Opioid-Induced Central Sleep Apnea

Abstract

Patients on chronic opioids have significant central sleep apnea (CSA) and complex sleep apnea. The mechanism of opioid-induced CSA most probably has to do with suppression of inspiration generated by the pre-Botzinger complex. The best approach for treatment of opioid-induced CSA is a programmed withdrawal of opioids. Another option is treatment with bilevel devices with backup rate, or the new adaptive servoventilation devices, which are effective in eliminating sleep-related breathing disorders. However, randomized clinical trials are needed to determine if treatment with positive airway pressure devices has any effect on quality of life or excess mortality.