Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical of Medical Sciences, Tehran, Iran.
Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Adv Respir Med. 2021;89(4):439-443. doi: 10.5603/ARM.a2020.0160. Epub 2021 Apr 19.
Opioids are used widely as analgesics and can play an important role in agonist maintenance therapy for opium dependence. Despite their benefits, the negative effects on the respiratory system remain an important side effect to be considered. Ataxic breathing, obstructive sleep apnea, and most of all central sleep apnea are among these concerns. Obstructive sleep apnea leads to various metabolic, cardiovascular, cognitive, and mental side effects and may result in abrupt mortality. Buprenorphine is a semisynthetic opioid, a partial mu-opioid agonist with limited respiratory toxicity preferably used by these patients, as it is accompanied by significantly lower risk factors in the development of obstructive and central sleep apnea. In this manuscript, the case of a patient is reported who underwent methadone maintenance therapy which was shifted to buprenorphine in order to observe possible changes in sleep-related breathing disorders. The results of this study indicate a reduction in these problems through the desaturation and apnea hypopnea index of methadone substituted by buprenorphine while no change in sleepiness was observed.
阿片类药物被广泛用作镇痛药，在阿片类药物依赖的激动剂维持治疗中可以发挥重要作用。尽管它们有好处，但对呼吸系统的负面影响仍然是一个需要考虑的重要副作用。共济失调性呼吸、阻塞性睡眠呼吸暂停，尤其是中枢性睡眠呼吸暂停都属于这方面的问题。阻塞性睡眠呼吸暂停会导致各种代谢、心血管、认知和精神方面的副作用，并可能导致突然死亡。丁丙诺啡是一种半合成阿片类药物，是一种有限的呼吸毒性的μ-阿片受体部分激动剂，这些患者最好使用，因为它在发展阻塞性和中枢性睡眠呼吸暂停方面的风险因素明显降低。在本文中，报告了一例患者，他接受了美沙酮维持治疗，随后转为丁丙诺啡，以观察睡眠相关呼吸障碍可能发生的变化。这项研究的结果表明，通过用丁丙诺啡替代美沙酮，可以降低这些问题的发生，而嗜睡程度没有变化。
