title: Adaptive servoventilation for treatment of opioid-associated central sleep apnea.
abstract: BACKGROUND
  Opioids have become part of contemporary treatment in the management of chronic pain. Although severe daytime ventilatory depression is uncommon, chronic use of opioids could be associated with severe central and obstructive sleep apnea.
  
  
  OBJECTIVE
  To determine the acute efficacy, and prolonged use of adaptive servoventilation (ASV) to treat central sleep apnea in patients on chronic opioids.
  
  
  METHODS
  Twenty patients on opioid therapy referred for evaluation of obstructive sleep apnea (OSA) were found to have central sleep apnea (CSA). The first 16 patients underwent continuous positive airway pressure (CPAP) titration, which showed persistent CSA. With the notion that CSA will be eliminated with continued use of CPAP, 4 weeks later, 9 of the 16 patients underwent a second CPAP titration which proved equally ineffective. Therefore, therapy with CPAP was abandoned. All patients underwent ASV titration.
  
  
  RESULTS
  Diagnostic polysomnography showed an average apnea-hypopnea index (AHI) of 61/h and a central-apnea index (CAI) of 32/h. On CPAP 1, AHI was 34/h and CAI was 20/h. Respective indices on CPAP 2 were AHI 33/h and CAI 19/h. During titration with ASV, CAI was 0/h and the average HI was 11/h on final pressures. With a reduction in AHI, oxyhemoglobin saturation nadir increased from 83% to 90%, and arousal index decreased from 29/h of sleep to 12/h on final ASV pressures. Seventeen patients were followed for a minimum of 9 months and up to 6 years. The mean long-term adherence was 5.1 ± 2.5 hours.
  
  
  CONCLUSIONS
  Chronic use of opioids could be associated with severe CSA which remains resistant to CPAP therapy. ASV device is effective in the treatment of CSA and over the long run, most patients remain compliant with the device. Randomized long-term studies are necessary to determine if treatment of sleep apnea with ASV improves quality of life and the known mortality associated with opioids.
authors.affiliation: SleepCare Diagnostics, Cincinnati, OH.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Javaheri
authors.affiliation: SleepCare Diagnostics, Cincinnati, OH.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Harris
authors.affiliation: SleepCare Diagnostics, Cincinnati, OH.
authors.forename: Joseph
authors.initials: J
authors.lastname: Howard
authors.affiliation: Heart and Vascular Center, Christ Hospital, Cincinnati, OH.
authors.forename: Eugene
authors.initials: E
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D059725:Interactive Ventilatory Support / Q000379:methods; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods; D020182:Sleep Apnea, Central / Q000139:chemically induced* / Q000628:therapy; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: ASV; CPAP; CSA; morphine; oxycontin