Obstructive sleep apnea, pain, and opioids: Is the riddle solved?

Current Opinion in Anaesthesiology

Volumn 29, Issue 1, 2016, Pages 134-140

  Lam, Karen K ^a   Kunder, Samuel ^a   Wong, Jean ^a   Doufas, Anthony G ^b   Chung, Frances ^a  

^a TORONTO WESTERN HOSPITAL   (Canada)

^b STANFORD UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

obstructive sleep apnea; opioids; pain; sleep disordered breathing

Indexed keywords

OPIATE; NARCOTIC ANALGESIC AGENT;

AIRWAY OBSTRUCTION; ANALGESIA; ANALGESIC ACTIVITY; APNEA; AROUSAL; ARTICLE; CHEMORECEPTOR REFLEX; CONTROLLED CLINICAL TRIAL (TOPIC); HEART DISEASE; HUMAN; INTERMITTENT HYPOXIA; KIDNEY DISEASE; OUTCOMES RESEARCH; OXYGEN SATURATION; PAIN; PERIOPERATIVE PERIOD; POSTOPERATIVE ANALGESIA; POSTOPERATIVE PAIN; POSTOPERATIVE PERIOD; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; RESPIRATION DEPRESSION; SLEEP DISORDERED BREATHING; TREATMENT RESPONSE; WAKEFULNESS; CHEMICALLY INDUCED; PAIN, POSTOPERATIVE;

ANALGESICS, OPIOID; HUMANS; PAIN, POSTOPERATIVE; SLEEP APNEA, OBSTRUCTIVE;

EID: 84952716562     PISSN: 09527907     EISSN: 14736500     Source Type: Journal    
DOI: 10.1097/ACO.0000000000000265     Document Type: Article

References (79)

