Risk of Sleep Apnea Increased with Use of Opiate Medications

According to a recent article in Pain Medicine, Dr. Lynn Webster found that sleep disordered breathing was common in chronic pain patients taking prescribed opiates. There was also a direct relationship between central sleep apnea and methadone when combined with benzodiazepines.

risks of sleep apneaOpiates are used for severe and intractable pain in patients who have not responded to other therapy. There is an increasing number of patients with chronic pain who are being prescribed opiate medications. Opiate medications include morphine, Kadian, Avinza, oxycodone, oxymorphone, OxyContin, Opana, Exalgo, and methadone. Benzodiazepines are typically prescribed for anxiety and muscle spasm.

There was a much higher rate of obstructive and central sleep apnea syndromes in those prescribed pain medications-75%, than in the general population, estimated to be at 2-4%. Central sleep apnea is estimated to occur at a rate of 5% in people greater than 65 years of age and 1.5 to 5% in men less than 65 years old. Central sleep apnea causes people to stop breathing during sleep because of faulty brain control. This is compared to obstructive apnea, which is associated with obesity and in other health problems, and typified by loud snoring.

Central sleep apnea is commonly associated with the absence of crescendo-decrescendo breath size and that central sleep apnea mechanism is different for people taking opioids than for people not taking opiates. The researchers feel that the opiates could be directly affecting the part of the brain that controls respiration.

The authors of the study noted that if opiate medications can increase sleep apnea risk, then chronic pain patients who are prescribed opiates may be at higher risk of morbidity and mortality. Recent research has focused on the synergy of opiates and benzodiazepines in causing respiratory depression.

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