennes LU, Polotsky VY. Opioids and obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):647-652.

Keywords: hypoglossal nerve; obstructive sleep apnea; opioids; respiratory physiology.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was supported by the US National Institutes of Health (grants: R01HL 128970, R01HL 138932, R61 HL156240, U18 DA052301) and the São Paulo Research Foundation (FAPESP; grant 2018/08758-3). C.F. and V.Y.P. have a patent pending (Leptin Prevents Opiate-induced Respiratory Depression). L.U.S. report no conflicts of interest.

Figures

Figure 1
Figure 1. Putative mechanisms by which opioids affect activity of the hypoglossal motoneurons.
REM = rapid eye movement, XIIN = hypoglossal nucleus.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. The Drug Overdose Epidemic . Behind the Numbers. Published March 19, 2020. . https://www.cdc.gov/drugoverdose/data/index.html . Accessed October 23, 2021.
    1. Han B , Compton WM , Blanco C , Crane E , Lee J , Jones CM . Prescription opioid use, misuse, and use disorders in U.S. adults: 2015 National Survey on Drug Use and Health . Ann Intern Med. 2017. ; 167 ( 5 ): 293 – 301 . - PubMed
    1. Ahmad F , Rossen L , Sutton P . Provisional Drug Overdose Death Counts. National Center for Health Statistics. Published online 2020. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
    1. Lin L , Brummett CM , Waljee JF , et al. . Association of opioid overdose risk factors and naloxone prescribing in US adults . J Gen Intern Med. 2020. ; 35 : 420 – 427 . - PMC - PubMed
    1. Gupta K , Nagappa M , Prasad A , et al. . Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses . BMJ Open. 2018. ; 8 ( 12 ): e024086 . - PMC - PubMed

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