Treatment for patients with sleep apnea on opioids for chronic pain: results of the OpSafe trial

Abstract

Study objectives: Approximately 20% of North Americans are afflicted with chronic pain with 3% being opioid users. The objective was to determine whether patients on opioids for chronic pain with newly diagnosed sleep apnea attended sleep clinic review and followed treatment recommendations.

Methods: The study was a post hoc analysis from a multicenter perspective cohort study. Inclusion criteria included adults taking opioid medications for chronic pain for >3 months. Demographic data and daily opioid dose were collected. Sleep apnea was diagnosed via level 1 polysomnography. Patients who attended sleep clinic review were grouped based on the types of treatment they received.

Results: A total of 204 patients completed polysomnography and 58.8% were diagnosed to have sleep apnea (apnea-hypopnea index ≥5 events/h). Of those with sleep apnea, 58% were recommended to have an evaluation by a sleep physician. Body mass index and age were 29.5 ± 6 kg/m² and 56 ± 12 years, respectively. Of those with newly diagnosed sleep apnea, 25% received treatment, with the majority being treated with positive airway pressure therapy, whereas the rest received positional therapy and opioids/sedative reduction. The adherence rate of positive airway pressure therapy was 55% at 1 year. Over 50% of participants on opioids for chronic pain with newly diagnosed sleep apnea declined attendance for sleep clinic review or treatment.

Conclusions: There was a high refusal rate to attend clinic for treatment. Adherence to positive airway pressure therapy was low at 55%. This sheds light on the high rate of treatment nonadherence and the need for further research.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Opioid Safety Program in Pain Clinics (Op-Safe); URL: https://www.clinicaltrials.gov/ct2/show/NCT02513836; Identifier: NCT02513836.

Keywords: PAP therapy; chronic pain; opioids; positional therapy; sleep apnea.

Conflict of interest statement

S.W. and S.M. contributed to data extraction and writing of the manuscript. C.R. contributed to writing of the manuscript. R.W. contributed to data analysis. F.C. contributed to study concept and design, data acquisition and interpretation, and writing of the manuscript and had full access to all the data in the study and takes responsibility for the integrity of the data. All authors contributed to critical revision of the manuscript for important intellectual content. This study was funded by the Ontario Ministry of Health and Long-Term Care Innovation Fund, University Health Network Foundation, and the Department of Anesthesia and Pain Medicine, University Health Network–Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. F.C. reports research support from the Ontario Ministry of Health and Long-Term Care and the University Health Network Foundation and UpToDate royalties and STOP-Bang proprietary to the University Health Network. J.W. reports grants from the Ontario Ministry of Health and Long-Term Care, Anesthesia Patient Safety Foundation, and the University of Toronto Merit Research Award. The other authors report no conflicts of interest.

© 2021 American Academy of Sleep Medicine.

Figures

Figure 1. Study flow chart.