Mental Health & Behavioral Sciences Service (MHBSS), James A. Haley Veterans' Hospital, Tampa, Florida (Drs Martin and Richardson); Departments of Psychiatry and Behavioral Neurosciences (Dr Martin) and Internal Medicine, Division of Pulmonary and Sleep Medicine (Drs Richardson and Schwartz), University of South Florida, Tampa; Defense Health Agency Traumatic Brain Injury Center of Excellence at James A. Haley Veterans Hospital, Tampa, Florida (Dr Richardson); Research Department, Craig Hospital, Englewood, Colorado (Ms Almeida); Department of Rehabilitation Medicine, Division of Rehabilitation Psychology, University of Washington School of Medicine, Seattle (Drs Starosta and Hoffman); Department of Physical Medicine & Rehabilitation, Indiana University, Indianapolis (Dr Hammond); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dr Fann); and Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas (Dr Bell).
J Head Trauma Rehabil. 2021;36(5):374-387. doi: 10.1097/HTR.0000000000000727.
To describe patient and clinical characteristics associated with receipt of opioid medications and identify differences in sleep quality, architecture, and sleep-related respiration between those receiving and not receiving opioid medications.
Acute inpatient rehabilitation care for moderate to severe traumatic brain injury (TBI).
A total of 248 consecutive admissions for inpatient rehabilitation care following moderate to severe TBI (average age of 43.6 years), who underwent level 1 polysomnography (PSG) (average time since injury: 120 days) across 6 sites.
Cross-sectional, secondary analyses.
The PSG sleep parameters included total sleep time (TST), sleep efficiency (SE), wake after sleep onset, rapid eye movement (REM) latency, sleep staging, and arousal and awakening indices. Respiratory measures included oxygen saturation, central apnea events per hour, obstructive apnea and hypopnea events per hour, and total apnea-hypopnea index.
After adjustment for number of prescribed medication classes, those receiving opioid medications on the day of PSG experienced increased TST relative to those not receiving opioid medications (estimated mean difference [EMD] = 31.58; 95% confidence interval [CI], 1.9-61.3). Other indices of sleep did not differ significantly between groups. Among respiratory measures those receiving opioids on the day of PSG experienced increased frequency of central sleep apnea events during total (EMD = 2.92; 95% CI, 0.8-5.0) and non-REM sleep (EMD = 3.37; 95% CI, 1.0-5.7) and higher frequency of obstructive sleep apnea events during REM sleep (EMD = 6.97; 95% CI, 0.1-13.8). Compared with those who did not, receiving opioids was associated with lower oxygen saturation nadir during total sleep (EMD = -3.03; 95% CI, -5.6 to -0.4) and a greater number of oxygen desaturations across REM (EMD = 8.15; 95% CI, 0.2-16.1), non-REM (EMD = 7.30; 95% CI, 0.3-14.4), and total sleep (EMD = 8.01; 95% CI, 0.8-15.2) Greater total apnea-hypopnea index was observed during REM (EMD = 8.13; 95% CI, 0.8-15.5) and total sleep (EMD = 7.26; 95% CI, 0.08-14.4) for those receiving opioids.
Opioid use following moderate to severe TBI is associated with an increase in indicators of sleep-related breathing disorders, a modifiable condition that is prevalent following TBI. As sleep-wake disorders are associated with poorer rehabilitation outcomes and opioid medications may frequently be administered following traumatic injury, additional longitudinal investigations are warranted in determining whether a causal relation between opioids and sleep-disordered breathing in those following moderate to severe TBI exists. Given current study limitations, future studies can improve upon methodology through the inclusion of indication for and dosage of opioid medications in this population when examining these associations.
描述与接受阿片类药物相关的患者和临床特征，并确定接受和不接受阿片类药物治疗的患者之间睡眠质量、结构和与睡眠相关的呼吸差异。
中度至重度创伤性脑损伤（TBI）的急性住院康复护理。
共有 248 名连续入住中度至重度 TBI 康复护理的患者（平均年龄为 43.6 岁），他们在 6 个地点接受了 1 级多导睡眠图（PSG）（平均受伤后时间：120 天）。
横断面，二次分析。
PSG 睡眠参数包括总睡眠时间（TST）、睡眠效率（SE）、睡眠后觉醒、快速眼动（REM）潜伏期、睡眠分期、觉醒和唤醒指数。呼吸测量包括血氧饱和度、每小时中枢性呼吸暂停事件、每小时阻塞性呼吸暂停和低通气事件以及总呼吸暂停-低通气指数。
调整了规定药物类别数量后，与未接受阿片类药物治疗的患者相比，当天接受阿片类药物治疗的患者 TST 增加（估计平均差异[EMD] = 31.58；95%置信区间[CI]，1.9-61.3）。两组之间其他睡眠指标无显著差异。在呼吸测量中，当天接受阿片类药物治疗的患者在总睡眠时间（EMD = 2.92；95%CI，0.8-5.0）和非快速眼动睡眠（EMD = 3.37；95%CI，1.0-5.7）期间的中央睡眠呼吸暂停事件频率更高，REM 睡眠期间的阻塞性睡眠呼吸暂停事件频率更高（EMD = 6.97；95%CI，0.1-13.8）。与未接受阿片类药物治疗的患者相比，接受阿片类药物治疗与总睡眠时间的血氧饱和度最低值较低（EMD = -3.03；95%CI，-5.6 至-0.4）以及 REM（EMD = 8.15；95%CI，0.2-16.1）、非快速眼动（EMD = 7.30；95%CI，0.3-14.4）和总睡眠时间（EMD = 8.01；95%CI，0.8-15.2）的血氧饱和度下降次数增加。接受阿片类药物治疗的患者 REM（EMD = 8.13；95%CI，0.8-15.5）和总睡眠时间（EMD = 7.26；95%CI，0.08-14.4）的总呼吸暂停-低通气指数较高。
中度至重度 TBI 后使用阿片类药物与睡眠相关呼吸障碍指标增加有关，这是 TBI 后普遍存在的一种可改变的情况。由于睡眠-觉醒障碍与康复结局较差有关，而阿片类药物可能经常在创伤后给予，因此需要进行更多的纵向研究，以确定中度至重度 TBI 患者中阿片类药物与睡眠呼吸障碍之间是否存在因果关系。鉴于目前研究的局限性，未来的研究可以通过在研究这些关联时纳入该人群中阿片类药物的适应症和剂量来改进方法。
