Sleep-Disordered Breathing Associated With Long-term Opioid Therapy*

Slides:



Advertisements
Similar presentations
A Cause of Excessive Daytime Sleepiness
Advertisements

Noninvasive Nasal Mask Ventilation for Acute Respiratory Failure
Volume 93, Issue 6, Pages (June 1988)
Volume 101, Issue 2, Pages (February 1992)
Positive Airway Pressure Treatment for Obstructive Sleep Apnea
Tell-tale Telangiectasias
Acute Cardiopulmonary Failure From Sleep-Disordered Breathing
Colloquium on Therapy of Right Heart Failure
Volume 74, Issue 5, Pages (November 1978)
Low-concentration Oxygen Therapy Via a Demand Oxygen Delivery System
Volume 90, Issue 5, Pages (November 1986)
Volume 77, Issue 5, Pages (May 1980)
When to Be Rash About a Fever and Headache
CPAP and High-Flow Nasal Cannula Oxygen in Bronchiolitis
Volume 102, Issue 3, Pages (September 1992)
Volume 128, Issue 3, Pages (September 2005)
Effects of Medroxyprogesterone Acetate in Obstructive Sleep Apnea
Volume 134, Issue 6, Pages (December 2008)
Volume 109, Issue 5, Pages (May 1996)
Hyperbaric Oxygenation in Cardiac and Pulmonary Disease
Prospective Study of Controlled Oxygen Therapy
Volume 121, Issue 2, Pages (February 2002)
From: Diagnosis and Initial Management of Obstructive Sleep Apnea without PolysomnographyA Randomized Validation Study Ann Intern Med. 2007;146(3):
Reversal of Central Sleep Apnea Using Nasal CPAP
Volume 127, Issue 6, Pages (June 2005)
Air Pollution and Chest Disease
Navin K. Jain, MD, Thiam H. Lie, MD, FCCP  CHEST 
Volume 138, Issue 5, Pages (November 2010)
Volume 55, Issue 1, Pages (January 1969)
Oxygen Therapy Titrated to Raise Mixed Venous Oxygen Content in COPD
Upper Airways Obstruction with Bilateral Vocal Cord Paralysis
Glen L. Prosise, B.A., Richard B. Berry, M.D., F.C.C.P.  CHEST 
Volume 113, Issue 4, Pages (April 1998)
Frank W. Ewald, MD, FCCP, Albert H. Scherff, MD  CHEST 
Volume 84, Issue 2, Pages (August 1983)
COUNTERPOINT: Is the Apnea-Hypopnea Index the Best Way to Quantify the Severity of Sleep-Disordered Breathing? No  Naresh M. Punjabi, MD, PhD, FCCP  CHEST 
A 15-Year-Old Boy with Mysterious Variability in Apnea-Hypopnea Index
Obstructive Sleep Apnea and Cardiovascular Disease
A Newborn Infant With Oxygen Desaturation During Sleep
Posthyperventilation Apnea Associated with Severe Hypoxemia
Handedness and Sleep Apnea
Obstructive Sleep Apnea following Bilateral Carotid Body Resection
Airway Stenting for Patients With Benign Airway Disease and the Food and Drug Administration Advisory  Lund Mark E. , MD, FCCP, Force Seth , MD, FCCP 
Apnea in the Nonobese CHEST Volume 153, Issue 4, (April 2018)
Jessica Cooksey, MD, Babak Mokhlesi, MD, FCCP  CHEST 
Sleep Apnea, Hypothyroidism and Pulmonary Edema
Point: Should Medicare Allow Respiratory Therapists to Independently Practice and Bill for Educational Activities Related to COPD? Yes  Thomas M. Fuhrman,
PEEP, Auto-PEEP, and Waterfalls
Relationships Between Insomnia and Sleep-Disordered Breathing
Point: Adherence to Early Goal-Directed Therapy
Robert M. Hoffman, MD, Ronald A. Stiller, MD, PhD, FCCP  CHEST 
Acute Upper Airway Obstruction
Ventilator-imposed Work of Breathing
The Pharyngeal Airway CHEST
Evolution in Reimbursement for Sleep Studies and Sleep Centers
Bedside Calibration Of Pulmonary Artery Catheters
Pulmonary Manifestations in a Case of Multiple Myeloma
Do CIs Give You Confidence?
A Single Nasal Prong for Continuous Oxygen Therapy
Sleep Apnea Increases the Risk of New Hospitalized Atrial Fibrillation
Nasal Airflow in Sleep-Disordered Breathing
Mc Grath Gregory , MD, Das-Gupta Mike , MD, Clarke Geoffrey , MD  CHEST 
Volume 72, Issue 5, Pages (November 1977)
Counterpoint: Should Medicare Allow Respiratory Therapists to Independently Practice and Bill for Educational Activities Related to COPD? No  Katherine.
Digitalis and Angina Pectoris
Denis A. Cozzi, MD, Silvia Ceccanti, MD  CHEST 
Hyperventilation Syndrome
Assessment of Airflow in Sleep Studies by Oronasal CO2 Detection
Volume 119, Issue 1, Pages (January 2001)
A Newborn Infant With Oxygen Desaturation During Sleep
Presentation transcript:

