Opioid-Induced Central Sleep Apnea: Mechanisms and Therapies

Chronic opioid use is an established risk factor for CSA, as shown by a high prevalence of CSA in this population. CSA is eliminated with withdrawal of opioids, and animal experimentations have shown potential mechanisms. CSA may be present on initial diagnostic polysomnography or it may emerge with initiation of CPAP therapy, referred to as complex sleep apnea. The first approach to therapy is programmed withdrawal of opioids, if possible. This is a difficult task. CPAP therapy is recommended for those with OSA, and development of complex sleep apnea should be looked for. For the latter patients and those patients whose diagnostic polysomnographies show CSA, we have used servoventilators effectively. Bilevel devices in the S/T mode are another alternative. However, long-term randomized clinical trials are needed to determine if effective treatment of CSA improves quality of life and the excess mortality of patients using opioids. © 2014 Elsevier Inc. All rights reserved.