title: A narrative review: The effects of opioids on sleep disordered breathing in chronic pain patients and methadone maintained patients.
abstract: Opioids increase the risk for sleep disordered breathing (SDB), but there are few studies examining the prevalence and risk factors for SDB, specifically central sleep apnea (CSA), and obstructive sleep apnea (OSA) in chronic pain patients on opioids as well as methadone maintained patients (MMPs).
  
  
  
  A literature review was conducted in which SDB was confirmed by polysomnography (PSG) in chronic pain patients on opioids as well as patients with a diagnosis of an opioid use disorder or opioid dependence on methadone maintenance treatment (MMT).
  
  
  
  About 22 reports were included. Six were with MMPs, and 16 were with chronic pain patients on opioids. Among MMPs, the prevalence of SDB ranged from 42.3% to 70%; 0-60% had CSA and 10-35.2% had OSA. In chronic pain patients on opioids, the prevalence of SDB ranged from 71% to 100%; 17-80% had CSA and 20-39% had OSA. In MMPs, studies found a positive association between BMI, weight gain, duration of MMT, non-Caucasian race and the number of obstructive apneas, as well as blood methadone concentrations and the number of central apneas. In chronic pain patients on opioids, older age, higher BMI, male gender, and higher opioid doses predicted more obstructive apneas; older age, lower BMI, male gender, higher pain levels, higher benzodiazepine doses, and higher opioid doses predicted more central apneas.
  
  
  
  CSA and OSA are common in MMPs and chronic pain patients on opioids. Among chronic pain patients, higher opioid doses appear to be a risk factor for CSA, and to a lesser extent OSA. Therefore, it is important for providers to screen these patient populations for SDB. (Am J Addict 2016;25:452-465).
authors.affiliation: Department of Addiction Psychiatry, UCLA-Kern, Bakersfield, California.
authors.forename: Sameer
authors.initials: S
authors.lastname: Hassamal
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Semel Institute of Neuroscience and Human Behavior, Los Angeles, California.
authors.forename: Karen
authors.initials: K
authors.lastname: Miotto
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Tisha
authors.initials: T
authors.lastname: Wang
authors.affiliation: Center of Excellence in Substance Abuse Treatment and Education, Veteran's Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000009:adverse effects; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone