Chronic opioid therapy can disrupt sleep, increase risk of sleep disorders
Medical providers must be aware of adverse effects of opioid treatment
November 19, 2019
Science Daily/American Academy of Sleep Medicine
Patients and medical providers should be aware that chronic opioid use can interfere with sleep by reducing sleep efficiency and increasing the risk of sleep-disordered breathing, according to a position statement from the American Academy of Sleep Medicine.
Opioid use has boomed in the last decade, with nearly 92 million Americans using prescription opioids and 11.5 million people misusing them. In addition to understanding the risks of opioid addiction and abuse, it is important for health care providers to be aware that chronic opioid use is associated with changes in sleep architecture and an increased risk of respiratory depression during sleep.
"This statement increases awareness among health care providers of the important adverse events that can occur in patients on chronic opioid therapy," said co-author Dr. R. Nisha Aurora, Associate Professor of Medicine at Rutgers Robert Wood Johnson Medical School in New Jersey. "The paper also highlights the need for providers to recognize and diagnose sleep-related breathing disorders that are frequently seen with chronic opioid use."
The position statement was developed by the AASM board of directors and is published in the Nov. 15 issue of the Journal of Clinical Sleep Medicine.
Patients who have chronic pain often experience fatigue and disturbed sleep. Studies have shown that chronic opioid therapy has the potential to further disrupt sleep by reducing sleep efficiency, slow wave sleep, and rapid eye movement sleep. Another adverse effect of opioid use is respiratory depression, which can increase the risk of sleep-related breathing disorders such as sleep-related hypoventilation, central sleep apnea and obstructive sleep apnea.
If left untreated, sleep-related breathing disorders can be harmful to a patient's health. However, they can be diagnosed by a medical provider following an overnight sleep study in a sleep center. Effective treatments also are available, including several modalities of positive airway pressure therapy. Medical providers who care for patients on chronic opioid therapy need to be aware of the signs of disrupted sleep, such as snoring and excessive daytime sleepiness, in order to provide their patients with high quality care.
"Because of the complex relationship between pain, sleep, daytime functioning, and opioid therapy, a strong collaboration between pain specialists, sleep physicians, and primary care providers is needed to optimize patient benefit and minimize complications when opioids are part of chronic therapy," said Dr. Aurora.
While opioid therapy can contribute to sleep disruption and sleep disorders, it can be an effective treatment for patients with restless legs syndrome (RLS), a sleep disorder associated with disturbed sleep. Some patients with severe, refractory RLS, who are unresponsive or intolerant to other therapies, may find relief by using opioid medications at much lower doses than those used to treat chronic pain.
Dr. Aurora is currently collaborating with the Brain Health Institute at Rutgers to study sleep in those seeking therapy for opioid addiction.
https://www.sciencedaily.com/releases/2019/11/191119143240.htm
Anxiety, depression linked to more opioid use after surgery
August 22, 2019
Science Daily/Michigan Medicine - University of Michigan
Surgeons wielding their life-saving scalpels, laparoscopic tools, or other implements to repair or remove what ails their patients understand all too well that pain is an unavoidable part of the healing process. Yet the current opioid crisis has made the standard prescribing practices for these highly effective analgesics fraught with risk.
New research from Michigan Medicine could help clinicians mitigate that risk by identifying which patients are more likely to continue to use opioids after their immediate recovery period.
"There is not much research on which surgical patients require more or less opioids, despite a push in the field for personalized medicine," says first author Daniel Larach, M.D., M.T.R., M.A., a resident at U-M at the time of the study and now assistant professor of clinical anesthesiology at the University of Southern California.
"Often with postoperative opioid prescribing, personalization falls by the wayside, with surgeons using the same amounts for every person receiving a certain procedure."
He and the study team looked at data for more than 1,000 people undergoing an elective hysterectomy, thoracic surgery, or a total knee or hip replacement. Before their procedures, each patient provided demographic information and filled out several screening questionnaires. They were given scores measuring their degree of depression, anxiety, fatigue, sleep disturbance, physical function, as well as the severity of their overall and surgical site pain. The research team also measured how many pills were prescribed per patient. Each patient was then contacted one month following surgery to assess how many opioid pills they had consumed.
"We found that anxiety is linked with more opioid use, which is disheartening to see but also heartening in the sense that this is something we could potentially target," says Larach.
Other patient factors linked to increased opioid use included younger age, non-white race, no college degree, alcohol and tobacco use, and sleep disturbance.
Chad Brummett, M.D., associate professor of anesthesiology and director of anesthesia clinical research and pain research, says people may be knowingly or unknowingly medicating for other conditions.
"The only thing we're giving them is opioids and we're not giving them alternatives or other options," he says. For example, patients with high anxiety around the time of surgery could be offered behavioral care or other non-opioid medications for anxiety and resulting pain.
Brummett, senior author on the Annals of Surgery paper, also notes that this study found overprescription of opioids for all surgical procedures and a correlation between the prescription size and use.
"I think it is striking that you see once again that the more you prescribe, the more patients take, even after adjusting for all of these other risk factors," explains Brummett.
Larach and Brummett note that right-sizing prescriptions through initiatives such as the Michigan Opioid Prescribing Engagement Network (OPEN), which provides recommendations for prescription amounts for various medical procedures, is a critical first step. But, they say, this step should be followed by more research into specific patient factors that can be addressed in other ways.
Says Brummett, "We are asking surgeons to learn about and think about pain and behavioral health in ways that we have not previously done. It will require an open mind."
https://www.sciencedaily.com/releases/2019/08/190822113307.htm