Tentindo Gregory S, Fishman Scott M, Li Chin-Shang, Wang Qinlu, Brass Steven D
Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA.
Department of Anesthesiology, Division of Pain Medicine, University of California Davis, Sacramento, CA, USA.
Nat Sci Sleep. 2018 Aug 1;10:217-224. doi: 10.2147/NSS.S167658. eCollection 2018.
Some patient subsets are at higher risk of sleep apnea, including patients with chronic pain. However, it is unclear whether patients and their caregivers are aware of the possibly increased risk of sleep apnea in this population. Chronic pain is often treated with opioids which may decrease both the central respiratory drive and the patency of the upper airway, potentially contributing to this sleep disorder. Using a self-reporting questionnaire approach in the chronic pain population, this study surveyed patient and caregiver awareness surrounding the risk of sleep apnea. In addition, we looked at the influence of opioid therapy on the prevalence of sleep apnea.
Consecutive patients presenting to a pain clinic were invited to participate anonymously in a survey that included the STOP-Bang sleep apnea questionnaire, which assesses patients' knowledge, testing, diagnosis, or treatment of sleep apnea and whether their caregivers had discussed with them their increased risk of sleep apnea and opioid use.
Among 305 participating patients, 58.2% (n=173) screened positive for sleep apnea. Among the 202 patients on opioid therapy, 59.2% (116/202) were STOP-Bang positive (score ≥3). However, only 37.5% (n=72/173) of these patients had discussed their risk of sleep apnea with a caregiver and only 30.7% (n=59) underwent testing. Against expectation, opioids did not increase the prevalence of sleep apnea in our study population.
Chronic pain patients had a high risk of sleep apnea, regardless of opioid prescription. Most patients were unaware of their increased risk and denied undergoing the necessary testing. Greater attention to screening, testing, and education for sleep apnea needs to be paid in chronic pain patients, especially given the potentially dangerous ramifications of opioid-induced sleep apnea.
部分患者亚组患睡眠呼吸暂停的风险较高，包括慢性疼痛患者。然而，尚不清楚患者及其护理人员是否意识到该人群中睡眠呼吸暂停风险可能增加。慢性疼痛常使用阿片类药物治疗，这可能会降低中枢呼吸驱动力和上呼吸道通畅性，从而可能导致这种睡眠障碍。本研究采用自我报告问卷法，对慢性疼痛人群中患者及护理人员对睡眠呼吸暂停风险的认知情况进行了调查。此外，我们还研究了阿片类药物治疗对睡眠呼吸暂停患病率的影响。
邀请连续到疼痛门诊就诊的患者匿名参与一项调查，该调查包括STOP-Bang睡眠呼吸暂停问卷，用于评估患者对睡眠呼吸暂停的认知、检测、诊断或治疗情况，以及其护理人员是否与他们讨论过睡眠呼吸暂停风险增加及阿片类药物使用的问题。
在305名参与调查的患者中，58.2%（n = 173）的患者睡眠呼吸暂停筛查呈阳性。在202名接受阿片类药物治疗的患者中，59.2%（116/202）的患者STOP-Bang问卷呈阳性（得分≥3）。然而，这些患者中只有37.5%（n = 72/173）与护理人员讨论过睡眠呼吸暂停风险，只有30.7%（n = 59）接受过检测。与预期相反，在我们的研究人群中，阿片类药物并未增加睡眠呼吸暂停的患病率。
慢性疼痛患者患睡眠呼吸暂停的风险较高，无论是否开具阿片类药物处方。大多数患者未意识到自身风险增加，且拒绝接受必要检测。对于慢性疼痛患者，需要更加关注睡眠呼吸暂停的筛查、检测和教育，尤其是考虑到阿片类药物引起的睡眠呼吸暂停可能产生的危险后果。
