Central Sleep Apnea and Opioid Use

Chronic opioid use has become a major public health issue. Individuals who use opioids may develop a distinct form of sleep apnea which is characterized by central apneas, irregular breathing, and at times hypoventilation. Those using higher opioid doses appear to be at increased risk, while other predisposing factors are yet to be established. Opioid-induced central sleep apnea (O-CSA) is accompanied by neurocognitive effects and may account for sleep disruption, daytime sleepiness, and other symptoms. The long-term impact of CSA in this group is not well-established. Dose reduction is the mainstay of treatment, although not always feasible. Positive airway pressure therapy has been utilized, with some patients responding to CPAP but potentially higher response rates to bilevel and adaptive servo-ventilation. Among patients with obstructive sleep apnea, opioids appear to be a risk factor for the emergence of CSA upon treatment with CPAP.