Hassamal Sameer, Miotto Karen, Wang Tisha, Saxon Andrew J
Department of Addiction Psychiatry, UCLA-Kern, Bakersfield, California.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Semel Institute of Neuroscience and Human Behavior, Los Angeles, California.
Am J Addict. 2016 Sep;25(6):452-65. doi: 10.1111/ajad.12424.
Opioids increase the risk for sleep disordered breathing (SDB), but there are few studies examining the prevalence and risk factors for SDB, specifically central sleep apnea (CSA), and obstructive sleep apnea (OSA) in chronic pain patients on opioids as well as methadone maintained patients (MMPs).
A literature review was conducted in which SDB was confirmed by polysomnography (PSG) in chronic pain patients on opioids as well as patients with a diagnosis of an opioid use disorder or opioid dependence on methadone maintenance treatment (MMT).
About 22 reports were included. Six were with MMPs, and 16 were with chronic pain patients on opioids. Among MMPs, the prevalence of SDB ranged from 42.3% to 70%; 0-60% had CSA and 10-35.2% had OSA. In chronic pain patients on opioids, the prevalence of SDB ranged from 71% to 100%; 17-80% had CSA and 20-39% had OSA. In MMPs, studies found a positive association between BMI, weight gain, duration of MMT, non-Caucasian race and the number of obstructive apneas, as well as blood methadone concentrations and the number of central apneas. In chronic pain patients on opioids, older age, higher BMI, male gender, and higher opioid doses predicted more obstructive apneas; older age, lower BMI, male gender, higher pain levels, higher benzodiazepine doses, and higher opioid doses predicted more central apneas.
CSA and OSA are common in MMPs and chronic pain patients on opioids. Among chronic pain patients, higher opioid doses appear to be a risk factor for CSA, and to a lesser extent OSA. Therefore, it is important for providers to screen these patient populations for SDB. (Am J Addict 2016;25:452-465).
阿片类药物会增加睡眠呼吸障碍（SDB）的风险，但针对服用阿片类药物的慢性疼痛患者以及美沙酮维持治疗患者（MMPs）中SDB，尤其是中枢性睡眠呼吸暂停（CSA）和阻塞性睡眠呼吸暂停（OSA）的患病率及危险因素的研究较少。
进行了一项文献综述，其中通过多导睡眠图（PSG）确诊了服用阿片类药物的慢性疼痛患者以及诊断为阿片类药物使用障碍或依赖美沙酮维持治疗（MMT）的患者存在SDB。
共纳入约22篇报告。6篇涉及MMPs，16篇涉及服用阿片类药物的慢性疼痛患者。在MMPs中，SDB的患病率在42.3%至70%之间；0 - 60%患有CSA，10 - 35.2%患有OSA。在服用阿片类药物的慢性疼痛患者中，SDB的患病率在71%至100%之间；17 - 80%患有CSA，20 - 39%患有OSA。在MMPs中，研究发现体重指数（BMI）、体重增加、MMT持续时间、非白种人种族与阻塞性呼吸暂停次数之间存在正相关，以及血液美沙酮浓度与中枢性呼吸暂停次数之间存在正相关。在服用阿片类药物的慢性疼痛患者中，年龄较大、BMI较高、男性以及阿片类药物剂量较高预示着更多的阻塞性呼吸暂停；年龄较大、BMI较低、男性、疼痛程度较高、苯二氮䓬类药物剂量较高以及阿片类药物剂量较高预示着更多的中枢性呼吸暂停。
CSA和OSA在MMPs以及服用阿片类药物的慢性疼痛患者中很常见。在慢性疼痛患者中，较高的阿片类药物剂量似乎是CSA的一个危险因素，对OSA的影响较小。因此，医疗服务提供者对这些患者群体进行SDB筛查很重要。（《美国成瘾杂志》2016年；25:452 - 465）
