Managing the Risk of Sleep Disordered Breathing During Long-term Opioid Therapy

Lynn Webster, MD

In appropriately selected patient populations, opioid medications can provide significant pain relief and improve patient function. Individualized risk: benefit analysis is critical to achieving good patient outcomes, however. Recent studies have shown that chronic opioid therapy is associated with central sleep apneas and ataxic breathing, among other neurorespiratory disturbances. Opioid receptors are located in brain regions thought to regulate sleep onset and maintenance, providing a plausible biochemical basis for the abnormal sleep architecture and sleep-disordered breathing found in many chronic pain patients receiving long-term μ-opioid therapy. While additional research is required to establish the clinical relevance of these and related findings, weighing the potential risks of chronic opioid use against known benefits requires vigilance, risk mitigation strategies, and continual patient monitoring.

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