title: Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series.
abstract: BACKGROUND
  Rates of opioid overdose deaths are increasing in the United States, leading to intensified efforts to provide medication-assisted treatments for opioid use disorders. It is not clear what effect opioid agonist treatments (ie, the µ-opioid receptor full agonist methadone and the partial agonist buprenorphine) may have on respiratory function. However, sleep-disordered breathing has been documented in methadone maintenance pharmacotherapy, and there is emerging evidence for similar sleep-disordered breathing in buprenorphine and buprenorphine-naloxone maintenance treatment.
  
  
  OBJECTIVE
  To provide further clinical evidence of sleep-disordered breathing emerging in the context of buprenorphine-naloxone maintenance pharmacotherapy.
  
  
  METHODS
  The authors report two additional cases of sleep-disordered breathing that developed in patients with severe opioid use disorders, treated successfully as outpatients with buprenorphine-naloxone maintenance. Both patients provided written consent for their clinical information to be included in this case report, and elements of their identities have been masked to provide confidentiality.
  
  
  RESULTS
  Two adult female patients, who were stable in buprenorphine-naloxone maintenance treatment developed daytime sleepiness, were referred for evaluation and found to have sleep-disordered breathing. One patient's daytime sleepiness improved with reduction in both buprenorphine-naloxone and other sedating medications as well as initiation of a constant positive airway pressure (CPAP) device. However, the other patient could not tolerate decreases in buprenorphine-naloxone and/or CPAP initiation and her daytime sleepiness persisted.
  
  
  CONCLUSIONS
  Buprenorphine-naloxone maintenance treatment can be associated with sleep-disordered breathing. It can be difficult to differentiate the cause(s) of sleep-disordered breathing among the effects of buprenorphine-naloxone treatment itself, co-occurring conditions, such as obesity and cigarette smoking or other medications, or some combination thereof. Regardless of etiology, sleep-disordered breathing and its consequences present unique challenges to the patient in recovery from an opioid use disorder and therefore warrants careful evaluation and management.
authors: Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, University of California, San Francisco, San Francisco, California.
authors: Jeffrey
authors: J
authors: DeVido
authors: Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors: Hilary
authors: H
authors: Connery
authors: Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors: Kevin P
authors: KP
authors: Hill
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects*; D003937:Diagnosis, Differential; D019468:Disease Management; D005260:Female; D006801:Humans; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage / Q000009:adverse effects*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D058850:Opiate Substitution Treatment / Q000009:adverse effects / Q000379:methods; D009293:Opioid-Related Disorders / Q000628:therapy*; D011175:Positive-Pressure Respiration / Q000379:methods; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013995:Time; D028761:Withholding Treatment
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine