{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T11:28:08Z","timestamp":1794050888648,"version":"4.8.0"},"reference-count":45,"publisher":"European Respiratory Society (ERS)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2012,9,21]]},"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:p>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 \u03bc-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.<\/jats:p><jats:p>70 consecutive patients admitted for therapy with buprenorphine\/naloxone were routinely evaluated with sleep medicine consultation and attended polysomnography.<\/jats:p><jats:p>The majority of patients were young (mean\u00b1<jats:sc>sd<\/jats:sc>age 31.8\u00b112.3 years), nonobese (mean\u00b1<jats:sc>sd<\/jats:sc>body mass index 24.9\u00b15.9 kg\u00b7m<jats:sup>\u22122<\/jats:sup>) and female (60%). Based upon the apnoea\/hypopnoea index (AHI), at least mild sleep disordered breathing (AHI \u22655 events\u00b7h<jats:sup>\u22121<\/jats:sup>) was present in 63% of the group. Moderate (AHI \u226515\u2013 &lt;30 events\u00b7h<jats:sup>\u22121<\/jats:sup>) and severe (AHI \u226530 events\u00b7h<jats:sup>\u22121<\/jats:sup>) sleep apnoea was present in 16% and 17%, respectively. Hypoxaemia, defined as an arterial oxygen saturation measured by pulse oximetry, of &lt;90% for \u226510% of sleep time, was present in 27 (38.6%) patients.<\/jats:p><jats:p>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.<\/jats:p>","DOI":"10.1183\/09031936.00120012","type":"journal-article","created":{"date-parts":[[2012,10,26]],"date-time":"2012-10-26T07:21:12Z","timestamp":1351236072000},"page":"394-403","source":"Crossref","is-referenced-by-count":73,"title":["Sleep disordered breathing in patients receiving therapy with buprenorphine\/naloxone"],"prefix":"10.1183","volume":"42","author":[{"given":"Robert J.","family":"Farney","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda M.","family":"McDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M.","family":"Boyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory L.","family":"Snow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.T.","family":"Nuttall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael F.","family":"Coudreaut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore J.","family":"Wander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2012,10,25]]},"reference":[{"key":"2024102021242018000_42.2.394.1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.2.632"},{"key":"2024102021242018000_42.2.394.2","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":"2024102021242018000_42.2.394.3","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2001.9633954.x"},{"key":"2024102021242018000_42.2.394.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2007.00343.x"},{"key":"2024102021242018000_42.2.394.5","doi-asserted-by":"crossref","unstructured":"Farney RJ Walker JM . Central sleep apnea due to drug or substance. In: Kushida C , ed. The Encyclopedia of Sleep. Vol. 3. Waltham, MA, Academic Press, 2013; pp. 253\u2013264.","DOI":"10.1016\/B978-0-12-378610-4.00318-1"},{"key":"2024102021242018000_42.2.394.6","first-page":"33","article-title":"Increase in poisoning deaths caused by non-illicit drugs \u2013 Utah, 1991\u20132003","volume":"54","author":"Centers for Disease Control and Prevention (CDC)","year":"2005","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024102021242018000_42.2.394.7","first-page":"1487","article-title":"Vital signs: overdoses of prescription opioid pain relievers \u2013 United States, 1999\u20132008","volume":"60","author":"Centers for Disease Control and Prevention (CDC)","year":"2011","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024102021242018000_42.2.394.8","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31816d83e4"},{"key":"2024102021242018000_42.2.394.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.3.249"},{"key":"2024102021242018000_42.2.394.10","unstructured":"Office of Diversion Control. National Forensic Laboratory Information System (NFLIS). Special Report: Methadone and Buprenorphine, 2003\u20132008. Washington, US Drug Enforcement Administration, 2009."},{"key":"2024102021242018000_42.2.394.11","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1994.71"},{"key":"2024102021242018000_42.2.394.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2004.07.005"},{"key":"2024102021242018000_42.2.394.13","first-page":"281","article-title":"Buprenorphine: new treatment of opioid addiction in primary care","volume":"57","author":"Kahan","year":"2011","journal-title":"Can Fam Physician"},{"key":"2024102021242018000_42.2.394.14","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/ael051"},{"key":"2024102021242018000_42.2.394.15","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aei145"},{"key":"2024102021242018000_42.2.394.16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.1.45"},{"key":"2024102021242018000_42.2.394.17","doi-asserted-by":"publisher","DOI":"10.1080\/10550490490440780"},{"key":"2024102021242018000_42.2.394.18","unstructured":"Substance Abuse and Mental Health Services Administration. Buprenorphine Drug Addiction Treatment Act of 2000. http:\/\/buprenorphine.samhsa.gov\/fulllaw.html Date last accessed: June 9, 2013. Date last updated: 2000."},{"key":"2024102021242018000_42.2.394.19","doi-asserted-by":"publisher","DOI":"10.1378\/chest.9981"},{"key":"2024102021242018000_42.2.394.20","unstructured":"McNicholas L . Clinical Guidelines for the use of Buprenorphine in the Treatment of Opioid Addiction. A Treatment Improvement Protocol. TIP 40. Rockville, US Department of Health and Human Services, 2004."