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(Chest. 2003;123:632-639.)
© 2003 American College of Chest Physicians

Sleep-Disordered Breathing Associated With Long-term Opioid Therapy*

Robert J. Farney, MD, FCCP; James M. Walker, PhD; Tom V. Cloward, MD, FCCP and Steven Rhondeau, MD

* From the Intermountain Sleep Disorders Center (Drs. Farney, Walker and Cloward) and Department of Anesthesia/Anesthesia Pain Management Service (Dr. Rhondeau), LDS Hospital, Salt Lake City, UT.

Correspondence to: Robert J. Farney, MD, FCCP, Intermountain Sleep Disorders Center, LDS Hospital, 325 Eighth Ave and C St, Salt Lake City, UT 84143; e-mail: rjfmd{at}msn.com

Three patients are described who illustrate distinctive patterns of sleep-disordered breathing that we have observed in patients who are receiving long-term, sustained-release opioid medications. Polysomnography shows respiratory disturbances occur predominantly during non-rapid eye movement (NREM) sleep and are characterized by ataxic breathing, central apneas, sustained hypoxemia, and unusually prolonged obstructive "hypopneas" secondary to delayed arousal responses. In contrast to what is usually observed in subjects with obstructive sleep apnea (OSA), oxygen desaturation is more severe and respiratory disturbances are longer during NREM sleep compared to rapid eye movement sleep. Further studies are needed regarding the effects of opioids on respiration during sleep as well as the importance of interaction with other medications and associated risk factors for OSA.

Key Words: ataxic breathing • Biot respiration • opioids • sleep apnea




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