Opioid-Induced Sleep Apnea

Mechanism of Opioid-Induced Sleep Apnea

Central respiratory depression occurs via activation of μ- and δ-opioid receptor subtypes in the ventrolateral medulla, which regulates respiratory rhythm, according to the British Journal of Pharmacology 1, 2
Opioids depress rate and depth of respiration, reduce upper airway patency, and blunt respiratory responsiveness to carbon dioxide and hypoxia, as reported in the British Journal of Pharmacology 1, 2, 3

Full opioid agonists are associated with 75-85% of patients having at least mild sleep apnea, with 36-41% having severe cases, as found in studies published in the British Journal of Pharmacology 1, 2, 4

High-risk patients, such as those with obesity, increased neck circumference, pre-existing respiratory compromise, or concurrent use of other CNS depressants, should be recognized, as recommended by the Annual Review of Medicine and other guidelines 5, 6
Polysomnography is required for definitive diagnosis, measuring apnea-hypopnea index, oxygen desaturation index, and minimum nocturnal oxygen saturation, according to the British Journal of Pharmacology 1, 2, 3