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Sleep disordered breathing in patients receiving therapy with buprenorphine/naloxone

Robert J. Farney, Amanda M. McDonald, Kathleen M. Boyle, Gregory L. Snow, R.T. Nuttall, Michael F. Coudreaut, Theodore J. Wander, James M. Walker
European Respiratory Journal 2013 42: 394-403; DOI: 10.1183/09031936.00120012
Robert J. Farney
1Intermountain Sleep Disorders Center, LDS Hospital, Salt Lake City, UT
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  • For correspondence: rjfmd@msn.com
Amanda M. McDonald
1Intermountain Sleep Disorders Center, LDS Hospital, Salt Lake City, UT
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Kathleen M. Boyle
1Intermountain Sleep Disorders Center, LDS Hospital, Salt Lake City, UT
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Gregory L. Snow
2Statistical Data Center, LDS Hospital, Salt Lake City, UT
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R.T. Nuttall
1Intermountain Sleep Disorders Center, LDS Hospital, Salt Lake City, UT
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Michael F. Coudreaut
3Psychiatry Dept, LDS Hospital, Salt Lake City, UT, USA
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Theodore J. Wander
3Psychiatry Dept, LDS Hospital, Salt Lake City, UT, USA
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James M. Walker
1Intermountain Sleep Disorders Center, LDS Hospital, Salt Lake City, UT
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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 nonapnoeic hypoxaemia. Buprenorphine, a partial μ-opioid agonist with limited respiratory toxicity, is widely used for the treatment of opioid dependency and chronic nonmalignant 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±sd age 31.8±12.3 years), nonobese (mean±sd body mass index 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 events·h−1) was present in 63% of the group. Moderate (AHI ≥15– <30 events·h−1) and severe (AHI ≥30 events·h−1) sleep apnoea was present in 16% and 17%, respectively. Hypoxaemia, defined as an arterial oxygen saturation measured by pulse oximetry, of <90% for ≥10% of sleep time, was present in 27 (38.6%) patients.

Despite the putative protective ceiling effect regarding ventilatory suppression observed during wakefulness, buprenorphine may induce significant alterations of breathing during sleep at routine therapeutic doses.

Footnotes

  • For editorial comments see page 297.

  • This article has supplementary material available from www.erj.ersjournals.com

  • Conflict of interest: Disclosures can be found alongside the online version of this article at www.erj.ersjournals.com

  • Received August 2, 2012.
  • Accepted September 21, 2012.
  • ©ERS 2013
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European Respiratory Journal: 42 (2)
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Sleep disordered breathing in patients receiving therapy with buprenorphine/naloxone
Robert J. Farney, Amanda M. McDonald, Kathleen M. Boyle, Gregory L. Snow, R.T. Nuttall, Michael F. Coudreaut, Theodore J. Wander, James M. Walker
European Respiratory Journal Aug 2013, 42 (2) 394-403; DOI: 10.1183/09031936.00120012

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Sleep disordered breathing in patients receiving therapy with buprenorphine/naloxone
Robert J. Farney, Amanda M. McDonald, Kathleen M. Boyle, Gregory L. Snow, R.T. Nuttall, Michael F. Coudreaut, Theodore J. Wander, James M. Walker
European Respiratory Journal Aug 2013, 42 (2) 394-403; DOI: 10.1183/09031936.00120012
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