1. Doufas AG. Obstructive sleep apnea, pain, and opioid analgesia in the postoperative patient. Curr Anesthesiol Rep 2014; 4:1-9.
2. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5:263-276.
3. Brown KA, Laferriè re A, Lakheeram I, Moss IR. Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology 2006; 105:665-669.
4. Cashman JN, Dolin SJ. Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data. Br J Anaesth 2004; 93:212-223.
5. Overdyk F, Dahan A, Roozekrans M, et al. Opioid-induced respiratory depression in the acute care setting: a compendium of case reports. Pain Manag 2014; 4:317-325.
6. Dahan A, Overdyk F, Smith T, et al. Pharmacovigilance: a review of opioidinduced respiratory depression in chronic pain patients. Pain physician 2013; 16:E85-E94.
7. Jayr C, Thomas H, Rey A, et al. Postoperative pulmonary complications. Epidural analgesia using bupivacaine and opioids versus parenteral opioids. Anesthesiology 1993; 78:666-676.
8. Tsui SL, Lo RJ, Tong WN, et al. A clinical audit for postoperative pain control on 1443 surgical patients. Acta Anaesthesiol Sin 1995; 33:137-148.
9. Wheatley RG, Somerville ID, Sapsford DJ, Jones JG. Postoperative hypoxaemia: comparison of extradural, i.m. and patient-controlled opioid analgesia. Br J Anaesth 1990; 64:267-275.
10. Sun Z, Sessler DI, Dalton JE, et al. Postoperative hypoxemia is common and persistent: a prospective blinded observational study. Anesth Analg 2015; 121:709-715.
11. Ramachandran SK, Haider N, Saran KA, et al. Life-threatening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesth 2011; 23:207-213.
12. Lee LA, Caplan RA, Stephens LS, et al. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology 2015; 122:659-665.
13. Chung F, Liao P, Elsaid H, et al. Factors associated with postoperative exacerbation of sleep-disordered breathing. Anesthesiology 2014; 120:299-311.
14. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev 2010; 90:47-112.
15. White DP, Younes MK. Obstructive sleep apnea. Compr Physiol 2012; 2:2541-2594.
16. Younes M. Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea. Am J Respir Crit Care Med 2003; 168:645-658.
17. Koo CY, Eikermann M. Respiratory effects of opioids in perioperative medicine. Open Anesthesiol J 2011; 5 (Suppl 1-M6):23-34.
18. Isono S, Remmers JE, Tanaka A, et al. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol (1985) 1997; 82:1319-1326.
19. Horner RL. Motor control of the pharyngeal musculature and implications for the pathogenesis of obstructive sleep apnea. Sleep 1996; 19:827-853.
20. Horner RL, Hughes SW, Malhotra A. State-dependent and reflex drives to the upper airway: basic physiology with clinical implication. J Appl Physiol (1985) 2014; 116:325-336.
21. Younes M, Ostrowski M, Atkar R, et al. Mechanisms of breathing instability in patients with obstructive sleep apnea. J Appl Physiol (1985) 2007; 103:1929-1941.
22. Younes M. Role of respiratory control mechanisms in the pathogenesis of obstructive sleep disorders. J Appl Physiol 2008; 105:1389-1405.
23. Loewen AH, Ostrowski M, Laprairie J, et al. Response of genioglossus muscle to increasing chemical drive in sleeping obstructive apnea patients. Sleep 2011; 34:1061-1073.
24. Younes M, Loewen AH, Ostrowski M, et al. Genioglossus activity available via nonarousal mechanisms vs. that required for opening the airway in obstructive apnea patients. J Appl Physiol (1985) 2012; 112:249-258.
25. Younes M. Role of arousals in the pathogenesis of obstructive sleep apnea. Am J Respir Crit Care Med 2004; 169:623-633.
26. Wang D, Marshall NS, Duffin J, et al. Phenotyping interindividual variability in obstructive sleep apnoea response to temazepam using ventilatory chemoreflexes during wakefulness. J Sleep Res 2011; 20:526-532.
27. Smith I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2013; 5:CD003002.
28. Mokhlesi B, Tulaimat A, Parthasarathy S. Oxygen for obesity hypoventilation syndrome: a double-edged sword? Chest 2011; 139:975-977.
29. Eckert DJ, Owens RL, Kehlmann GB, et al. Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold. Clin Sci (Lond) 2011; 120:505-514.
30. Eikermann M, Fassbender P, Zaremba S, et al. Pentobarbital dose-dependently increases respiratory genioglossus muscle activity while impairing diaphragmatic function in anesthetized rats. Anesthesiology 2009; 110:1327-1334.
31. Hudgel DW, Hendricks C, Dadley A. Alteration in obstructive apnea pattern induced by changes in oxygen-and carbon-dioxide-inspired concentrations. Am Rev Respir Dis 1988; 138:16-19.
32. Eckert DJ, Younes MK. Arousal from Sleep: Implications for Obstructive Sleep Apnea Pathogenesis and Treatment. J Appl Physiol (1985) 2014; 116:302-313.
33. Stuth EA, Stucke AG, Zuperku EJ. Effects of anesthetics, sedatives, and opioids on ventilatory control. Compr Physiol 2012; 2:2281-2367.
34. Wang D, Somogyi AA, Yee BJ, et al. The effects of a single mild dose of morphine on chemoreflexes and breathing in obstructive sleep apnea. Respir Physiol Neurobiol 2013; 185:526-532.
35. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108:812-821.
36. Haack M, Lee E, Cohen DA, Mullington JM. Activation of the prostaglandin system in response to sleep loss in healthy humans: potential mediator of increased spontaneous pain. Pain 2009; 145:136-141.
37. Haack M, Pollmächer T, Mullington JM. Diurnal and sleep-wake dependent variations of soluble TNF-and IL-2 receptors in healthy volunteers. Brain Behav Immun 2004; 18:361-367.
38. Haack M, Sanchez E, Mullington JM. Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers. Sleep 2007; 30:1145-1152.
39. Irwin MR, Wang M, Campomayor CO, et al. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med 2006; 166:1756-1762.
40. Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep 2007; 30:494-505.
41. Edwards RR, Grace E, Peterson S, et al. Sleep continuity and architecture: associations with pain-inhibitory processes in patients with temporomandibular joint disorder. Eur J Pain 2009; 13:1043-1047.
42. Edwards RR, Quartana PJ, Allen RP, et al. Alterations in pain responses in treated and untreated patients with restless legs syndrome: associations with sleep disruption. Sleep Med 2011; 12:603-609.
