Evidence map›Paper›PMID 26545144›Full record

ReviewCurrent opinion in anaesthesiology2016

Obstructive sleep apnea, pain, and opioids: is the riddle solved?

Karen K Lam, Samuel Kunder, Jean Wong, Anthony G Doufas, Frances Chung

Registry-linked trialOpen access · hybridAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Current opinion in anaesthesiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06566482 (Mini-dose Dexmedetomidine-Esketamine Supplemented Analgesia for Postoperative Sleep Promotion in Patients at High-risk of Obstructive Sleep Apnea), which is not on this map. Cited by 58 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
58citing papers in PubMed, 4 pooled it
9.4field-weighted citation impact, top 1% 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.

NCT06566482 phase4recruitingnot on this mapstarted 2024, after this paper: background citation

Mini-dose Dexmedetomidine-Esketamine Supplemented Analgesia for Postoperative Sleep Promotion in Patients at High-risk of Obstructive Sleep Apnea: A Randomized Trial

TypeinterventionalSponsorPeking University First HospitalRan2024 to 2025Enrolled100ConditionsObstructive Sleep Apnea, Surgery, Dexmedetomidine, EsketamineArmsDexmedetomidine-esketamine combination, Placebo
3 · Its place in the literature

Who cites it

58 citing papers in PubMed, 4 syntheses or guidelines pooled it, 139 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Guideline
  4. Guideline
  5. Trial
  6. Trial
  7. Trial
  8. Review
  9. Article
  10. Article
  11. Opioids and Respiratory Related Consequences.Sleep medicine clinics · 2025
    Review
  12. Review
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Opioid-Based vs Opioid-Free Anesthesia in Breast Cancer Surgery.Journal of pharmacy & bioallied sciences · 2023
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

Karen K LamaDepartment of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada bDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.
Samuel Kunder
Jean Wong
Anthony G Doufas
Frances Chung
Toronto Western Hospital · CAUniversity Health Network · CAAssociation of Perioperative Registered Nurses · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purpose of reviewPerioperative opioid-based pain management of patients suffering from obstructive sleep apnea (OSA) may present challenges because of concerns over severe ventilatory compromise. The interaction between intermittent hypoxia, sleep fragmentation, pain, and opioid responses in OSA, is complex and warrants a special focus of perioperative outcomes research. RECENT

findingsLife-threatening opioid-related respiratory events are rare. Epidemiologic evidence suggests that OSA together with other serious renal and heart disease, is among those conditions predisposing patients for opioid-induced ventilatory impairment (OIVI) in the postoperative period. Both intermittent hypoxia and sleep fragmentation, two distinct components of OSA, enhance pain. Intermittent hypoxia may also potentiate opioid analgesic effects. Activation of major inflammatory pathways may be responsible for the effects of sleep disruption and intermittent hypoxia on pain and opioid analgesia. Recent experimental evidence supports that these, seemingly contrasting, phenotypes of pain-increasing and opioid-enhancing effects of intermittent hypoxia, are not mutually exclusive. Although the effect of intermittent hypoxia on OIVI has not been elucidated, opioids worsen postoperative sleep-disordered breathing in OSA patients. A subset of these patients, characterized by decreased chemoreflex responsiveness and high arousal thresholds, might be at higher risk for OIVI. SUMMARY: OSA may complicate opioid-based perioperative management of pain by altering both pain processing and sensitivity to opioid effect.

Indexed as

Analgesics, OpioidHumansPostoperative PainSleep Apnea, ObstructiveAnalgesics, Opioid

Identifiers

PMID26545144
PMCPMC4927322
OpenAlexW2437873802

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

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.