长期接受阿片类药物治疗的慢性疼痛患者的睡眠呼吸障碍和慢性呼吸衰竭
Sleep disordered breathing and chronic respiratory failure in patients with chronic pain on long term opioid therapy.
作者信息
Rose Anand R, Catcheside Peter G, McEvoy R Doug, Paul Denzil, Kapur Dilip, Peak Emily, Vakulin Andrew, Antic Nicholas A
机构信息
Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia;
Pain Management Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia;
出版信息
J Clin Sleep Med. 2014 Aug 15;10(8):847-52. doi: 10.5664/jcsm.3950.
STUDY OBJECTIVES
The use of opioid medication for chronic pain has been increasing. The main aim of this study was to assess how many patients on opioids for chronic pain had sleep disordered breathing (SDB) and the type of SDB. The impact of these medications on daytime arterial blood gas (ABG) measurements and psychomotor vigilance was also studied.
METHODS
Twenty-four patients (aged 18-75 years) on long-term opioids were prospectively recruited. Patients underwent home polysomnogram (PSG), psychomotor vigilance testing (PVT), and awake daytime ABG. Overnight PSG findings were compared to those of patients matched for age, sex, and BMI referred to our sleep service for evaluation of SDB. PVT results in the patient cohort were compared to PVT in healthy controls.
RESULTS
Forty-six percent of opioid patients had severe SDB as defined by an apnea hypopnea index (AHI) > 30/h. The severity of SDB was similar in opioid-treated pain clinic patients and sleep clinic patients (mean ± SD AHI: Opioid-treated patients 32.7 ± 25.6; Sleep Study comparator group 28.9 ± 24.6, p = 0.6). Opioid patients had a higher frequency of central apneas and a lower arousal index (CAI: 3.9 ± 8.3 vs. 0.3 ± 0.5 events/h; p = 0.004, AI 8.0 ± 4.1 vs. 20.1 ± 13.8, p < 0.001). Pain clinic patients had impaired gas exchange during sleep and wakefulness. Nine of 20 (45%) had daytime hypercapnia, indicating a surprising number were in chronic respiratory failure. Morphine equivalent doses correlated with the severity of SDB. PVT was impaired when compared to a healthy PVT comparator group (RT: Opioid-treated patients 0.43 ± 0.27: Healthy PVT comparator group 0.28 ± 0.03 sec; p < 0.001).
CONCLUSIONS
Patients on long-term opioids frequently have severe SDB, which in part is central in origin. PVT was markedly impaired. Half of the patients studied have evidence of chronic ventilatory failure.
COMMENTARY
A commentary on this article appears in this issue on page 853
研究目的
用于慢性疼痛的阿片类药物的使用一直在增加。本研究的主要目的是评估有多少使用阿片类药物治疗慢性疼痛的患者存在睡眠呼吸障碍（SDB）以及SDB的类型。还研究了这些药物对日间动脉血气（ABG）测量和精神运动警觉性的影响。
方法
前瞻性招募了24名长期使用阿片类药物的患者（年龄18 - 75岁）。患者接受了家庭多导睡眠图（PSG）、精神运动警觉性测试（PVT）和清醒状态下的日间ABG检测。将夜间PSG结果与年龄、性别和BMI相匹配的因SDB前来我们睡眠服务中心评估的患者的结果进行比较。将患者队列的PVT结果与健康对照组的PVT结果进行比较。
结果
46%的阿片类药物患者存在严重SDB，定义为呼吸暂停低通气指数（AHI）> 30次/小时。在接受阿片类药物治疗的疼痛门诊患者和睡眠门诊患者中，SDB的严重程度相似（平均±标准差AHI：接受阿片类药物治疗的患者为32.7±25.6；睡眠研究对照组为28.9±24.6，p = 0.6）。阿片类药物患者中枢性呼吸暂停的频率更高，觉醒指数更低（中枢性呼吸暂停指数：3.9±8.3对0.3±0.5次/小时；p = 0.004，觉醒指数8.0±4.1对20.1±13.8，p < 0.001）。疼痛门诊患者在睡眠和清醒时气体交换均受损。20名患者中有9名（45%）存在日间高碳酸血症，这表明有相当数量的患者处于慢性呼吸衰竭状态。吗啡等效剂量与SDB的严重程度相关。与健康PVT对照组相比，PVT受损（反应时间：接受阿片类药物治疗的患者为0.43±0.27秒；健康PVT对照组为0.28±0.03秒；p < 0.001）。
结论
长期使用阿片类药物的患者经常存在严重的SDB，部分原因是中枢性的。PVT明显受损。所研究的患者中有一半有慢性通气衰竭的证据。
评论
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