Opioids for Obstructive Sleep Apnea Should Be Used With Caution

Although higher-quality evidence is needed, current literature suggests that opioids should be used with caution in individuals with obstructive sleep apnea (OSA) in order to prevent opioid-induced respiratory depression (OIRD), according to study results published in Anesthesia and Analgesia.

The researchers conducted a systematic literature search of studies published between 1946 and 2017, using Medline, ePub Ahead of Print/Medline In-process, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed, and ClinicalTrials.Gov. Of 4321 initial studies, 40 met the inclusion criteria: ie, randomized controlled trials and prospective and retrospective observational studies that reported data on postoperative outcomes in participants with OSA receiving short-term opioid treatment.

Overall, the studies were not found to yield high-quality evidence on the comparative impact of acute opioid analgesia in patients with vs without OSA. Included studies were found to have significant limitations, including risk for bias, and there was significant heterogeneity among studies with regard to OSA severity, perioperative settings, outcome definitions, and the presence or absence of a number of perioperative drivers.

Despite limitations, the researchers did find some consistency across the studies indicating that opioids may have a detrimental effect in individuals with OSA. In particular, the initial 24 hours after opioid administration seem to be the most critical in terms of life-threatening OIRD. In addition, OSA-related increases in pain perception and enhanced opioid sensitivity may predispose patients with OSA to a higher risk for OIRD without overdosing.

“While more research is needed, retrospective analyses suggest that opioid-related serious adverse events may be largely preventable with a more cautious approach to opioid use,” the researchers wrote. “This includes the utilization of multimodal analgesia to reduce opioid requirement, caution, or avoidance of concurrent administration of sedatives and opioids by multiple pathways (eg, [patient-controlled analgesia] plus background infusion).”

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Reference

Cozowicz C, Chung F, Doufas AG, et al. Opioids for acute pain management in patients with obstructive sleep apnea: a systematic review [published online June 28, 2018]. Anesth Analg. doi:10.1213/ANE.0000000000003549