Comborbidities likely explain opioid + sleep apnea mortality risk

Key clinical point: Comorbid conditions may explain the relationship between opioid use, sleep apnea, and death.

Major finding: Opioid use was not significantly associated with mortality after adjustment for sleep apnea and comorbidities (odds ratio, 1.37).

Data source: A retrospective analysis of data for 1,867 patients from the prospective observational DREAM cohort.

Disclosures: Dr. Sharifi reported having no disclosures.



AUSTIN, TEX. – Any association between opioid use and death in patients with sleep apnea cannot be explained by sleep apnea alone, according to a retrospective analysis of data from the prospective observational DREAM study.

In 1,867 patients with moderate or severe sleep apnea who were on an opioid medication, no association was seen between opioid use and severity of sleep-disordered breathing, even with increasing doses, Dr. Husham Sharifi reported at the annual meeting of the American College of Chest Physicians.

Further, when opioid use was analyzed as an unadjusted variable, it was associated with an increase in mortality (odds ratio, 1.53), but this effect was attenuated by adjustment for sleep apnea (OR, 1.52), and was further attenuated – to the point where it was no longer statistically significant – by adjustment for both sleep apnea and Charlson Comorbidity Index (OR, 1.37), said Dr. Sharifi, who was an attending physician at Brigham and Women’s Hospital, Boston, at the time he completed this research. He is now a fellow at Stanford (Calif.) University.

Sleep apnea remained an independent predictor of mortality even after adjustment for opioid use and Charlson Comorbidity Index, he said.

The DREAM study, which stands for Determining Risk of Vascular Events by Apnea Monitoring, includes a well-defined cohort of patients at three Veterans Administration sleep centers who were referred for overnight polysomnography for suspected sleep-disordered breathing between Jan. 1, 2000, and Dec. 31, 2004. All patients had an Apnea-Hypopnea Index score greater than 15, indicating moderate to severe sleep apnea, and all were on opioid medication. The patients were followed for between 3 and 10 years, with follow-up ending Dec. 31, 2010.

Opioid use has increased dramatically over the past 20 years – by more than 700%, Dr. Sharifi said.

While there does not appear to be a significant impact of opioid use on daytime respiration, there are some limited data suggesting that it may be associated with sleep-disordered breathing, he said.

The current findings, though limited by a number of factors including the observational nature of the study and possible selection bias as the DREAM cohort is a referral population, suggest that the relationship between opioid use and sleep apnea death is likely explained not by sleep apnea, but by an increased prevalence of known risk factors for morbidity and mortality in patients who take opioids and have sleep apnea, he concluded.

Dr. Sharifi reported having no disclosures.

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