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Positive airway pressure therapy in patients with opioid-related central sleep apnea

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Abstract

Purpose

This study aims to compare treatment response and adherence rate to positive airway pressure (PAP) in patients with opioid-related central sleep apnea (O-CSA) and idiopathic central sleep apnea (I-CSA).

Methods

We performed a retrospective chart over a 5-year period performed at a VA sleep center. Continuous PAP (CPAP) was prescribed initially for all participants. For those nonresponders (apnea hypopnea index (AHI) of >10/h), bi-level PAP (BiPAP) or adaptive servoventilation (ASV) was instituted upon provider’s discretion. Adherence to therapy was checked with the built-in meter.

Results

Thirty-four patients with O-CSA and 61 with I-CSA were included in the analysis. The two groups were comparable with respect to age, body mass index (BMI), Epworth Sleepiness Scale, and burden of comorbidities. The mean daily equivalent dose of morphine in the O-CSA was 168 mg (range 30–1,217 mg). In the O-CSA group, 24 % of PAP-naïve patients responded to CPAP compared to 38 % in the I-CSA group. BiPAP and ASV were comparable in eliminating central events in both O-CSA (66 versus 60 %) and I-CSA (93 versus 90 %), respectively. Eight patients (24 %) with O-CSA and six patients (10 %) with I-CSA were considered nonresponders. The adherence rate was 48 and 24 % in the I-CSA group compared to 23 and 18 % in the O-CSA group at 3 and 12 months following initiation of effective treatment (p = 0.04 and p = 0.6).

Conclusions

The presence of O-CSA does not preclude an adequate response to CPAP. Adherence rate to PAP was poor in both the O-CSA and I-CSA groups. Further studies are needed to define optimal adherence rate and long-term benefits of PAP in CSA.

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References

  1. (1997) The use of opioids for the treatment of chronic pain. A consensus statement from the American Academy of Pain Medicine and the American Pain Society. Clin J Pain 13(1):6–8

  2. Colliver JD, Gfroerer JC (2008) Motive for nonmedical use of prescription pain relievers in the national survey on drug use and health. J Pain Off J Am Pain Soc 9(6):487–489, discussion 494–486

    Article  Google Scholar 

  3. Trescot AM, Boswell MV, Atluri SL, Hansen HC, Deer TR, Abdi S, Jasper JF, Singh V, Jordan AE, Johnson BW, Cicala RS, Dunbar EE, Helm S 2nd, Varley KG, Suchdev PK, Swicegood JR, Calodney AK, Ogoke BA, Minore WS, Manchikanti L (2006) Opioid guidelines in the management of chronic non-cancer pain. Pain Physician 9(1):1–39

    PubMed  Google Scholar 

  4. Manchikanti L (2006) Prescription drug abuse: what is being done to address this new drug epidemic? Testimony before the Subcommittee on Criminal Justice, Drug Policy and Human Resources. Pain Physician 9(4):287–321

    PubMed  Google Scholar 

  5. Breivik H (2005) Opioids in chronic non-cancer pain, indications and controversies. Eur J Pain 9(2):127–130

    Article  CAS  PubMed  Google Scholar 

  6. Manchikanti L, Damron KS, McManus CD, Barnhill RC (2004) Patterns of illicit drug use and opioid abuse in patients with chronic pain at initial evaluation: a prospective, observational study. Pain Physician 7(4):431–437

    PubMed  Google Scholar 

  7. Wang D, Teichtahl H, Drummer O, Goodman C, Cherry G, Cunnington D, Kronborg I (2005) Central sleep apnea in stable methadone maintenance treatment patients. Chest 128(3):1348–1356

    Article  PubMed  Google Scholar 

  8. Farney RJ, Walker JM, Cloward TV, Rhondeau S (2003) Sleep-disordered breathing associated with long-term opioid therapy. Chest 123(2):632–639

    Article  PubMed  Google Scholar 

  9. Teichtahl H, Wang D, Cunnington D, Quinnell T, Tran H, Kronborg I, Drummer OH (2005) Ventilatory responses to hypoxia and hypercapnia in stable methadone maintenance treatment patients. Chest 128(3):1339–1347

    Article  PubMed  Google Scholar 

  10. The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (2013) Program THO. http://www.hopweb.org/hop/login.cfm. Accessed 7 May 2013

  11. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28(4):499–521

    PubMed  Google Scholar 

  12. (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22(5):667–689

  13. Issa FG, Sullivan CE (1986) Reversal of central sleep apnea using nasal CPAP. Chest 90(2):165–171

    Article  CAS  PubMed  Google Scholar 

  14. Hoffstein V, Slutsky AS (1987) Central sleep apnea reversed by continuous positive airway pressure. Am Rev Respir Dis 135(5):1210–1212

