Sleep disordered breathing in patients receiving therapy with buprenorphine/naloxone
Sleep disordered breathing in patients receiving therapy with buprenorphine/naloxone
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DOI：
10.1183/09031936.00120012
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发表时间：
2013-08-01
影响因子：
24.3
通讯作者：
Walker, James M.
中科院分区：
文献类型：
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作者：
Farney, Robert J.;McDonald, Amanda M.;Walker, James M.
长期使用阿片类药物的患者在睡眠期间有发生异常复杂和潜在致命的呼吸障碍的风险，包括中枢性和阻塞性呼吸暂停、呼吸不足、共济失调性呼吸和非呼吸暂停性低氧血症。丁丙诺啡是一种具有有限呼吸毒性的部分μ阿片激动剂，广泛用于治疗阿片依赖和慢性非恶性疼痛。然而，其引起睡眠呼吸障碍的可能性尚未研究。连续70例接受丁丙诺啡/纳洛酮治疗的患者常规接受睡眠医学咨询并接受多导睡眠图检查。（平均+/- SD年龄31.8 +/- 12.3岁），非肥胖（平均+/- SD体重指数24.9 +/- 5.9 kg.m（-2））和女性（60%）。根据呼吸暂停/低通气指数（AHI），63%的患者至少存在轻度睡眠呼吸障碍（AHI ≥ 5次事件·h（-1））。中度（AHI >= 15-= 30事件-h（-1））睡眠呼吸暂停分别为16%和17%。低氧血症，定义为动脉血氧饱和度测量的脉搏血氧饱和度，= 10%的睡眠时间，存在于27（38.6%）patients.Despite假定的保护性上限效应，关于清醒期间观察到的呼吸抑制，丁丙诺啡可能会引起显着的改变，在睡眠中的常规治疗剂量。
Patients using chronic opioids are at risk for exceptionally complex and potentially lethal disorders of breathing during sleep, including central and obstructive apnoeas, hypopnoeas, ataxic breathing and nonapnoeic hypoxaemia. Buprenorphine, a partial mu-opioid agonist with limited respiratory toxicity, is widely used for the treatment of opioid dependency and chronic nonmalignant pain. However, its potential for causing sleep disordered breathing has not been studied.70 consecutive patients admitted for therapy with buprenorphine/naloxone were routinely evaluated with sleep medicine consultation and attended polysomnography.The majority of patients were young (mean +/- SD age 31.8 +/- 12.3 years), nonobese (mean +/- SD body mass index 24.9 +/- 5.9 kg.m(-2)) and female (60%). Based upon the apnoea/hypopnoea index (AHI), at least mild sleep disordered breathing (AHI >= 5 events.h(-1)) was present in 63% of the group. Moderate (AHI >= 15-= 30 events-h(-1)) sleep apnoea was present in 16% and 17%, respectively. Hypoxaemia, defined as an arterial oxygen saturation measured by pulse oximetry, of = 10% of sleep time, was present in 27 (38.6%) patients.Despite the putative protective ceiling effect regarding ventilatory suppression observed during wakefulness, buprenorphine may induce significant alterations of breathing during sleep at routine therapeutic doses.