43. Haack M, Scott-Sutherland J, Santangelo G, et al. Pain sensitivity and modulation in primary insomnia. Eur J Pain 2012; 16:522-533.
44. Smith MT, Wickwire EM, Grace EG, et al. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. Sleep 2009; 32:779-790.
45. Smith MT, Klick B, Kozachik S, et al. Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain. Pain 2008; 138:497-506.
46. Raymond I, Nielsen TA, Lavigne G, et al. Quality of sleep and its daily relationship to pain intensity in hospitalized adult burn patients. Pain 2001; 92:381-388.
47. Khalid I, Roehrs TA, Hudgel DW, Roth T. Continuous positive airway pressure in severe obstructive sleep apnea reduces pain sensitivity. Sleep 2011; 34:1687-1691.
48. Doufas AG, Tian L, Davies MF, Warby SC. Nocturnal intermittent hypoxia is independently associated with pain in subjects suffering from sleep-disordered breathing. Anesthesiology 2013; 119:1149-1162.
49. Rabbitts JA, Groenewald CB, Dietz NM, et al. Perioperative opioid requirements are decreased in hypoxic children living at altitude. Paediatr Anaesth 2010; 20:1078-1083.
50. Brown KA, Laferriè re A, Moss IR. Recurrent hypoxemia in young children with obstructive sleep apnea is associated with reduced opioid requirement for analgesia. Anesthesiology 2004; 100:806-810.
51. Laferriè re A, Liu JK, Moss IR. Neurokinin-1 versus mu-opioid receptor binding in rat nucleus tractus solitarius after single and recurrent intermittent hypoxia. Brain Res Bull 2003; 59:307-313.
52. Moss IR, Laferriè re A. Central neuropeptide systems and respiratory control during development. Respir Physiol Neurobiol 2002; 131:15-27.
53. Brown KA. Intermittent hypoxia and the practice of anesthesia. Anesthesiology 2009; 110:922-927.
54. Moss IR, Brown KA, Laferriè re A. Recurrent hypoxia in rats during development increases subsequent respiratory sensitivity to fentanyl. Anesthesiology 2006; 105:715-718.
55. Sadhasivam S, Chidambaran V, Ngamprasertwong P, et al. Race and unequal burden of perioperative pain and opioid related adverse effects in children. Pediatrics 2012; 129:832-838.
56. Sanders JC, King MA, Mitchell RB, Kelly JP. Perioperative complications of adenotonsillectomy in children with obstructive sleep apnea syndrome. Anesth Analg 2006; 103:1115-1121.
57. Kajimura S, Aida K, Duan C. Insulin-like growth factor-binding protein-1 (IGFBP-1) mediates hypoxia-induced embryonic growth and developmental retardation. Proc Natl Acad Sci U S A 2005; 102:1240-1245.
58. Doufas AG, Tian L, Padrez KA, et al. Experimental pain and opioid analgesia in volunteers at high risk for obstructive sleep apnea. PLoS One 2013; 8:e54807.
59. Turan A, You J, Egan C, et al. Chronic intermittent hypoxia is independently associated with reduced postoperative opioid consumption in bariatric patients suffering from sleep-disordered breathing. PLoS One 2015; 10:e0127809.
60. Guzy RD, Hoyos B, Robin E, et al. Mitochondrial complex III is required for hypoxia-induced ROS production and cellular oxygen sensing. Cell Metab 2005; 1:401-408.
61. Lavie L. Obstructive sleep apnoea syndrome: an oxidative stress disorder. Sleep Med Rev 2003; 7:35-51.
62. Zhang JM, An J. Cytokines, inflammation, and pain. Int Anesthesiol Clin 2007; 45:27-37.
63. Kawasaki Y, Zhang L, Cheng JK, Ji RR. Cytokine mechanisms of central sensitization: distinct and overlapping role of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha in regulating synaptic and neuronal activity in the superficial spinal cord. J Neurosci 2008; 28:5189-5194.
64. Ren K, Dubner R. Interactions between the immune and nervous systems in pain. Nat Med 2010; 16:1267-1276.
65. Bruehl S, Burns JW, Gupta R, et al. Endogenous opioid function mediates the association between laboratory-evoked pain sensitivity and morphine analgesic responses. Pain 2013; 154:1856-1864.
66. Gislason T, Almqvist M, Boman G, et al. Increased CSF opioid activity in sleep apnea syndrome. Regression after successful treatment. Chest 1989; 96:250-254.
67. Lydic R, Baghdoyan HA. Sleep, anesthesiology, and the neurobiology of arousal state control. Anesthesiology 2005; 103:1268-1295.
68. Lydic R, Keifer JC, Baghdoyan HA, Becker L. Microdialysis of the pontine reticular formation reveals inhibition of acetylcholine release by morphine. Anesthesiology 1993; 79:1003-1012.
69. Mortazavi S, Thompson J, Baghdoyan HA, Lydic R. Fentanyl and morphine, but not remifentanil, inhibit acetylcholine release in pontine regions modulating arousal. Anesthesiology 1999; 90:1070-1077.
70. Nelson AM, Battersby AS, Baghdoyan HA, Lydic R. Opioid-induced decreases in rat brain adenosine levels are reversed by inhibiting adenosine deaminase. Anesthesiology 2009; 111:1327-1333.
71. Wu M, Sahbaie P, Zheng M, et al. Opiate-induced changes in brain adenosine levels and narcotic drug responses. Neuroscience 2013; 228:235-242.
72. Cronin A, Keifer JC, Baghdoyan HA, Lydic R. Opioid inhibition of rapid eye movement sleep by a specific mu receptor agonist. Br J Anaesth 1995; 74:188-192.
73. Cronin AJ, Keifer JC, Davies MF, et al. Postoperative sleep disturbance: influences of opioids and pain in humans. Sleep 2001; 24:39-44.
74. Moore JT, Kelz MB. Opiates, sleep, and pain: the adenosinergic link. Anesthesiology 2009; 111:1175-1176.
75. Bernards CM, Knowlton SL, Schmidt DF, et al. Respiratory and sleep effects of remifentanil in volunteers with moderate obstructive sleep apnea. Anesthesiology 2009; 110:41-49.
76. Knill RL, Moote CA, Skinner MI, Rose EA. Anesthesia with abdominal surgery leads to intense REM sleep during the first postoperative week. Anesthesiology 1990; 73:52-61.
77. Rosenberg J, Wildschiødtz G, Pedersen MH, et al. Late postoperative nocturnal episodic hypoxaemia and associated sleep pattern. Br J Anaesth 1994; 72:145-150.
78. Macintyre PE, Loadsman JA, Scott DA. Opioids, ventilation and acute pain management. Anaesth Intensive Care 2011; 39:545-558.
79. Chung F, Liao P, Yegneswaran B, et al. Postoperative changes in sleepdisordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology 2014; 120:287-298.