{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T13:32:21Z","timestamp":1771680741809,"version":"3.50.1"},"reference-count":43,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/100019210","name":"University Health Network Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100019210","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Department of Anesthesia and Pain Medicine, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2020,7,2]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>The past two decades has seen a substantial rise in the use of opioids for chronic pain, along with opioid-related mortality and adverse effects. A contributor to opioid-associated mortality is the high prevalence of moderate\/severe sleep-disordered breathing, including central sleep apnea and obstructive sleep apnea, in patients with chronic pain. Although evidence-based treatments are available for sleep-disordered breathing, patients are not frequently assessed for sleep-disordered breathing in pain clinics. To aid healthcare providers in this area of clinical uncertainty, we present evidence on the interaction between opioids and sleep-disordered breathing, and the prevalence and predictive factors for sleep-disordered breathing in patients on opioids for chronic pain. We provide recommendations on how to evaluate patients on opioids for risk of moderate\/severe sleep-disordered breathing in clinical care, which could lead to earlier use of therapeutic interventions for opioid-associated sleep-disordered breathing, such as opioid cessation or positive airway pressure therapy. This would improve quality of life and well-being of patients with chronic pain.<\/jats:p>","DOI":"10.1136\/rapm-2020-101540","type":"journal-article","created":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T17:18:14Z","timestamp":1600103894000},"page":"826-830","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Sleep-disordered breathing in patients on opioids for chronic pain"],"prefix":"10.1136","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3283-3125","authenticated-orcid":false,"given":"Janannii","family":"Selvanathan","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip W H","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2372-965X","authenticated-orcid":false,"given":"Clodagh M","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,9,14]]},"reference":[{"key":"2025101110352019000_45.10.826.1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6736a2"},{"key":"2025101110352019000_45.10.826.2","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.pnpbp.2017.07.014","article-title":"Sleep, chronic pain, and opioid risk for apnea","volume":"87","author":"Marshansky","year":"2018","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"key":"2025101110352019000_45.10.826.3","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13601"},{"key":"2025101110352019000_45.10.826.4","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.smrv.2019.03.005","article-title":"The effect of opioid therapy on sleep quality in patients with chronic non-malignant pain: A systematic review and exploratory meta-analysis","volume":"45","author":"Tang","year":"2019","journal-title":"Sleep Med Rev"},{"key":"2025101110352019000_45.10.826.5","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000279"},{"key":"2025101110352019000_45.10.826.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2019-000523"},{"key":"2025101110352019000_45.10.826.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)80125-8"},{"key":"2025101110352019000_45.10.826.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)81896-7"},{"key":"2025101110352019000_45.10.826.9","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen094"},{"key":"2025101110352019000_45.10.826.10","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2008\/11\/S105"},{"key":"2025101110352019000_45.10.826.11","doi-asserted-by":"publisher","DOI":"10.12703\/P6-79"},{"key":"2025101110352019000_45.10.826.12","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1093\/bja\/aex341","article-title":"Death or near-death in patients with obstructive sleep apnoea: a compendium of case reports of critical complications","volume":"119","author":"Subramani","year":"2017","journal-title":"Br J Anaesth"},{"key":"2025101110352019000_45.10.826.13","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.5664\/jcsm.8062","article-title":"Chronic opioid therapy and sleep: an American Academy of sleep medicine position statement","volume":"15","author":"Rosen","year":"2019","journal-title":"J Clin Sleep Med"},{"key":"2025101110352019000_45.10.826.14","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.5962"},{"key":"2025101110352019000_45.10.826.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2016.07.002"},{"key":"2025101110352019000_45.10.826.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2013.01.003"},{"key":"2025101110352019000_45.10.826.17","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00003413"},{"key":"2025101110352019000_45.10.826.18","unstructured":"American Academy of Sleep Medicine . International classification of sleep disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014."},{"key":"2025101110352019000_45.10.826.19","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.160.4.9903020"},{"key":"2025101110352019000_45.10.826.20","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000672"},{"key":"2025101110352019000_45.10.826.