• Andreas Schwarzer, Marie Aichinger-Hinterhofer, Christoph Maier, Jan Vollert, and Jörg Werner Walther.
• Departments of aPain Medicine, and bInternal Medicine, Pneumology, Allergology and Sleep Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
• Pain. 2015 Nov 1; 156 (11): 2167-74.

AbstractAn increased cardiovascular event rate in elderly patients under opioid medications was recently reported. One reason for this increase could be the occurrence of nocturnal apnea and hypoxia, as a consequence of sleep-disordered breathing (SDB). Using a controlled study, we prospectively analyzed SDB using polysomnography in a total of 18 patients before and after opioid withdrawal (opioid withdrawal group [OG]) and 14 patients before and after comprehensive pain management (without any strong-acting opioids) who served as the control group (CG). To analyze the differences, unpaired/paired t tests and Mann-Whitney U tests/Wilcoxon rank tests were used. At baseline, the OG presented more nocturnal apneas/hypopneas than the CG with an apnea-hypopnea index (AHI) of 41.4 ± 27.8 vs 21.8 ± 15.9 (P = 0.018). After treatment, the AHI decreased significantly only in the withdrawal group (OG: 16.7 ± 8.9; CG: 20.1 ± 12.9) (P < 0.01). Before treatment, none of the CG but half of the OG patients showed central apnea, which disappeared afterwards. A mean O2 saturation during rapid eye movement sleep lower than 90% was found in 27.5% of the OG patients before opioid withdrawal and in none of the patients after withdrawal (P < 0.01). The AHI was not significantly affected by body mass index, age, or sex. Obviously, nocturnal apnea and O2 desaturation occurred more frequently, as was clinically expected in patients with opioid intake; these findings may explain the opioid-associated cardiovascular morbidity. Thus, SDB may be a risk at lower opioid doses than hitherto described, and particular caution should be exercised in patients with comorbidities that might make them vulnerable to the consequences of SDB.

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