低剂量吗啡对COPD睡眠和呼吸困难的影响:一项随机试验
Thomas J Altree1, Alison J Pinczel2, Barbara Toson2
1Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Adelaide, Australia; Respiratory and Sleep Medicine Unit, Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia.
Chest
|December 15, 2024
概括
低剂量吗啡对COPD患者的睡眠效率或呼吸事件没有影响. 然而,它导致了夜间低通风的增加,这可能是有害的副作用,尽管没有改善呼吸困难.
科学领域:
- 肺部医学 肺部医学
- 睡眠医学 睡眠医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 低剂量吗啡用于慢性COPD呼吸困难,怀疑睡眠相关机制.
- 在COPD中阿片类药物的安全性是令人担忧的,而吗啡对COPD患者睡眠的影响仍未得到研究.
- 这项研究客观地评估了低剂量吗啡对COPD睡眠的影响.
研究的目的:
- 客观地确定低剂量吗啡对COPD患者睡眠效率和其他睡眠参数的影响.
- 调查吗啡对呼吸困难的影响与睡眠相关的潜在机制.
- 在COPD患者的睡眠期间评估低剂量吗啡的安全性.
主要方法:
- 一个随机的,双重匿名的交叉试验,在19名COPD患者中比较持续释放吗啡 (20 mg/d) 与安慰剂.
- 在实验室进行过夜的多睡眠摄影,以测量睡眠效率作为主要结果.
- 二次结果包括睡眠呼吸障碍,氧化,二氧化碳水平,生物标志物,喘息和驾驶模拟器性能.
主要成果:
- 吗啡和安慰剂之间的睡眠效率 (66% vs 67%) 和睡眠呼吸障碍的频率是相似的.
- 吗啡降低了呼吸频率,但降低了夜间氧气和率 (平均为2%,最低值为5%),并增加了通过皮肤的二氧化碳水平.
- 接受吗啡的42%的参与者满足了夜间低通风标准,而接受安慰剂的21% (P = .02).
结论:
- 稳定状态低剂量的吗啡不会改变COPD患者的睡眠效率,睡眠障碍呼吸频率或第二天的警觉性.
- 吗啡可能会诱导夜间低通风,这可能是COPD患者的潜在有害影响.
- 不良事件,主要是恶心,在吗啡治疗中更频繁.
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