Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
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Opioids have become part of contemporary treatment in the management of chronic pain. However, chronic use of opioids has been associated with high prevalence of sleep apnea which could contribute to morbidity and mortality of such patients. ⋯ Opioids may cause severe sleep apnea syndrome. Acute treatment with CPAP eliminates obstructive apneas but increases central apneas. Adaptive pressure support servoventilation proves to be effective in the treatment of sleep related breathing disorders in patients on chronic opioids. Long-term studies on a large number of patients are necessary to determine if treatment of sleep apnea improves quality of life, decreases daytime sleepiness, and ultimately decreases the likelihood of unexpected death of patients on opioids.
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Adaptive servoventilation (ASV) can be effective therapy for specific types of central apnea such as Cheyne-Stokes respiration (CSR). Patients treated chronically with opioids develop central apneas and ataxic breathing patterns (Biot's respiration), but therapy with CPAP is usually unsuccessful. There are no published studies of ASV in patients with sleep apnea complicated by chronic opioid therapy. ⋯ Due to residual respiratory events and hypoxemia, ASV was considered insufficient therapy in these patients. Persistence of obstructive events could be due to suboptimal pressure settings (end expiratory and/or maximal inspiratory). Residual central events could be related to fundamental differences in the pathophysiology of CSR compared to opioid induced breathing disturbances.
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Comparative Study
Autoadjusting positive pressure trial in adults with sleep apnea assessed by a simplified diagnostic approach.
To describe our clinical experience with autoadjusting positive airway pressure (APAP) trials carried out on patients with moderate-to-severe obstructive sleep apnea (OSA). ⋯ The APAP trial was effective in decreasing RDI with an acceptable adherence rate; however, residual OSAwas a frequent finding. Our results support that in up to one-third of patients evaluated by a simplified diagnostic approach, CPAP titration based on 95th percentile pressure may not be sufficient if residual RDI < 10 events/h is considered as a therapeutic target.
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Weight loss may reduce the severity of obstructive sleep apnea (OSA), but persistence of OSA following surgical weight loss has not been defined. We sought to clarify the impact of bariatric surgery on OSA. We hypothesized that, despite substantial weight loss and reductions in the apnea-hypopnea index (AHI), many will have persistent disease. ⋯ Surgical weight loss reduces the AHI, but many patients have residual OSA one year after bariatric surgery.