},{"key":"2024102021242018000_42.2.394.21","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5664\/jcsm.26432","article-title":"Polysomnography in hospitalized patients using a wireless wide area network","volume":"2","author":"Farney","year":"2006","journal-title":"J Clin Sleep Med"},{"key":"2024102021242018000_42.2.394.22","unstructured":"Iber C Ancoli-Israel S Chesson A . The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. 1st Edn. Westchester, American Academy of Sleep Medicine, 2007."},{"key":"2024102021242018000_42.2.394.23","doi-asserted-by":"crossref","first-page":"311","DOI":"10.5664\/jcsm.27230","article-title":"Adaptive servoventilation (ASV) in patients with sleep disordered breathing associated with chronic opioid medications for non-malignant pain","volume":"4","author":"Farney","year":"2008","journal-title":"J Clin Sleep Med"},{"key":"2024102021242018000_42.2.394.24","doi-asserted-by":"publisher","DOI":"10.1023\/A:1010933404324"},{"key":"2024102021242018000_42.2.394.25","unstructured":"Breiman L . Manual on Setting Up, Using, and Understanding Random Forests V3. 1. http:\/\/oz.berkeley.edu\/users\/breiman\/Using_random_forests_V31.pdf Date last accessed: June 10, 2013."},{"key":"2024102021242018000_42.2.394.26","first-page":"18","article-title":"Classification and regression by random forest","volume":"2","author":"Liaw","year":"2002","journal-title":"R News"},{"key":"2024102021242018000_42.2.394.27","unstructured":"Conover WJ . One-sample Kolmogorov test. Practical Nonparametric Statistics. 1st Edn. New York, John Wiley & Sons, 1971; pp. 295\u2013301."},{"key":"2024102021242018000_42.2.394.28","unstructured":"Conover WJ . Two-sample Smirnov test. Practical Nonparametric Statistics. 1st Edn. New York, John Wiley & Sons, 1971; pp. 309\u2013314."},{"key":"2024102021242018000_42.2.394.29","doi-asserted-by":"crossref","first-page":"459","DOI":"10.5664\/JCSM.1306","article-title":"The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea\/hypopnea index","volume":"7","author":"Farney","year":"2011","journal-title":"J Clin Sleep Med"},{"key":"2024102021242018000_42.2.394.30","doi-asserted-by":"crossref","first-page":"545","DOI":"10.5664\/jcsm.27987","article-title":"Mallampati class is not useful in the clinical assessment of sleep clinic patients","volume":"6","author":"Hukins","year":"2010","journal-title":"J Clin Sleep Med"},{"key":"2024102021242018000_42.2.394.31","doi-asserted-by":"crossref","unstructured":"Bowman AWA . Applied Smoothing Techniques for Data Analysis. The Kernel Approach with S-Plus Illustrations. NewYork, Oxford University Press, 1997.","DOI":"10.1093\/oso\/9780198523963.001.0001"},{"key":"2024102021242018000_42.2.394.32","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J R Stat Soc Series B Stat Methodol"},{"key":"2024102021242018000_42.2.394.33","doi-asserted-by":"publisher","DOI":"10.2165\/00139709-200625020-00002"},{"key":"2024102021242018000_42.2.394.34","unstructured":"Labby D Koder M Amann T . Opioids and Chronic Non-Malignant Pain: A Clinician's Handbook. Portland, CareOregon, 2003."},{"key":"2024102021242018000_42.2.394.35","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen094"},{"key":"2024102021242018000_42.2.394.36","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S0165-6147(00)01616-3","article-title":"Incomplete cross tolerance and multiple \u03bc-opioid peptide receptors","volume":"22","author":"Pasternak","year":"2001","journal-title":"Trends Pharmacol Sci"},{"key":"2024102021242018000_42.2.394.37","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000147711.51122.4B"},{"key":"2024102021242018000_42.2.394.38","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1016\/S0376-8716(03)00056-5","article-title":"The clinical pharmacology of buprenorphine: extrapolating from the laboratory to the clinic","volume":"70","author":"Walsh","year":"2003","journal-title":"Drug Alcohol Depend"},{"key":"2024102021242018000_42.2.394.39","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S0022-3565(25)10510-7","article-title":"Acute administration of buprenorphine in humans: partial agonist and blockade effects","volume":"274","author":"Walsh","year":"1995","journal-title":"J Pharmacol Exp Ther"},{"key":"2024102021242018000_42.2.394.40","doi-asserted-by":"publisher","DOI":"10.1007\/BF02246290"},{"key":"2024102021242018000_42.2.394.41","doi-asserted-by":"publisher","DOI":"10.1016\/S0379-0738(01)00454-6"},{"key":"2024102021242018000_42.2.394.42","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9120(02)00304-1"},{"key":"2024102021242018000_42.2.394.43","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-6576.2003.00201.x"},{"key":"2024102021242018000_42.2.394.44","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-008-0208-4"},{"key":"2024102021242018000_42.2.394.45","doi-asserted-by":"crossref","first-page":"305","DOI":"10.5664\/jcsm.27229","article-title":"Adaptive pressure support servoventilation: a novel treatment for sleep apnea associated with use of opioids","volume":"4","author":"Javaheri","year":"2008","journal-title":"J Clin Sleep Med"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/09031936.00120012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T18:19:05Z","timestamp":1745086745000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/09031936.00120012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,10,25]]},"references-count":45,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2013,7,31]]},"published-print":{"date-parts":[[2013,8]]}},"alternative-id":["10.1183\/09031936.00120012"],"URL":"https:\/\/doi.org\/10.1183\/09031936.00120012","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,10,25]]}}}