Prevalence of sleep-disordered breathing in opioid users with chronic pain: a systematic review and meta-analysis

Talha Mubashir; Mahesh Nagappa; Nilufar Esfahanian; Joseph Botros; Abdul A Arif; Colin Suen; Jean Wong; Clodagh M Ryan; Frances Chung

doi:10.5664/jcsm.8392

Prevalence of sleep-disordered breathing in opioid users with chronic pain: a systematic review and meta-analysis

J Clin Sleep Med. 2020 Jun 15;16(6):961-969. doi: 10.5664/jcsm.8392.

Authors

Talha Mubashir¹, Mahesh Nagappa², Nilufar Esfahanian¹, Joseph Botros¹, Abdul A Arif¹, Colin Suen¹, Jean Wong^{1

3}, Clodagh M Ryan⁴, Frances Chung¹

Affiliations

¹ Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
² Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Western University, London, Ontario, Canada.
³ Department of Anesthesia and Pain Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
⁴ Centre of Sleep Health and Research, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Abstract

Study objectives: Opioids have been reported to increase the risk for sleep-disordered breathing (SDB) in patients with noncancer chronic pain on opioid therapy. This study aims to determine the pooled prevalence of SDB in opioid users with chronic pain and compare it with patients with pain:no opioids and no pain:no opioids.

Methods: A literature search of PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials was conducted. We included all observational studies that reported the prevalence of SDB in patients with chronic pain on long-term opioid therapy (≥3 months). The primary outcome was the pooled prevalence of SDB in opioid users with chronic pain (pain:opioids group) and a comparison with pain:no opioids and no pain:no opioids groups. The meta-analysis was performed using a random-effects model.

Results: After screening 1,404 studies, 9 studies with 3,791 patients were included in the meta-analysis (pain:opioids group, n = 3181 [84%]; pain:no opioids group, n = 359 [9.4%]; no pain:no opioids group, n = 251 [6.6%]). The pooled prevalence of SDB in the pain:opioids, pain:no opioids, and no pain:no opioids groups were 91%, 83%, and 72% in sleep clinics and 63%, 10%, and 75% in pain clinics, respectively. Furthermore, in the pain: opioids group, central sleep apnea prevalence in sleep and pain clinics was 33% and 20%, respectively.

Conclusions: The pooled prevalence of SDB in patients with chronic pain on opioid therapy is not significantly different compared with pain:no opioids and no pain:no opioids groups and varies considerably depending on the site of patient recruitment (ie, sleep vs pain clinics). The prevalence of central sleep apnea is high in sleep and pain clinics in the pain:opioids group. Clinical Trial Registration: Registry: PROSPERO: International prospective register of systematic reviews; Name: Prevalence of sleep disordered breathing, hypoxemia and hypercapnia in patients on oral opioid therapy for chronic pain management; URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018103298; Identifier: CRD42018103298.

Keywords: opioids; prevalence; sleep-disordered breathing.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Analgesics, Opioid / therapeutic use
Chronic Pain* / drug therapy
Chronic Pain* / epidemiology
Humans
Prevalence
Sleep Apnea Syndromes* / epidemiology
Sleep Apnea, Central*

Substances

Analgesics, Opioid