Opioids for Acute Pain Management in Patients With Obstructive Sleep Apnea: A Systematic Review.

  title={Opioids for Acute Pain Management in Patients With Obstructive Sleep Apnea: A Systematic Review.},
  author={Crispiana Cozowicz and Frances F Chung and Anthony G. Doufas and Mahesh Nagappa and Stavros G. Memtsoudis},
  journal={Anesthesia \& Analgesia},
The intrinsic nature of opioids to suppress respiratory function is of particular concern among patients with obstructive sleep apnea (OSA). The association of OSA with increased perioperative risk has raised the question of whether patients with OSA are at higher risk for opioid-induced respiratory depression (OIRD) compared to the general population. The aims of this systematic review were to summarize current evidence with respect to perioperative OIRD, changes in sleep-disordered breathing… 

The influence of acute morphine use on obstructive sleep apnea: A systematic review and meta‐analysis

A single dose of 30 or 40 mg morphine does not have a significant effect on sleep or respiratory outcomes compared to placebo in patients with OSA, challenging the orthodoxy that opioids worsen OSA.

Identification and treatment of obstructive sleep apnea by a primary care team with a subset focus on chronic pain management

Team based care management for participants taking prescription opioids, where STOP-Bang questionnaires were completed, were associated with an increase in the identification and treatment of OSA.

Perioperative Pain Management in Morbid Obesity

The role of opioid-sparing pharmacological adjuvants and implementation of standardized protocols are discussed, future areas of research in perioperative pain management in this patient population are highlighted, and further advancements in acute pain management are sought.

Poor Sleep, Worse Outcomes: Obstructive Sleep Apnea and Perioperative Care.

The results of a systematic review of largely observational studies that characterize the relationship among obstructive sleep apnea, sleep-disordered breathing, postoperative anesthesia care, and opioids are examined.

Best perioperative practice in management of ambulatory patients with obstructive sleep apnea

It is important to identify patients with OSA, with the goal to raise awareness among providers, mitigate risk and improve outcomes, and highlight the best perioperative practices in the management of OSA patients undergoing ambulatory surgical procedures.

Perioperative Care of the Orthopedic Patient with Sleep-Disordered Breathing: Obstructive Sleep Apnea

This chapter focuses on current evidence, knowledge and clinical recommendations in respect to the perioperative care of surgical patients at risk or diagnosed with OSA.

Preoperative optimization of obstructive sleep apnea

The current best available evidence with regard to the screening, diagnosis, and treatment of OSA in the preoperative period is summarized to provide preoperative clinics with the knowledge necessary to optimize OSA patients for surgery and improve outcomes associated with this devastating disease.

Obstructive sleep apnea endotypes and their postoperative relevance

Each of the 4 key OSA endotypes is described, the ways that OSA therapies target these endotypes, the potential endotype-specific impacts of postoperative risk factors on OSA severity, and new methods that have recently been developed to noninvasively measure an individual’s endotypic traits are described.

Perioperative Opioid Consumption is Not Reduced in Cyanotic Patients Presenting for the Fontan Procedure

In contrast to other populations with chronic hypoxemia exposure, children with cyanotic CHD did not appear to have increased sensitivity to the effects of opioid medications.



Does Obstructive Sleep Apnea Influence Perioperative Outcome? A Qualitative Systematic Review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing

The majority of studies suggest that the presence of OSA is associated with an increased risk of postoperative complications, and the association between OSA and in-hospital mortality varied among studies.

Obstructive sleep apnea, pain, and opioids: is the riddle solved?

OSA may complicate opioid-based perioperative management of pain by altering both pain processing and sensitivity to opioid effect in patients suffering from obstructive sleep apnea.

Respiratory depression associated with patient-controlled analgesia: a review of eight cases

  • R. Etches
  • Medicine
    Canadian journal of anaesthesia = Journal canadien d'anesthesie
  • 1994
The Office of Medical Quality Improvement retrospectively searched for reports of respiratory depression in a database compiled from the charts of approximately 1600 patients who had received PCA at the University of Alberta Hospitals in 1992, finding eight cases of serious respiratory depression.

Association of opioid prescription and perioperative complications in obstructive sleep apnea patients undergoing total joint arthroplasties

Higher levels of opioid prescription were associated with higher odds for gastrointestinal complications and adverse effects on cost and length of stay but lower odds for pulmonary complications in OSA patients undergoing joint arthroplasties.

Respiratory and Sleep Effects of Remifentanil in Volunteers with Moderate Obstructive Sleep Apnea

The data suggest that caution is warranted when administering opioids to subjects with moderate OSA, but that the primary risk may be central apnea, not obstructive apnea.

Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome.

The incidence of postoperative desaturation, respiratory failure, postoperative cardiac events, and ICU transfers was higher in patients with OSA, and a significant degree of heterogeneity of the effect among studies was found.

Obstructive Sleep Apnea, Pain, and Opioid Analgesia in the Postoperative Patient

  • A. Doufas
  • Medicine
    Current Anesthesiology Reports
  • 2013
Current evidence does not support a direct relationship between an isolated preoperative diagnosis of OSA and increased risk for OIVI during postoperative analgesic therapy, but older age, comorbidity burden, and increased postoperative sedation, seem to be important promoters of potentially severe OivI in the postoperative patient.

Experimental Pain and Opioid Analgesia in Volunteers at High Risk for Obstructive Sleep Apnea

Nocturnal hypoxemia in subjects at high risk for OSA was associated with an increased potency of opioid analgesia and other pro-inflammatory mediators predicted an enhanced opioid potency.