Opioid-Related Sleep-Disordered Breathing: An Update for Clinicians

2020 ◽  
Vol 37 (11) ◽  
pp. 970-973
Author(s):  
Waqas Jehangir ◽  
Alexander D. Karabachev ◽  
Zankhana Mehta ◽  
Mellar Davis
Keyword(s):  
Primary Care Physicians ◽  
Sleep Disordered Breathing ◽  
The United States ◽  
Intractable Pain ◽  
Opioid Use ◽  
Term Administration ◽  
Chronic Opioid Use ◽  
Disordered Breathing

Opioids are an effective treatment for patients with intractable pain. Long-term administration of opioids for pain relief is being delivered by an increasing number of medical providers in the United States including primary care physicians and nonspecialists. One common complication of chronic opioid use is sleep-disordered breathing which can result in various morbidities as well as an increase in all-cause mortality. It is important for providers to understand the relationship between opioids and sleep-disordered breathing as well as methods to improve diagnosis and strategies for treatment. This review aims to update clinicians on the mechanism, diagnosis, and treatment of opioid-related sleep-disordered breathing in order to improve the quality of care for patients with chronic pain.

scholarly journals Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing

2020 ◽  
Author(s):  
Juliana Alves Sousa Caixeta ◽  
Jessica Caixeta Silva Sampaio ◽  
Vanessa Vaz Costa ◽  
Isadora Milhomem Bruno da Silveira ◽  
Carolina Ribeiro Fernandes de Oliveira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Long Term Effects ◽  
Obstructive Sleep ◽  
Long Term Impact ◽  
Disordered Breathing

Abstract Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p-values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

scholarly journals Long-Term Impact of Sleep-Disordered Breathing on Quality of Life in Children With Obesity

2018 ◽  
Vol 14 (03) ◽  
pp. 451-458 ◽  
Author(s):  
Sherri L. Katz ◽  
Joanna E. MacLean ◽  
Nicholas Barrowman ◽  
Lynda Hoey ◽  
Linda Horwood ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Sleep Disordered Breathing ◽  
Long Term Impact ◽  
Disordered Breathing

scholarly journals Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series

2015 ◽  
Vol 11 (4) ◽  
pp. 363 ◽  
Author(s):  
Jeffrey DeVido, MD ◽  
Hilary Connery, MD, PhD ◽  
Kevin P. Hill, MD, MHS
Keyword(s):  
Daytime Sleepiness ◽  
Sleep Disordered Breathing ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
The United States ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Use Disorders ◽  
Disordered Breathing

Background: Rates of opioid overdose deaths are increasing in the United States, leading to intensified efforts to provide medication-assisted treatments for opioid use disorders. It is not clear what effect opioid agonist treatments (ie, the μ-opioid receptor full agonist methadone and the partial agonist buprenorphine) may have on respiratory function. However, sleep-disordered breathing has been documented in methadone maintenance pharmacotherapy, and there is emerging evidence for similar sleep-disordered breathing in buprenorphine and buprenorphine-naloxone maintenance treatment.Objective: To provide further clinical evidence of sleep-disordered breathing emerging in the context of buprenorphine-naloxone maintenance pharmacotherapy.Methods: The authors report two additional cases of sleep-disordered breathing that developed in patients with severe opioid use disorders, treated successfully as outpatients with buprenorphine-naloxone maintenance. Both patients provided written consent for their clinical information to be included in this case report, and elements of their identities have been masked to provide confidentiality.Results: Two adult female patients, who were stable in buprenorphine-naloxone maintenance treatment developed daytime sleepiness, were referred for evaluation and found to have sleep-disordered breathing. One patient's daytime sleepiness improved with reduction in both buprenorphine-naloxone and other sedating medications as well as initiation of a constant positive airway pressure (CPAP) device. However, the other patient could not tolerate decreases in buprenorphinenaloxone and/or CPAP initiation and her daytime sleepiness persisted.Conclusion: Buprenorphine-naloxone maintenance treatment can be associated with sleep-disordered breathing. It can be difficult to differentiate the cause(s) of sleep-disordered breathing among the effects of buprenorphine-naloxone treatment itself, co-occurring conditions, such as obesity and cigarette smoking or other medications, or some combination thereof. Regardless of etiology, sleep-disordered breathing and its consequences present unique challenges to the patient in recovery from an opioid use disorder and therefore warrants careful evaluation and management.

