Impact of Opioid Dose and Obstructive Sleep Apnea in Chronic Opioid Patients Using STOP-Bang Questionnaire

Abstract

Background: Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. While patients on chronic opioids are at increased risk of sleep-disordered breathing, there is a lack of data on the relationship between opioid dose and OSA risk in particular. The STOP-Bang Questionnaire (SBQ) is a common screening tool for OSA, but it has not been well studied in patients on chronic opioid therapy.

Objectives: This study uses the SBQ to examine the relationship between total daily opioid dose and the risk of OSA in patients on chronic opioid therapy.

Study design: Retrospective chart review.

Setting: Academic medical center pain clinic.

Methods: Patients on stable doses of chronic opioids who completed the SBQ were grouped into 3 OSA risk categories, including low (SBQ score 0-2), medium (SBQ score 3-4), and high risk (SBQ score 5-8). Morphine equivalent daily dose (MEDD) was calculated and compared between the 3 risk groups. In a secondary analysis, patients were instead grouped into opioid dose categories, including low MEDD (≤ 20), medium MEDD (21-50), and high MEDD (> 50). The SBQ scores were then compared between the 3 MEDD groups.

Results: The charts of 190 patients on chronic opioid therapy were reviewed. One hundred forty-seven patients did not have a prior diagnosis of OSA. Of these, 92 (63%) patients completed the SBQ. Fifty-five percent were women and 45% men. The average age was 59. The average MEDD was 23.32. In the primary analysis based on the SBQ score, 39% were low risk for OSA, 42% medium risk, and 18% were high risk. There was no difference in total MEDD between the 3 groups (P = 0.83). In the secondary analysis based on total MEDD, 58% had low MEDD, 32% had medium MEDD, and 11% had high MEDD. There was no significant difference in SBQ scores between these groups (P = 0.51).

Limitations: This is a single center study, and only 63% of eligible patients completed the SBQ. The study did not attempt to control for potential confounders. The SBQ results were not confirmed with a polysomnogram.

Conclusion: We found no relationship between the opioid dose and the risk of OSA as measured by the SBQ score in this chronic opioid population. Opioids may be more associated with sleep apnea due to central rather than obstructive processes, and additional screening tools beyond the SBQ may be needed to better screen for sleep apnea in this population.

Keywords: chronic opioids; obstructive sleep apnea; opioid dose; screening; sleep apnea; Stop-bang questionnaire.