Sleep-Disordered Breathing Associated With Long-term Opioid Therapy* Farney Robert J. , MD, FCCP, Walker James M. , PhD, Cloward Tom V. , MD, FCCP, Rhondeau Steven , MD  CHEST  Volume 123, Issue 2, Pages 632-639 (February 2003) DOI: 10.1378/chest.123.2.632 Copyright © 2003 The American College of Chest Physicians Terms and Conditions

Figure 1 Top, A: Sleep/wake hypnogram and Sao2 across the night in case 1. Note the recurrent and gradual progressive declines of Sao2 that were associated with prolonged obstructive hypopneas (minimum duration, 5 min). These episodes were more pronounced following the ingestion of additional hydrocodone at 1:10 am. Also note that the severity of respiratory disturbances and hypoxemia were less during REM sleep compared to NREM sleep. Center, B: This 600-s sample corresponds with the area denoted as 1B on Figure 1, top, A. There is no cessation of airflow or respiratory effort associated with the progressive decrease in Sao2. Increasing tracheal sound implies increasing respiratory effort. Evidence of airway obstruction and hypoxemia are quickly reversed with a few deep breaths. Bottom, C: This 60-s sample corresponds with the area denoted as 1C on Figure 1, top, A. The airflow signal obtained by nasal pressure transducer shows flattening, characteristic of increased upper airway resistance. Note the reversal of hypoxemia with a few deep breaths. CHEST 2003 123, 632-639DOI: (10.1378/chest.123.2.632) Copyright © 2003 The American College of Chest Physicians Terms and Conditions

Figure 2 Top, A: Sleep/wake hypnogram and Sao2 across the night in case 2. It can be seen that the most severe desaturations of Sao2 occurred during NREM sleep. The earlier-than-normal REM onset and increased frequency of REM episodes can be associated with depression. Supplemental oxygen at 2 L/min was added at 3:00 am and maintained the Sao2 near 94%; however, respiratory disturbances continued (bottom, C). Center, B: This 300-s sample corresponds with the area denoted as 2B on Figure 2, top, A during NREM sleep and while breathing room air. The respiratory pattern is characteristic of Biot or ataxic breathing, the ventilatory equivalent of atrial fibrillation. Notice the irregularity of the respiratory rate, effort, and airflow associated with variable degrees of hypoxemia and that this pattern is present during NREM sleep. Bottom, C: This 300-s sample corresponds with the area denoted as 2C on Figure 2, top, A during NREM sleep and while receiving supplemental oxygen at 2 L/min. Hypoxemia was corrected; however, ataxic breathing pattern persisted. CHEST 2003 123, 632-639DOI: (10.1378/chest.123.2.632) Copyright © 2003 The American College of Chest Physicians Terms and Conditions

Figure 3 Top: Sleep/wake hypnogram, Sao2, and nasal CPAP across the night in case 3. Note the presence of continuous desaturations during NREM sleep but not during REM sleep. There was no improvement as CPAP was increased from the previous therapeutic level of 10 to 16 cm H2O. Bottom: This 300-s sample corresponds with the area denoted as 3B on Figure 3, top, A and shows the transition between NREM and REM sleep at a CPAP level of 16 cm H2O. Note the progression from central apneas during NREM sleep to typical normal variable breathing pattern in REM sleep. CHEST 2003 123, 632-639DOI: (10.1378/chest.123.2.632) Copyright © 2003 The American College of Chest Physicians Terms and Conditions