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2017.05.004"},{"key":"2025101110352019000_45.10.826.22","first-page":"1168","article-title":"What is central sleep apnea?","volume":"55","author":"Malhotra","year":"2010","journal-title":"Respir Care"},{"key":"2025101110352019000_45.10.826.23","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.chest.2016.05.022","article-title":"Opioids and sleep-disordered breathing","volume":"150","author":"Van Ryswyk","year":"2016","journal-title":"Chest"},{"key":"2025101110352019000_45.10.826.24","doi-asserted-by":"crossref","first-page":"847","DOI":"10.5664\/jcsm.3950","article-title":"Sleep disordered breathing and chronic respiratory failure in patients with chronic pain on long term opioid therapy","volume":"10","author":"Rose","year":"2014","journal-title":"J Clin Sleep Med"},{"key":"2025101110352019000_45.10.826.25","doi-asserted-by":"publisher","DOI":"10.1007\/s40140-013-0047-0"},{"key":"2025101110352019000_45.10.826.26","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.170363"},{"key":"2025101110352019000_45.10.826.27","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1111\/ajad.12424","article-title":"A narrative review: the effects of opioids on sleep disordered breathing in chronic pain patients and methadone maintained patients","volume":"25","author":"Hassamal","year":"2016","journal-title":"Am J Addict"},{"key":"2025101110352019000_45.10.826.28","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1111\/pme.12910","article-title":"Opioid therapy and sleep disorders: risks and mitigation strategies","volume":"16 Suppl 1","author":"Cheatle","year":"2015","journal-title":"Pain Med"},{"key":"2025101110352019000_45.10.826.29","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/j.1526-4637.2007.00343.x","article-title":"Sleep-disordered breathing and chronic opioid therapy","volume":"9","author":"Webster","year":"2008","journal-title":"Pain Med"},{"key":"2025101110352019000_45.10.826.30","doi-asserted-by":"crossref","first-page":"961","DOI":"10.5664\/jcsm.8392","article-title":"Prevalence of sleep-disordered breathing in opioid users with chronic pain: a systematic review and meta-analysis","volume":"16","author":"Mubashir","year":"2020","journal-title":"J Clin Sleep Med"},{"key":"2025101110352019000_45.10.826.31","doi-asserted-by":"crossref","first-page":"E569","DOI":"10.36076\/ppj\/2019.19.E569","article-title":"What is the prevalence of symptomatic obstructive sleep apnea syndrome in chronic spinal pain patients? An assessment of the correlation of OSAS with chronic opioid therapy, obesity, and smoking","volume":"19","author":"Pampati","year":"2016","journal-title":"Pain Physician"},{"key":"2025101110352019000_45.10.826.32","doi-asserted-by":"crossref","first-page":"217","DOI":"10.2147\/NSS.S167658","article-title":"The prevalence and awareness of sleep apnea in patients suffering chronic pain: an assessment using the Stop-Bang sleep apnea questionnaire","volume":"10","author":"Tentindo","year":"2018","journal-title":"Nat Sci Sleep"},{"key":"2025101110352019000_45.10.826.33","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31816d83e4"},{"key":"2025101110352019000_45.10.826.34","doi-asserted-by":"crossref","first-page":"455","DOI":"10.5664\/jcsm.26908","article-title":"Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing","volume":"3","author":"Walker","year":"2007","journal-title":"J Clin Sleep Med"},{"key":"2025101110352019000_45.10.826.35","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0500"},{"key":"2025101110352019000_45.10.826.36","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aes022"},{"key":"2025101110352019000_45.10.826.37","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-0903"},{"key":"2025101110352019000_45.10.826.38","doi-asserted-by":"crossref","first-page":"829","DOI":"10.5664\/jcsm.6628","article-title":"Opioids cause central and complex sleep apnea in humans and reversal with discontinuation: a plea for detoxification","volume":"13","author":"Javaheri","year":"2017","journal-title":"J Clin Sleep Med"},{"key":"2025101110352019000_45.10.826.39","doi-asserted-by":"crossref","first-page":"57","DOI":"10.5055\/jom.2014.0192","article-title":"Treatment of opioid-related central sleep apnea with positive airway pressure: a systematic review","volume":"10","author":"Reddy","year":"2014","journal-title":"J Opioid Manag"},{"key":"2025101110352019000_45.10.826.40","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.jsmc.2017.07.007","article-title":"Sleep disordered breathing caused by chronic opioid use","volume":"12","author":"Chowdhuri","year":"2017","journal-title":"Sleep Med Clin"},{"key":"2025101110352019000_45.10.826.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsmc.2018.02.002"},{"key":"2025101110352019000_45.10.826.42","doi-asserted-by":"crossref","first-page":"579","DOI":"10.5664\/jcsm.2164","article-title":"Reversal of central sleep apnea following discontinuation of opioids","volume":"8","author":"Davis","year":"2012","journal-title":"J Clin Sleep Med"},{"key":"2025101110352019000_45.10.826.43","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-010-9254-3"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2020-101540","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T17:35:29Z","timestamp":1760204129000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2020-101540"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,14]]},"references-count":43,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,9,18]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1136\/rapm-2020-101540"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2020-101540","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,14]]}}}