Javaheri Shahrokh, Patel Sanjiv
Bethesda North Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio.
The Ohio State Medical School, Columbus, Ohio.
J Clin Sleep Med. 2017 Jun 15;13(6):829-833. doi: 10.5664/jcsm.6628.
Central sleep apnea (CSA) and continuous positive airway pressure (CPAP) emergent CSA are common in patients for whom opioids have been prescribed for chronic pain management. It is not known if opioids are the potential cause of CSA. We report the case of a patient who underwent multiple full nights of polysomnography testing while on opioids, off opioids, and with various positive airway pressure devices. While on opioids, the patient had severe CSA that persisted during both CPAP and bilevel titration but was eliminated with adaptive servoventilation therapy. Some time later, opioid use was discontinued by the patient. Repeat polysomnography showed resolution of the sleep-disordered breathing. Later-while the patient was still off opioids-she had gained weight and become symptomatic; polysomnography showed obstructive sleep apnea without CSA. This time, therapy with CPAP showed elimination of sleep apnea without emergent CSA. These data collectively indicate that opioids were the cause of CSA as well as emergent CSA.
中枢性睡眠呼吸暂停（CSA）和持续气道正压通气（CPAP）诱发的CSA在因慢性疼痛管理而开具阿片类药物的患者中很常见。尚不清楚阿片类药物是否是CSA的潜在原因。我们报告了一例患者的病例，该患者在服用阿片类药物、停用阿片类药物以及使用各种气道正压通气设备的情况下，接受了多个整夜的多导睡眠图测试。在服用阿片类药物期间，患者患有严重的CSA，在CPAP和双水平滴定期间持续存在，但通过适应性伺服通气治疗得以消除。一段时间后，患者停用了阿片类药物。重复多导睡眠图显示睡眠呼吸障碍得到缓解。后来，当患者仍未服用阿片类药物时，她体重增加并出现症状；多导睡眠图显示为阻塞性睡眠呼吸暂停，无CSA。这次，CPAP治疗显示消除了睡眠呼吸暂停，无诱发的CSA。这些数据共同表明，阿片类药物是CSA以及诱发CSA的原因。
