Gavidia Ronald, Emenike Amara, Meng Anran, Jansen Erica C, Hershner Shelley, Goldstein Cathy, Fetterolf Judy, Dunietz Galit Levi
Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan.
Tallahassee Memorial Hospital Sleep Disorders Center, Tallahassee, Florida.
J Clin Sleep Med. 2021 Jan 1;17(1):55-60. doi: 10.5664/jcsm.8826.
Opioids are known to contribute to central sleep apnea (CSA), but the influence of nonopioid central nervous system active medications (CNSAMs) on CSA remains unclear. In light of the hypothesized impact of nonopioid CNSAMs on respiration, we examined the relationships between the use of opioids only, nonopioid CNSAMs alone, and their combination with CSA.
Among all adults who underwent polysomnography testing at the University of Michigan's sleep laboratory between 2013 and 2018 (n = 10,606), we identified 212 CSA cases and randomly selected 300 controls. Participants were classified into four groups based on their medication use: opioids alone, nonopioid CNSAMs only, their combination, and a reference group, including those who did not use any of these medications. We defined CSA as a binary outcome and as a continuous variable using central apnea index data. Logistic and linear regression were used to examine associations between medication use, CSA diagnosis, and central apnea index.
Study participants included 58% men, and mean age was 50 (± 14 standard deviation years. Nearly half of the study participants did not use opioids or nonopioid CNSAMs, 6% used opioids alone, 27% nonopioid CNSAMs alone, and 16% used a combination of these medications. In adjusted analyses, opioids-only users had a nearly twofold increase in CSA odds, whereas those who used a combination of opioids and nonopioid CNSAMs had fivefold higher odds of CSA relative to the reference group. In contrast, the use of nonopioid CNSAMs alone had protective associations with CSA.
This report showed increased odds of CSA, particularly among patients with sleep complaints who were prescribed opioids in combination with nonopioid CNSAMs compared with those who did not use any of these medications.
已知阿片类药物会导致中枢性睡眠呼吸暂停（CSA），但非阿片类中枢神经系统活性药物（CNSAMs）对CSA的影响尚不清楚。鉴于非阿片类CNSAMs对呼吸的假定影响，我们研究了仅使用阿片类药物、单独使用非阿片类CNSAMs以及它们与CSA联合使用之间的关系。
在2013年至2018年期间于密歇根大学睡眠实验室接受多导睡眠图测试的所有成年人（n = 10606）中，我们确定了212例CSA病例，并随机选择了300名对照。参与者根据其用药情况分为四组：仅使用阿片类药物、仅使用非阿片类CNSAMs、两者联合使用以及一个参照组，包括未使用这些药物中的任何一种的人。我们使用中枢性呼吸暂停指数数据将CSA定义为二元结局和连续变量。采用逻辑回归和线性回归来研究用药情况、CSA诊断和中枢性呼吸暂停指数之间的关联。
研究参与者中58%为男性，平均年龄为50岁（±14标准差岁）。近一半的研究参与者未使用阿片类药物或非阿片类CNSAMs，6%仅使用阿片类药物，27%仅使用非阿片类CNSAMs，16%同时使用了这些药物。在调整分析中，仅使用阿片类药物的使用者患CSA的几率增加了近两倍，而同时使用阿片类药物和非阿片类CNSAMs的使用者患CSA的几率相对于参照组高出五倍。相比之下，单独使用非阿片类CNSAMs与CSA存在保护性关联。
本报告显示CSA的几率增加，特别是在有睡眠主诉且同时开具阿片类药物和非阿片类CNSAMs的患者中，与未使用这些药物的患者相比。
