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Obstructive sleep apnea, pain, and opioids: is the riddle solved?
Karen K Lam1, Samuel Kunder, Jean Wong
1aDepartment of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada bDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.
Current Opinion in Anaesthesiology
|November 7, 2015
Summary
Managing pain with opioids in patients with obstructive sleep apnea (OSA) requires caution. OSA can alter pain perception and opioid response, potentially increasing risks during the perioperative period.
Area of Science:
- Anesthesiology and Pain Management
- Sleep Medicine
- Respiratory Physiology
Background:
- Obstructive sleep apnea (OSA) presents unique challenges for perioperative pain management.
- Concerns exist regarding opioid-induced ventilatory impairment (OIVI) in OSA patients.
- The interplay of hypoxia, sleep fragmentation, pain, and opioid effects in OSA is complex.
Purpose of the Study:
- To review the impact of OSA on perioperative pain management.
- To explore the complex interactions between OSA, pain, and opioid analgesia.
- To highlight research on perioperative outcomes in OSA patients undergoing opioid-based pain management.
Main Methods:
- Review of epidemiological and experimental evidence.
- Analysis of the effects of intermittent hypoxia and sleep fragmentation on pain and opioid response.
- Examination of risk factors for OIVI in OSA patients.
Main Results:
- Life-threatening opioid-related respiratory events are rare, but OSA is a predisposing condition for OIVI.
- Intermittent hypoxia and sleep fragmentation in OSA enhance pain perception.
- Intermittent hypoxia may potentiate opioid analgesic effects, with inflammatory pathways implicated.
- Opioids can worsen postoperative sleep-disordered breathing in OSA patients.
- Patients with decreased chemoreflex responsiveness and high arousal thresholds may be at higher risk for OIVI.
Conclusions:
- Obstructive sleep apnea complicates perioperative pain management with opioids.
- OSA alters both pain processing and sensitivity to opioid effects.
- Further research is warranted to optimize perioperative outcomes for OSA patients.