Medical College of Wisconsin, Milwaukee, WI.
Allstar Pain Management, Annapolis, MD.
Pain Physician. 2022 Nov;25(8):E1263-E1267.
Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. While patients on chronic opioids are at increased risk of sleep-disordered breathing, there is a lack of data on the relationship between opioid dose and OSA risk in particular. The STOP-Bang Questionnaire (SBQ) is a common screening tool for OSA, but it has not been well studied in patients on chronic opioid therapy.
This study uses the SBQ to examine the relationship between total daily opioid dose and the risk of OSA in patients on chronic opioid therapy.
Retrospective chart review.
Academic medical center pain clinic.
Patients on stable doses of chronic opioids who completed the SBQ were grouped into 3 OSA risk categories, including low (SBQ score 0-2), medium (SBQ score 3-4), and high risk (SBQ score 5-8). Morphine equivalent daily dose (MEDD) was calculated and compared between the 3 risk groups. In a secondary analysis, patients were instead grouped into opioid dose categories, including low MEDD (≤ 20), medium MEDD (21-50), and high MEDD (> 50). The SBQ scores were then compared between the 3 MEDD groups.
The charts of 190 patients on chronic opioid therapy were reviewed. One hundred forty-seven patients did not have a prior diagnosis of OSA. Of these, 92 (63%) patients completed the SBQ. Fifty-five percent were women and 45% men. The average age was 59. The average MEDD was 23.32. In the primary analysis based on the SBQ score, 39% were low risk for OSA, 42% medium risk, and 18% were high risk. There was no difference in total MEDD between the 3 groups (P = 0.83). In the secondary analysis based on total MEDD, 58% had low MEDD, 32% had medium MEDD, and 11% had high MEDD. There was no significant difference in SBQ scores between these groups (P = 0.51).
This is a single center study, and only 63% of eligible patients completed the SBQ. The study did not attempt to control for potential confounders. The SBQ results were not confirmed with a polysomnogram.
We found no relationship between the opioid dose and the risk of OSA as measured by the SBQ score in this chronic opioid population. Opioids may be more associated with sleep apnea due to central rather than obstructive processes, and additional screening tools beyond the SBQ may be needed to better screen for sleep apnea in this population.
阻塞性睡眠呼吸暂停（OSA）是最常见的睡眠呼吸障碍形式。虽然慢性阿片类药物使用者患睡眠呼吸障碍的风险增加，但关于阿片类药物剂量与 OSA 风险之间的关系的数据却很少。STOP-Bang 问卷（SBQ）是 OSA 的常用筛查工具，但在接受慢性阿片类药物治疗的患者中，该工具的研究还不够充分。
本研究使用 SBQ 检查慢性阿片类药物使用者的总日阿片类药物剂量与 OSA 风险之间的关系。
回顾性图表审查。
学术医疗中心疼痛诊所。
完成 SBQ 的稳定剂量慢性阿片类药物使用者被分为 3 个 OSA 风险类别，包括低风险（SBQ 评分 0-2）、中风险（SBQ 评分 3-4）和高风险（SBQ 评分 5-8）。计算并比较了 3 个风险组之间的吗啡等效日剂量（MEDD）。在二次分析中，患者按阿片类药物剂量分类，包括低 MEDD（≤20）、中 MEDD（21-50）和高 MEDD（>50）。然后比较了 3 个 MEDD 组之间的 SBQ 评分。
共回顾了 190 名接受慢性阿片类药物治疗患者的病历。147 名患者没有 OSA 的既往诊断。其中，92 名（63%）患者完成了 SBQ。55%为女性，45%为男性。平均年龄为 59 岁。平均 MEDD 为 23.32。在基于 SBQ 评分的主要分析中，39%的患者 OSA 风险低，42%的患者 OSA 风险中，18%的患者 OSA 风险高。3 组之间的总 MEDD 无差异（P=0.83）。在基于总 MEDD 的二次分析中，58%的患者 MEDD 低，32%的患者 MEDD 中，11%的患者 MEDD 高。这些组之间的 SBQ 评分无显著差异（P=0.51）。
这是一项单中心研究，只有 63%的合格患者完成了 SBQ。该研究没有尝试控制潜在的混杂因素。SBQ 结果未通过多导睡眠图进行确认。
在接受慢性阿片类药物治疗的人群中，我们没有发现阿片类药物剂量与 SBQ 评分所测 OSA 风险之间存在关联。阿片类药物可能更多地与中枢性而不是阻塞性睡眠呼吸暂停有关，因此可能需要除 SBQ 以外的其他额外筛查工具来更好地筛查该人群的睡眠呼吸暂停。
