Opioids are widely prescribed for
pain management, and it is estimated that 40% of adults in the United States use prescription
opioids every year.
Opioid misuse leads to high mortality, with
respiratory depression as the main cause of death. Animal and human studies indicate that
opioid use may lead to
sleep-disordered breathing.
Opioids affect control of breathing and impair upper airway function, causing
central apneas, upper
airway obstruction, and
hypoxemia during sleep. The presence of
obstructive sleep apnea (OSA) increases the risk of
opioid-induced
respiratory depression. However, even if the relationship between
opioids and
central sleep apnea is firmly established, the question of whether
opioids can aggravate OSA remains unanswered. While several reports have shown a high prevalence of OSA and nocturnal
hypoxemia in patients receiving a high dose of
opioids, other studies did not find a correlation between
opioid use and obstructive events. These differences can be attributed to considerable interindividual variability, divergent effects of
opioids on different phenotypic traits of OSA, and wide-ranging methodology. This review will discuss mechanistic insights into the effects of
opioids on the upper airway and hypoglossal motor activity and the association of
opioid use and
obstructive sleep apnea.
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