Jungquist Carla R, Flannery Marie, Perlis Michael L, Grace Jeanne T
School of Nursing, University of Rochester, Rochester, New York 14642, USA.
Pain Manag Nurs. 2012 Jun;13(2):70-9. doi: 10.1016/j.pmn.2010.04.003. Epub 2010 Nov 19.
This research assessed: 1) whether patients thought to have sleep disordered breathing would have more severe symptoms if they were taking opioids; 2) whether severity of sleep disordered breathing was associated with class or dose of opioid; and 3) whether pain intensity was associated with sleep disordered breathing. A descriptive cross-sectional study of patients referred for assessment of sleep disorders was conducted. Data were collected on a total of 419 subjects (no pain [n = 171], chronic pain without opioid treatment [n = 187], and chronic pain with opioid treatment [n = 61]). The findings suggest that regardless of opioid drug or dose, the management of chronic pain with opioids is not likely to exacerbate obstructive sleep apnea at stable doses. However, central sleep apnea was associated with opioid use. Patients with chronic pain taking opioids had a mean of 5 ± 13 central apneic events per hour compared with 1.6 ± 7 events per hour in patients without pain and not taking opioids. Oxygen saturation mean nadir 83.5% (opioid group) versus 82.9% (no pain, pain without opioid) was not significantly different. The clinical relevance of the effect is unknown, so the potential for marginal respiratory disturbance (an increase of 2.8 central events per hour for every 100 mg morphine-equivalent opioid dose) must be weighed against the therapeutic value of pain management with opioids.
1）被认为有睡眠呼吸障碍的患者在服用阿片类药物时是否会有更严重的症状；2）睡眠呼吸障碍的严重程度是否与阿片类药物的类别或剂量相关；3）疼痛强度是否与睡眠呼吸障碍相关。对被转诊进行睡眠障碍评估的患者进行了一项描述性横断面研究。共收集了419名受试者的数据（无疼痛[n = 171]、未接受阿片类药物治疗的慢性疼痛[n = 187]、接受阿片类药物治疗的慢性疼痛[n = 61]）。研究结果表明，无论阿片类药物的种类或剂量如何，在稳定剂量下使用阿片类药物治疗慢性疼痛不太可能加重阻塞性睡眠呼吸暂停。然而，中枢性睡眠呼吸暂停与阿片类药物的使用有关。服用阿片类药物的慢性疼痛患者每小时平均有5±13次中枢性呼吸暂停事件，而无疼痛且未服用阿片类药物的患者每小时有1.6±7次。最低平均血氧饱和度在阿片类药物组为83.5%，在无疼痛组和未使用阿片类药物的疼痛组为82.9%，差异无统计学意义。该效应的临床相关性尚不清楚，因此必须权衡轻微呼吸紊乱的可能性（每100毫克吗啡等效阿片类药物剂量每小时中枢性事件增加2.8次）与使用阿片类药物进行疼痛管理的治疗价值。
