title: Pain Intensity and Opioid Utilization in Response to CPAP Therapy in Veterans with Obstructive Sleep Apnea on Chronic Opioid Treatment.
abstract: Sleep fragmentation has been linked to poor pain tolerance and lowered pain threshold. Little evidence exists on whether continuous positive airway pressure (CPAP) adherence in veterans with obstructive sleep apnea (OSA) who are taking opioids for non-malignant pain would ameliorate pain and reduce consumption of opioids.
  
  
  
  A retrospective case-control study was performed at a VA sleep center. Pain intensity was assessed using the Numerical Categorical Scale prior to CPAP treatment and 12-mo follow-up. Opioids intake was assessed using the morphine equivalent daily dose (MEDD). Adherence to CPAP was evaluated with the built-in meter.
  
  
  
  We reviewed 113 patients with OSA (apnea-hypopnea index [AHI] 35.9 ± 29.5) using a MEDD of 61.6 mg (range 5-980 mg) and a control group of 113 veterans with OSA (AHI 33.4 ± 27.3) on no opioids treatment. CPAP adherence was significantly lower at 12 mo in opioid-treated patients compared to controls (37% versus 55%; p = 0.01). Greater pain intensity was the only independent variable associated with CPAP non-adherence at 12-mo follow-up (p = 0.03). Compared to baseline, no significant difference was observed in pain intensity or consumption of opioids in CPAP adherent patients.
  
  
  
  CPAP treatment did not reduce pain intensity or consumption of opioids in veterans with chronic pain who have coexisting OSA. CPAP adherence was lower in opioid-treated veterans with OSA compared to opioid-free veterans with OSA. Pain intensity was the only determinant of CPAP adherence. Future studies are needed to evaluate pain management program on adherence to CPAP.
authors.affiliation: The Veterans Affairs Western New York Healthcare System, Buffalo, NY.|Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jaoude
authors.affiliation: The Veterans Affairs Western New York Healthcare System, Buffalo, NY.
authors.forename: Ashima
authors.initials: A
authors.lastname: Lal
authors.affiliation: The Veterans Affairs Western New York Healthcare System, Buffalo, NY.|Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions.
authors.forename: Leah
authors.initials: L
authors.lastname: Vermont
authors.affiliation: The Veterans Affairs Western New York Healthcare System, Buffalo, NY.|Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions.
authors.forename: Jahan
authors.initials: J
authors.lastname: Porhomayon
authors.affiliation: The Veterans Affairs Western New York Healthcare System, Buffalo, NY.|Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions.|Department of Social and Preventive Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions.|Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions.
authors.forename: Ali A
authors.initials: AA
authors.lastname: El-Solh
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016022:Case-Control Studies; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy*; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid
keywords: adherence; opioids; pain intensity; sleep apnea