Abstract
Patients using chronic opioids are at risk for exceptionally complex and potentially lethal disorders of breathing during sleep including central and obstructive apnoeas, hypopnoeas, ataxic breathing and non-apneic hypoxemia. Buprenorphine, a partial ì-opioid agonist with limited respiratory toxicity, is widely used for treatment of opioid dependency and chronic non-malignant pain however its potential for causing sleep disordered breathing has not been studied.
70 consecutive patients admitted for therapy with buprenorphine/naloxone were routinely evaluated with sleep medicine consultation and attended polysomnography.
The majority of patients were young (mean age ± SD =31.8±12.3 years), non-obese (mean BMI ± SD =24.9±5.9 kg·m−2) and female (60%). Based upon the apnoea/ hypopnoea index (AHI), at least mild sleep disordered breathing (AHI ≥5·hr−1) was present in 63% of the group. Moderate (AHI ≥15 to <30·hr−1) and severe sleep apnoea (AHI ≥30·hr−1) was present in 16% and 17% respectively. Hypoxemia, defined as an SpO2 of <90% for ≥10% of sleep time, was present in 27 patients (38.6%)
Despite the putative protective ceiling effect regarding ventilatory suppression observed during wakefulness, buprenorphine may induce significant alterations of breathing during sleep using routine therapeutic doses.
- Biot's respiration/ataxic breathing
- buprenorphine/naloxone
- central sleep apnoea
- opioids
- polysomnography
- random Forest
- ERS