title: Medium Increased Risk for Central Sleep Apnea but Not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Opioids are associated with higher risk for ataxic breathing and sleep apnea. We conducted a systematic literature review and meta-analysis to assess the influence of long-term opioid use on the apnea-hypopnea and central apnea indices (AHI and CAI, respectively).
  
  
  METHODS
  A systematic review protocol (Cochrane Handbook guidelines) was developed for the search and analysis. We searched Embase, Medline, ACP Journal Club, and Cochrane Database up to November 2014 for three topics: (1) narcotics, (2) sleep apnea, and (3) apnea-hypopnea index. The outcome of interest was the variation in AHI and CAI in opioid users versus non-users. Two reviewers performed the data search and extraction, and disagreements were resolved by discussion. Results were combined by standardized mean difference using a random effect model, and heterogeneity was tested by χ(2) and presented as I(2) statistics.
  
  
  RESULTS
  Seven studies met the inclusion criteria, for a total of 803 patients with obstructive sleep apnea (OSA). We compared 2 outcomes: AHI (320 opioid users and 483 non-users) and 790 patients with CAI (315 opioid users and 475 non-users). The absolute effect size for opioid use was a small increased in apnea measured by AHI = 0.25 (95% CI: 0.02-0.49) and a medium for CAI = 0.45 (95% CI: 0.27-0.63). Effect consistency across studies was calculated, showing moderate heterogeneity at I(2) = 59% and 29% for AHI and CAI, respectively.
  
  
  CONCLUSIONS
  The meta-analysis results suggest that long-term opioid use in OSA patients has a medium effect on central sleep apnea.
authors.affiliation: Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.|Faculty of Graduate and Postdoctoral Studies, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Marie-Lou
authors.initials: ML
authors.lastname: Filiatrault
authors.affiliation: Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.|Department of Emergency Medicine, Research Center, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chauny
authors.affiliation: Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.|Department of Emergency Medicine, Research Center, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.
authors.forename: Raoul
authors.initials: R
authors.lastname: Daoust
authors.affiliation: Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.|Department of Emergency Medicine, Research Center, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.
authors.forename: Marie-Pier
authors.initials: MP
authors.lastname: Roy
authors.affiliation: Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.|Department of Surgery, Hôpital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Denis
authors.affiliation: Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.|Department of Surgery, Hôpital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada.|Faculty of Dental Medicine, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lavigne
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D006801:Humans; D017286:Polysomnography; D012306:Risk; D020182:Sleep Apnea, Central / Q000139:chemically induced*; D020181:Sleep Apnea, Obstructive / Q000139:chemically induced*; D013995:Time
chemical_list: D000701:Analgesics, Opioid
keywords: apnea-hypopnea index; central sleep apnea; meta-analysis; narcotic; opioid; sleep apnea; systematic review