Perioperative opioids aggravate obstructive breathing in sleep apnea syndrome: mechanisms and alternative anesthesia strategies.

Abstract

Opioids induce and increase the severity of most sleep-disordered breathing in all patients, but especially in morbidly obese patients. Discussed herein are the direct impact and mechanisms of opioids on inducing and exacerbating obstructive sleep apnea syndrome in normal and morbidly obese patients. Respiratory depression is a larger problem than obstructive sleep apnea syndrome during the first night after an opioid anesthesia because of the reduced amount of deep sleep and rapid-eye-movement sleep. Acute tolerance to the analgesic effects of opioids can be observed after one anesthetic opioid dose, although tolerance to the side-effects of opioids develops more slowly. Therefore, it makes sense to avoid all opioids intraoperatively. A recently developed multimodal nonopioid anesthesia method may prevent development of acute tolerance and facilitate postoperative pain management with less opioids and sleep-disordered breathing. A multimodal nonopioid anesthesia method avoids the necessity for intraoperative opioids, reduces the need for postoperative opioid use, and improves analgesia with less narcotic.