Cardiorespiratory complications of neuraxial opioids in patients with obstructive sleep apnea: a systematic review

J Clin Anesth. 2013 Nov;25(7):591-9. doi: 10.1016/j.jclinane.2013.02.015. Epub 2013 Aug 27.


We sought to determine the rate of cardiorespiratory complications following neuraxial opioid administration in the setting of obstructive sleep apnea (OSA). This systematic review of the leading biomedical databases originated from a university-affiliated, tertiary-care teaching hospital. A systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the International Pharmaceutical Abstracts Database (1970 - September 2011) was undertaken. Cardiorespiratory complications were stratified into minor and major based on existing OSA literature. Five studies, including a total of 121 patients, were selected for analysis. All studies comprised low-quality evidence. Six major cardiorespiratory complications were reported among 5 (4.1%) patients and included three deaths, one cardiorespiratory arrest, and two episodes of severe respiratory depression. Five of these complications occurred during continuous fentanyl-containing epidural infusions and without concurrent positive airway pressure treatment. The rate of cardiorespiratory complications following the administration of neuraxial opioids to surgical patients with OSA is difficult to determine.

Keywords: Analgesics; Apnea; Epidural injections; Intrathecal injections; Neuraxial anesthesia; Obstructive sleep apnea; Opioid analgesics; Postoperative complications.

Publication types

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

MeSH terms

  • Analgesia, Epidural / adverse effects*
  • Analgesia, Epidural / methods
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / physiopathology
  • Fentanyl / administration & dosage
  • Fentanyl / adverse effects
  • Humans
  • Respiratory Insufficiency / chemically induced
  • Respiratory Insufficiency / epidemiology
  • Respiratory Insufficiency / physiopathology
  • Sleep Apnea, Obstructive / physiopathology*


  • Analgesics, Opioid
  • Fentanyl