    CAS  PubMed  Google Scholar 

  15. Aurora RN, Chowdhuri S, Ramar K, Bista SR, Casey KR, Lamm CI, Kristo DA, Mallea JM, Rowley JA, Zak RS, Tracy SL (2012) The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep 35(1):17–40

    PubMed Central  PubMed  Google Scholar 

  16. Badr MS, Toiber F, Skatrud JB, Dempsey J (1995) Pharyngeal narrowing/occlusion during central sleep apnea. J Appl Physiol 78(5):1806–1815

    CAS  PubMed  Google Scholar 

  17. Edwards BA, Sands SA, Feeney C, Skuza EM, Brodecky V, Wilkinson MH, Berger PJ (2009) Continuous positive airway pressure reduces loop gain and resolves periodic central apneas in the lamb. Respir Physiol Neurobiol 168(3):239–249

    Article  PubMed  Google Scholar 

  18. Ramar K, Ramar P, Morgenthaler TI (2012) Adaptive servoventilation in patients with central or complex sleep apnea related to chronic opioid use and congestive heart failure. J Clin Sleep Med 8(5):569–576

    PubMed Central  PubMed  Google Scholar 

  19. Javaheri S, Malik A, Smith J, Chung E (2008) Adaptive pressure support servoventilation: a novel treatment for sleep apnea associated with use of opioids. J Clin Sleep Med 4(4):305–310

    PubMed Central  PubMed  Google Scholar 

  20. Farney RJ, Walker JM, Boyle KM, Cloward TV, Shilling KC (2008) Adaptive servoventilation (ASV) in patients with sleep disordered breathing associated with chronic opioid medications for non-malignant pain. J Clin Sleep Med 4(4):311–319

    PubMed Central  PubMed  Google Scholar 

  21. Chowdhuri S, Ghabsha A, Sinha P, Kadri M, Narula S, Badr MS (2012) Treatment of central sleep apnea in U.S. veterans. J Clin Sleep Med 8(5):555–563

    PubMed Central  PubMed  Google Scholar 

  22. Teschler H, Dohring J, Wang YM, Berthon-Jones M (2001) Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med 164(4):614–619

    Article  CAS  PubMed  Google Scholar 

  23. Pepperell JC, Maskell NA, Jones DR, Langford-Wiley BA, Crosthwaite N, Stradling JR, Davies RJ (2003) A randomized controlled trial of adaptive ventilation for Cheyne-Stokes breathing in heart failure. Am J Respir Crit Care Med 168(9):1109–1114

    Article  PubMed  Google Scholar 

  24. Philippe C, Stoica-Herman M, Drouot X, Raffestin B, Escourrou P, Hittinger L, Michel PL, Rouault S, d’Ortho MP (2006) Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a six month period. Heart 92(3):337–342

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Banno K, Okamura K, Kryger MH (2006) Adaptive servo-ventilation in patients with idiopathic Cheyne-Stokes breathing. J Clin Sleep Med 2(2):181–186

    PubMed  Google Scholar 

  26. Alattar MA, Scharf SM (2009) Opioid-associated central sleep apnea: a case series. Sleep Breath 13(2):201–206

    Article  CAS  PubMed  Google Scholar 

  27. Guilleminault C, Cao M, Yue HJ, Chawla P (2010) Obstructive sleep apnea and chronic opioid use. Lung 188(6):459–468

    Article  PubMed  Google Scholar 

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Acknowledgments

This material is based upon work supported in part by the Department of Veterans Affairs and Clinical Sciences Research and Development. The contents of this manuscript do not represent the views of the Department of Veterans Affairs or the US Government.

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Authors and Affiliations

  1. The Veterans Affairs Western New York Healthcare System, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Medical Research, Bldg. 20 (151) VISN02, 3495 Bailey Avenue, Buffalo, NY, 14215-1199, USA

    Anthony Troitino, Nawman Labedi, Thomas Kufel & Ali A. El-Solh

  2. Division of Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA

    Anthony Troitino, Nawman Labedi & Ali A. El-Solh

  3. Department of Anesthesiology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA

    Ali A. El-Solh

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  1. Anthony Troitino
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  2. Nawman Labedi
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  3. Thomas Kufel
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  4. Ali A. El-Solh
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Correspondence to Ali A. El-Solh.

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Troitino, A., Labedi, N., Kufel, T. et al. Positive airway pressure therapy in patients with opioid-related central sleep apnea. Sleep Breath 18, 367–373 (2014). https://doi.org/10.1007/s11325-013-0894-4

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  • DOI: https://doi.org/10.1007/s11325-013-0894-4

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