Pathogenesis of sleep-disordered breathing in the setting of opioid use: a multiple mediation analysis using physiology
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View abstract on PubMed
Summary
This summary is machine-generated.Opioid use increases central sleep apnea and worsens hypoxemia by affecting breathing control. Targeting these physiological changes may reduce the negative respiratory effects of chronic opioid therapy.
Area Of Science
- Pulmonary Medicine
- Sleep Medicine
- Pharmacology
Background
- Opioid medications are widely prescribed and known to affect respiratory and sleep patterns.
- Chronic opioid use is clinically associated with central sleep apnea and may exacerbate obstructive sleep apnea.
- The precise mechanisms linking opioids to sleep-disordered breathing (SDB) remain unclear.
Purpose Of The Study
- To investigate the physiological mechanisms by which opioids influence the pathogenesis of sleep-disordered breathing.
- To compare polysomnographic and physiological parameters between individuals using opioids and matched controls.
Main Methods
- A case-control study involving patients with polysomnography-confirmed SDB (Apnea-Hypopnea Index ≥ 5/hour).
- Opioid users were matched 1:3 to non-opioid controls based on sex, age, and BMI.
- Physiological parameters influencing SDB were analyzed from polysomnography signals, with mediation analysis used to assess opioid effects.
Main Results
- Opioid users (n=178) showed significantly more central apneas (2.8 vs. 1.7 events/hr) and worsened hypoxemia (5% vs. 3% sleep with SpO2 < 88%) compared to controls (n=534).
- Opioid use was associated with higher loop gain, lower respiratory rate, and increased respiratory rate variability.
- Higher loop gain and increased respiratory rate variability mediated the opioid effect on central apneas, but not on hypoxemia.
Conclusions
- Opioids exert multi-level physiological effects that contribute to sleep-disordered breathing.
- Interventions targeting elevated loop gain and respiratory rate variability may mitigate the adverse respiratory effects of chronic opioid use.
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