Chronic intermittent hypoxia is independently associated with reduced postoperative opioid consumption in bariatric patients suffering from sleep-disordered breathing.

Alparslan Turan,Daniel I Sessler,Yashar Eshraghi,Jing You,Cameron Egan,Raktim Ghosh,Somnath Bose,Lovkesh Arora,Anthony G Doufas,Shahbaz Qavi,Ashish Khanna,Alex Fu,Shahrad Taheri

doi:10.1371/journal.pone.0127809

Alparslan Turan, Daniel I Sessler + Show 11 more

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https://doi.org/10.1371/journal.pone.0127809

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Abstract

BackgroundEvidence suggests that recurrent nocturnal hypoxemia may affect pain response and/or the sensitivity to opioid analgesia. We tested the hypothesis that nocturnal hypoxemia, quantified by sleep time spent at an arterial saturation (SaO2) < 90% and minimum nocturnal SaO2 on polysomnography, are associated with decreased pain and reduced opioid consumption during the initial 72 postoperative hours in patients having laparoscopic bariatric surgery.MethodsWith Institutional Review Board approval, we examined the records of all patients who underwent laparoscopic bariatric surgery between 2004 and 2010 and had an available nocturnal polysomnography study. We assessed the relationships between the time-weighted average of pain score and total opioid consumption during the initial 72 postoperative hours, and: (a) the percentage of total sleep time spent at SaO2 < 90%, (b) the minimum nocturnal SaO2, and (c) the number of apnea/hypopnea episodes per hour of sleep. We used multivariable regression models to adjust for both clinical and sleep-related confounders.ResultsTwo hundred eighteen patients were included in the analysis. Percentage of total sleep time spent at SaO2 < 90% was inversely associated with total postoperative opioid consumption; a 5-%- absolute increase in the former would relatively decrease median opioid consumption by 16% (98.75% CI: 2% to 28%, P = 0.006). However, the percentage of total sleep time spent at SaO2 < 90% was not associated with pain. The minimum nocturnal SaO2 was associated neither with total postoperative opioid consumption nor with pain. In addition, neither pain nor total opioid consumption was significantly associated with the number of apnea/hypopnea episodes per hour of sleep.ConclusionsPreoperative nocturnal intermittent hypoxia may enhance sensitivity to opioids.

Highlights

Sleep disruption and recurrent nocturnal hypoxemia are distinct pathophysiological components of obstructive sleep apnea (OSA), and both are thought to influence pain processing [1,2,3] and opioid analgesia [4,5]
Percentage of total sleep time spent at SaO2 < 90% was inversely associated with total postoperative opioid consumption; a 5-%- absolute increase in the former would relatively decrease median opioid consumption by 16% (98.75% confidence intervals (CI): 2% to 28%, P = 0.006)
The adjusted estimated ratio of medians of total opioid consumption was 0.84 (98.75% CI: 0.72 to 0.98) for a 5-%-absolute increase in the percentage of total sleep time spent at SaO2 < 90% (Table 2)

Summary

Introduction

Sleep disruption and recurrent nocturnal hypoxemia are distinct pathophysiological components of obstructive sleep apnea (OSA), and both are thought to influence pain processing [1,2,3] and opioid analgesia [4,5]. The contrast between insomnia and OSA with respect to pain sensitivity suggests that the two basic phenotypic components of OSA namely sleep disruption and recurrent nocturnal hypoxemia, have different or even opposite effects on pain processing. Consistent with this hypothesis, there is an association in OSA patients between nocturnal intermittent hypoxia and increased analgesic sensitivity to opioids [5]. We tested the hypothesis that nocturnal hypoxemia, quantified by sleep time spent at an arterial saturation (SaO2) < 90% and minimum nocturnal SaO2 on polysomnography, are associated with decreased pain and reduced opioid consumption during the initial 72 postoperative hours in patients having laparoscopic bariatric surgery

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