Sleep Disordered Breathing Caused by Chronic Opioid Use

2017 ◽  
Vol 12 (4) ◽  
pp. 573-586 ◽  
Author(s):  
Susmita Chowdhuri ◽  
Shahrokh Javaheri
Keyword(s):  
Sleep Disordered Breathing ◽  
Opioid Use ◽  
Chronic Opioid Use ◽  
Disordered Breathing

Long-Term Impact of Adenotonsillectomy on Quality of Life in Thai Children with Sleep-Disordered Breathing

2020 ◽  
Vol 103 (8) ◽  
pp. 736-740
Keyword(s):  
Quality Of Life ◽  
Sleep Disordered Breathing ◽  
Pediatric Population ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Siriraj Hospital ◽  
Long Term Impact ◽  
Disordered Breathing

Background: Sleep disordered breathing (SDB) is a spectrum of disorders that is characterized by abnormal respiratory patterns during sleep, with symptoms that include snoring, mouth breathing, and pauses in breathing. No previous study has investigated the long-term impact of adenotonsillectomy on the quality of life in Thai children with SDB. Objective: To investigate the long-term impact of adenotonsillectomy on the quality of life in Thai pediatric patients with SDB as measured by Obstructive Sleep Apnea-18 (OSA-18) questionnaire. Materials and Methods: The present study was retrospectively conducted in Thai pediatric SDB that underwent adenotonsillectomy at Siriraj Hospital between January 1997 and December 2010. Caregivers of the present study children completed the OSA-18 questionnaire pre-operatively and at least 6-months post-operatively. Demographic and pre-operative polysomnography (PSG) data were also collected and analyzed. Pre-operative and post-operative OSA-18 total score and OSA-18 scores for all five domains were compared using paired t-test. Results: Forty-nine children with SDB that underwent adenotonsillectomy were included. There were 30 boys (61.2%) and 19 girls (38.8%), with a mean age of 6.1±2.6 years (range 3.0 to 12.1). Pre-operative PSG was performed in 32 children (65.3%), with a mean apnea-hypopnea index of 12.6±12.4. Mean pre-operative and post-operative total OSA-18 score was 69.8±16.1 and 36.0±12.9, respectively. Mean duration from surgery to completion of the OSA-18 questionnaire after adenotonsillectomy was 12.5±4.6 months (range 6 to 28). Total OSA-18 score and the scores for all five OSA-18 domains were significantly improved after adenotonsillectomy (p<0.001 and <0.001, respectively). Conclusion: Long-term quality of life in Thai children with SDB was improved significantly after adenotonsillectomy, as evidenced by the significant improvement in OSA-18 total score and all OSA-18 domains. Based on these findings, the authors encourage adenotonsillectomy as the first-line treatment for SDB in Thai pediatric population. Keywords: Long-term impact, Adenotonsillectomy, Quality of life, Thai children, Sleep-disordered breathing, SDB

scholarly journals Might chronic opioid use impact sleep-disordered breathing and vice versa?

2020 ◽  
Vol 16 (6) ◽  
pp. 843-845
Author(s):  
Jeremy E. Orr ◽  
Mark S. Wallace ◽  
Atul Malhotra
Keyword(s):  
Sleep Disordered Breathing ◽  
Opioid Use ◽  
Chronic Opioid Use ◽  
Disordered Breathing

Temperature-Controlled Radiofrequency Tongue Base Reduction for Sleep-Disordered Breathing: Long-Term Outcomes

2002 ◽  
Vol 127 (3) ◽  
pp. 230-234 ◽  
Author(s):  
Kasey K. Li ◽  
Nelson B. Powell ◽  
Robert W. Riley ◽  
Christian Guilleminault
Keyword(s):  
Sleep Disordered Breathing ◽  
Tongue Base ◽  
Long Term Outcomes ◽  
Sf 36 ◽  
Temperature Controlled ◽  
Tongue Base Reduction ◽  
Disordered Breathing

OBJECTIVE: Our goal was to evaluate the long-term outcomes of temperature-controlled radiofrequency reduction of the tongue base in sleep-disordered breathing. METHODS: The 18 patients from our initial pilot study were reevaluated. Clinical examinations, polysomnography (PSG), questionnaires, visual analog scales, and a comparative SF-36 were used to assess long-term outcomes. RESULTS: Sixteen of the original 18 patients completed this study; 2 patients were lost to follow-up. The mean follow-up was 28 months. There was a mean weight increase of 3.1 ± 7.9 kg. The original pretreatment Respiratory Disturbance Index (RDI) was a mean of 39.5 with a mean mean oxygen saturation nadir (LSAT) of 81.9%, and the posttreatment RDI was a mean of 17.8 with a mean LSAT of 88.3%. Follow-up PSG data showed a persistent improvement of the mean Apnea Index compared with pretreatment (5.4 vs 22.1) without significant changes compared with posttreatment (4.1). However, there were changes in the follow-up Hypopnea Index (HI) of 22.9 compared with the pretreatment and posttreatment HI values of 17.4 and 13.6, respectively. This resulted in a relapse of the RDI from a posttreatment value of 17.8 to 28.7. The LSAT also worsened from 88.3% to 85.8%. However, there was no significant deterioration in the quality-of-life measurements by SF-36 or in daytime sleepiness by Epworth Sleepiness Scale. CONCLUSION: The success of temperature-controlled radiofrequency tongue base reduction for sleep-disordered breathing may reduce with time. PSG demonstrated that long-term relapse is primarily reflected in the HI without significant detrimental effects on the patient's quality of life (SF-36) and sleepiness (Epworth Sleepiness Scale). Continual evaluation of this treatment modality is warranted.

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