Sleep-disordered breathing in patients on opioids for chronic pain

Reg Anesth Pain Med. 2020 Oct;45(10):826-830. doi: 10.1136/rapm-2020-101540. Epub 2020 Sep 14.


The past two decades has seen a substantial rise in the use of opioids for chronic pain, along with opioid-related mortality and adverse effects. A contributor to opioid-associated mortality is the high prevalence of moderate/severe sleep-disordered breathing, including central sleep apnea and obstructive sleep apnea, in patients with chronic pain. Although evidence-based treatments are available for sleep-disordered breathing, patients are not frequently assessed for sleep-disordered breathing in pain clinics. To aid healthcare providers in this area of clinical uncertainty, we present evidence on the interaction between opioids and sleep-disordered breathing, and the prevalence and predictive factors for sleep-disordered breathing in patients on opioids for chronic pain. We provide recommendations on how to evaluate patients on opioids for risk of moderate/severe sleep-disordered breathing in clinical care, which could lead to earlier use of therapeutic interventions for opioid-associated sleep-disordered breathing, such as opioid cessation or positive airway pressure therapy. This would improve quality of life and well-being of patients with chronic pain.

Keywords: analgesics, opioid; chronic pain; drug-related side effects and adverse reactions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Chronic Pain* / diagnosis
  • Chronic Pain* / drug therapy
  • Chronic Pain* / epidemiology
  • Clinical Decision-Making
  • Humans
  • Quality of Life
  • Sleep Apnea Syndromes* / chemically induced
  • Sleep Apnea Syndromes* / diagnosis
  • Sleep Apnea Syndromes* / epidemiology
  • Uncertainty


  • Analgesics, Opioid