Opioid Analgesic Use in Patients with Sleep Disorders: A Retrospective Cohort Study Using Electronic Health Records

Abstract

The objective of this study was to utilize electronic health records to determine the incidence of opiate prescription following diagnosis of a sleep related disorder. Opiate use disrupts sleep architecture triggering sleep disturbances, and neurobiological mechanisms exist through which sleep disorders modify opiate reward pathways. We hypothesized patients with sleep disorders will have increased opiate prescriptions following diagnosis. We used data from the TriNetX electronic health records network which includes over 80 million patients from 57 health care organizations across the world. We compared adult patients with the most common sleep disorders against adults with negative polysomnography. Patients with a sleep disorder were more likely to use opioids than those without a sleep disorder (RR 1.39, 95% CI 1.35, 1.44). Patients with a sleep disorder also had significantly more unique opiate uses in their medical record (2.56, sd 12.18, p < 0.001) compared to individuals without a sleep disorder (1.101, sd 5.57). Sleep disorder patients also used an opiate closer to the date of their sleep assessment compared to patients without a sleep disorder (median 2078 and 3345 days, respectively). These results support our hypothesis of increased opiate use by patients with a sleep disorder. Sleep disorder patients are more likely to receive opiates, receive a higher quantity, and receive them closer to their sleep assessment. These results support that the association between opiates and nighttime breathing disorders is bidirectional.