Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia.
Discipline of Medicine, University of Adelaide, Adelaide, Australia.
Drugs Aging. 2015 Dec;32(12):1045-53. doi: 10.1007/s40266-015-0325-2.
Managing pain in residents of residential aged care facilities (RACFs) is challenging, especially for people with dementia. Clinicians must weigh the benefits of analgesic use against the potential for adverse events, particularly daytime sleepiness.
The aim was to investigate the association between analgesic use and daytime sleepiness in residents with and without dementia in RACFs.
This was a cross-sectional study of 383 permanent residents from six low-level and high-level RACFs in South Australia. Main measures included analgesic use in the previous 24 h, analgesic load and self-reported daytime sleepiness. Covariates included relevant comorbidities (insomnia, depression, painful conditions), Charlson's Comorbidity Index, sedative load, self-reported and clinician-observed pain and dementia severity. Logistic regression was used to compute odds ratios (ORs) and confidence intervals (CIs) for the association between analgesic use and daytime sleepiness.
Analgesics were used by 288 residents (75.2%) in the previous 24 h. These included paracetamol (n = 264, 68.9%), opioids (n = 110, 28.7%) and oral NSAIDs (n = 14, 3.7%). Overall, 116 (30.3%) residents were categorized as having daytime sleepiness. Of those with dementia, 77 (45.6%) were categorized as having daytime sleepiness. Opioid use in the previous 24 h was not associated with daytime sleepiness in unadjusted or adjusted analyses. Paracetamol use was positively associated with daytime sleepiness (OR 2.31; 95% CI 1.20-4.42).
Although daytime sleepiness occurred in a large number of residents, especially those with dementia, this sleepiness was not necessarily associated with use of opioids. The risk of opioid-induced sedation may have been managed by strategies including preferential prescribing of paracetamol to residents at risk of sleepiness, opioid discontinuation in residents who experienced sleepiness, and use of low doses of opioids.
管理养老院居民的疼痛是具有挑战性的，特别是对于患有痴呆症的人。临床医生必须权衡使用镇痛药的益处与潜在不良反应的风险，尤其是白天嗜睡。
本研究旨在调查养老院中患有和不患有痴呆症的居民使用镇痛药与白天嗜睡之间的关联。
这是一项在南澳大利亚的六家低级别和高级别的养老院中的 383 名常住居民的横断面研究。主要措施包括在过去 24 小时内使用镇痛药、镇痛药负荷和自我报告的白天嗜睡。协变量包括相关合并症（失眠、抑郁、疼痛状况）、Charlson 合并症指数、镇静剂负荷、自我报告和临床医生观察到的疼痛和痴呆症严重程度。使用逻辑回归计算使用镇痛药与白天嗜睡之间关联的优势比（OR）和置信区间（CI）。
在过去 24 小时内，有 288 名居民（75.2%）使用了镇痛药。这些镇痛药包括扑热息痛（n=264，68.9%）、阿片类药物（n=110，28.7%）和口服非甾体抗炎药（n=14，3.7%）。总体而言，有 116 名（30.3%）居民被归类为白天嗜睡。在患有痴呆症的居民中，有 77 名（45.6%）被归类为白天嗜睡。在未调整和调整分析中，过去 24 小时内使用阿片类药物与白天嗜睡无关。扑热息痛的使用与白天嗜睡呈正相关（OR 2.31；95%CI 1.20-4.42）。
尽管有大量居民，尤其是患有痴呆症的居民出现白天嗜睡，但这种嗜睡并不一定与阿片类药物的使用有关。通过优先为有嗜睡风险的居民开扑热息痛、在出现嗜睡的居民中停用阿片类药物以及使用低剂量阿片类药物等策略，可能已经管理了阿片类药物引起的镇静的风险。
