Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia.
School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
Respirology. 2016 Feb;21(2):386-91. doi: 10.1111/resp.12681. Epub 2015 Nov 12.
The management of chronic refractory breathlessness is one of the indications for regular low-dose (≤30 mg/24 h) oral sustained release morphine. Morphine may disrupt sleep in some conditions and improve sleep quality in others. This study aimed to determine any signal of regular, low-dose morphine on perceived sleep disruption due to breathlessness and perceived sleep quality.
This is a secondary analysis of data from 38 participants with refractory breathlessness (30 male; 33 with COPD) aged 76 ± 0.9 years who completed a double-blind, randomized, placebo-controlled, cross-over study in which they received 20 mg oral sustained release morphine daily and placebo for 4 days each. Participant ratings of sleep disruption due to breathlessness and perceived sleep quality were obtained daily throughout the 8-day trial.
Perceived sleep disruption due to breathlessness over the 4-day period ranged between 13% and 32% of participants for placebo and 13% and 26% for morphine, decreasing by each day of the study during the morphine arm. Most participants reported 'very good' or 'quite good' sleep throughout the trial and were less likely to perceive poor sleep quality during the morphine arm (odds ratio = 0.55, 95% confidence interval: 0.34-0.88, P = 0.01). Participants who reported decreased breathlessness during the 4 days on morphine were also likely to report improved sleep quality with morphine (P = 0.039).
Four days of low-dose morphine improved perceived sleep quality in elderly participants with refractory breathlessness. Regular low-dose morphine targeted to reduce refractory breathlessness may yield associated benefits by reducing sleep disruption and improving sleep quality.
慢性难治性呼吸困难的管理是定期低剂量（≤30 毫克/24 小时）口服缓释吗啡的适应证之一。吗啡在某些情况下可能会扰乱睡眠，而在其他情况下则可能会改善睡眠质量。本研究旨在确定常规低剂量吗啡是否会对呼吸困难引起的睡眠障碍和睡眠质量感知产生任何影响。
这是对 38 名难治性呼吸困难患者（30 名男性；33 名患有 COPD）的数据分析的二次分析，这些患者年龄为 76 ± 0.9 岁，完成了一项双盲、随机、安慰剂对照、交叉研究，在该研究中，他们每天接受 20 毫克口服缓释吗啡和安慰剂治疗，各持续 4 天。在 8 天的试验中，参与者每天都要对呼吸困难引起的睡眠障碍和睡眠质量感知进行评分。
安慰剂组和吗啡组参与者在 4 天期间因呼吸困难而导致的睡眠障碍比例分别为 13%至 32%和 13%至 26%，在吗啡组中，研究的每一天都在下降。大多数参与者在整个试验中报告“非常好”或“相当好”的睡眠质量，并且在吗啡组中不太可能出现睡眠质量差的情况（优势比=0.55，95%置信区间：0.34-0.88，P=0.01）。在接受吗啡治疗的 4 天内报告呼吸困难减轻的参与者也可能报告服用吗啡后睡眠质量得到改善（P=0.039）。
4 天的低剂量吗啡可改善老年难治性呼吸困难患者的睡眠质量感知。针对减轻难治性呼吸困难的常规低剂量吗啡可能会通过减少睡眠障碍和改善睡眠质量来带来相关益处。
