J Addict Nurs. 2023;34(4):E180-E188. doi: 10.1097/JAN.0000000000000470. Epub 2023 Sep 28.
Opioids are a leading cause of drug overdose deaths in the United States. Methadone used as medication for opioid use disorder (MOUD) reduces drug cravings and promotes abstinence. However, individuals in methadone-based MOUD treatment commonly report subjective sleep complaints and are at risk for respiratory depression from opioids. We investigated nighttime sleep and respiratory function in eight individuals (six women, two men; ages 31-68 years) in their first 90 days of methadone-based MOUD treatment. Participants underwent overnight cardiorespiratory polysomnography. Sleep and respiratory variables were characterized with descriptive statistics for comparison to reference data from similarly aged healthy adults. Although participants spent 8.1 ± 0.3 hours (mean ± SD ) in bed, their total sleep time was only 6.8 ± 1.3 hours. They exhibited longer sleep latency and intermittent wakefulness. Sleep structure was irregular, with disrupted sleep cycles. Participants also displayed a decreased amount of N1 sleep and an increased amount of N3 sleep, compared with reference data. Participants showed respiratory depression, with an average apnea-hypopnea index of 16.5 ± 8.9 events per hour. Central sleep apneas comprised 69.1% ± 20.9% of the respiratory events. A Cheyne-Stokes-like breathing pattern, consisting of 30-second cycles of three central sleep apneas, was observed in 75% of participants. Our results suggest that individuals early in methadone-based MOUD treatment experience disordered sleep and respiratory disturbances. Such nighttime physiological changes may have serious long-term health consequences and contribute to unintended overdose rates. Identifying and treating MOUD individuals with sleep apnea could reduce risk of death.
阿片类药物是美国药物过量死亡的主要原因。美沙酮作为阿片类药物使用障碍（MOUD）的药物治疗，可减少药物渴望并促进戒断。然而，接受美沙酮为基础的 MOUD 治疗的个体通常会报告主观睡眠问题，并存在阿片类药物引起呼吸抑制的风险。我们研究了 8 名（6 名女性，2 名男性；年龄 31-68 岁）在接受美沙酮为基础的 MOUD 治疗的头 90 天内的夜间睡眠和呼吸功能。参与者接受了整夜心肺多导睡眠图检查。使用描述性统计数据对睡眠和呼吸变量进行了特征描述，以与年龄相似的健康成年人的参考数据进行比较。尽管参与者在床上度过了 8.1 ± 0.3 小时（平均值 ± 标准差），但他们的总睡眠时间仅为 6.8 ± 1.3 小时。他们的睡眠潜伏期和间歇性觉醒时间更长。睡眠结构不规则，睡眠周期中断。与参考数据相比，参与者还表现出 N1 睡眠时间减少和 N3 睡眠时间增加。参与者显示出呼吸抑制，平均呼吸暂停-低通气指数为 16.5 ± 8.9 次/小时。中枢性睡眠呼吸暂停占呼吸事件的 69.1%±20.9%。在 75%的参与者中观察到一种类似于 Cheyne-Stokes 的呼吸模式，由 30 秒长的三个中枢性睡眠呼吸暂停周期组成。我们的研究结果表明，在接受美沙酮为基础的 MOUD 治疗的早期，个体经历了睡眠障碍和呼吸紊乱。这种夜间生理变化可能会产生严重的长期健康后果，并导致意外的过量率增加。识别和治疗 MOUD 患者的睡眠呼吸暂停可能会降低死亡风险。
