Murin Peyton J, Wang Jora, Martins Yuri Chaves
Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
College of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
J Clin Med. 2025 Jul 4;14(13):4758. doi: 10.3390/jcm14134758.
Opioid use in patients with sleep disordered breathing (SDB) presents therapeutic challenges within chronic pain and sleep medicine. Opioids impair respiratory drive through μ-opioid receptor activation in brainstem respiratory centers, exacerbating both obstructive and central apneas. Chronic opioid use is also linked to a high prevalence of central sleep apnea and increased nocturnal hypoventilation. Simultaneously, SDB contributes to heightened pain sensitivity via intermittent hypoxia, systemic inflammation, and alterations in neural plasticity. These mechanisms may influence opioid efficacy and dosing requirements. This review summarizes current evidence on how SDB and opioid use interact, emphasizing chronic opioid use in the setting of chronic pain management. We discuss the underlying mechanisms, clinical impacts, and potential avenues for enhanced diagnosis and therapy in this population. We conclude that the intersection of SDB and opioid use presents a complex clinical challenge that demands a multidisciplinary approach. Enhanced screening, personalized pharmacologic strategies, and integration of advanced diagnostics are essential for mitigating risks and optimizing care. Future research should focus on mechanistic studies and interventional trials to guide evidence-based management of this high-risk population.
睡眠呼吸障碍（SDB）患者使用阿片类药物在慢性疼痛和睡眠医学领域带来了治疗挑战。阿片类药物通过激活脑干呼吸中枢的μ-阿片受体损害呼吸驱动力，加重阻塞性和中枢性呼吸暂停。长期使用阿片类药物还与中枢性睡眠呼吸暂停的高患病率以及夜间通气不足增加有关。同时，睡眠呼吸障碍通过间歇性缺氧、全身炎症和神经可塑性改变导致疼痛敏感性增强。这些机制可能影响阿片类药物的疗效和剂量需求。本综述总结了关于睡眠呼吸障碍与阿片类药物使用如何相互作用的现有证据，重点关注慢性疼痛管理背景下的长期阿片类药物使用。我们讨论了该人群中潜在的机制、临床影响以及增强诊断和治疗的潜在途径。我们得出结论，睡眠呼吸障碍与阿片类药物使用的交叉点提出了一个复杂的临床挑战，需要多学科方法。加强筛查、个性化药物治疗策略以及先进诊断方法的整合对于降低风险和优化护理至关重要。未来的研究应侧重于机制研究和干预试验，以指导对这一高风险人群进行循证管理。
