Evidence map›Paper›PMID 25126029›Full record

ArticleJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2014

Sleep disordered breathing and chronic respiratory failure in patients with chronic pain on long term opioid therapy.

Anand R Rose, Peter G Catcheside, R Doug McEvoy, Denzil Paul, Dilip Kapur, Emily Peak, Andrew Vakulin, Nicholas A Antic

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 3 pooled it
6.2field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 3 syntheses or guidelines pooled it, 91 citations in OpenAlex.

  1. Pooled it
  2. Prevalence of sleep-disordered breathing in opioid users with chronic pain: a systematic review and meta-analysis.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2020
    Pooled it
  3. Medium Increased Risk for Central Sleep Apnea but Not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2016
    Pooled it
  4. Review
  5. Article
  6. Opioids and Respiratory Related Consequences.Sleep medicine clinics · 2025
    Review
  7. Review
  8. Article
  9. Article
  10. Article
  11. Review
  12. Article
  13. Review
  14. Review
  15. Article
  16. Article
  17. Article
  18. Review
  19. Sleep-Related Breathing Disorders: When CPAP Is Not Enough.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2021
    Review
  20. Still just the tip of the iceberg.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2020
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Anand R RoseAdelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia;
Peter G CatchesideAdelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia;
R Doug McEvoyAdelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia;
Denzil PaulAdelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia;
Dilip KapurPain Management Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia;
Emily PeakAdelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia;
Andrew VakulinAdelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia; ; Sleep and Circadian Research Group and NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, Sydney, Australia.
Nicholas A AnticAdelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia;
Flinders University · AUFlinders Medical Centre · AUThe University of Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

objectivesThe use of opioid medication for chronic pain has been increasing. The main aim of this study was to assess how many patients on opioids for chronic pain had sleep disordered breathing (SDB) and the type of SDB. The impact of these medications on daytime arterial blood gas (ABG) measurements and psychomotor vigilance was also studied.

methodsTwenty-four patients (aged 18-75 years) on long-term opioids were prospectively recruited. Patients underwent home polysomnogram (PSG), psychomotor vigilance testing (PVT), and awake daytime ABG. Overnight PSG findings were compared to those of patients matched for age, sex, and BMI referred to our sleep service for evaluation of SDB. PVT results in the patient cohort were compared to PVT in healthy controls.

resultsForty-six percent of opioid patients had severe SDB as defined by an apnea hypopnea index (AHI) > 30/h. The severity of SDB was similar in opioid-treated pain clinic patients and sleep clinic patients (mean ± SD AHI: Opioid-treated patients 32.7 ± 25.6; Sleep Study comparator group 28.9 ± 24.6, p = 0.6). Opioid patients had a higher frequency of central apneas and a lower arousal index (CAI: 3.9 ± 8.3 vs. 0.3 ± 0.5 events/h; p = 0.004, AI 8.0 ± 4.1 vs. 20.1 ± 13.8, p < 0.001). Pain clinic patients had impaired gas exchange during sleep and wakefulness. Nine of 20 (45%) had daytime hypercapnia, indicating a surprising number were in chronic respiratory failure. Morphine equivalent doses correlated with the severity of SDB. PVT was impaired when compared to a healthy PVT comparator group (RT: Opioid-treated patients 0.43 ± 0.27: Healthy PVT comparator group 0.28 ± 0.03 sec; p < 0.001).

conclusionsPatients on long-term opioids frequently have severe SDB, which in part is central in origin. PVT was markedly impaired. Half of the patients studied have evidence of chronic ventilatory failure. COMMENTARY: A commentary on this article appears in this issue on page 853

Indexed as

Analgesics, OpioidArousalBlood Gas AnalysisCase-Control StudiesChronic DiseaseChronic PainFemaleHumansMaleMiddle AgedPolysomnographyRespiratory InsufficiencySleep Apnea SyndromesAnalgesics, Opioidhypercapniaopioidssleep apnea

Identifiers

PMID25126029
PMCPMC4106937
OpenAlexW1978768801

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.