The effect of acute morphine on obstructive sleep apnoea: a randomised double-blind placebo-controlled crossover trial

Thorax
Luke RowsellDavid Wang

Abstract

Anaesthesiology guidelines suggest that opioids worsen obstructive sleep apnoea (OSA) despite no randomised controlled trial evidence. We therefore conducted a randomised controlled trial to evaluate the effects of a common clinical dose of morphine on OSA, and to identify clinical phenotype and genotype vulnerability to opioid-respiratory depression. Under a double-blind, randomised, crossover design, 60 male patients with OSA attended two visits to the hospital sleep laboratory, at least 1 week apart. Either 40 mg controlled-release oral morphine or placebo was administered. Awake ventilatory chemoreflex tests were performed post dose and prior to overnight polysomnography monitoring. Blood was sampled before sleep and the next morning for toxicology and genotype analyses. Sleep time with oxygen saturation (SpO2) <90% (T90) was the primary outcome. Despite a large inter-individual variability, 40 mg morphine did not worsen T90 and apnoea-hypopnoea index, and only decreased the SpO2 nadir by 1.3%. In patients with severe OSA, a lower baseline CO2ventilatory response threshold correlated with the worsening of T90, apnoea-hypopnoea index and oxygen desaturation index with morphine use. Patients with OSA and the A118G OPRM1 polym...Continue Reading

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Citations

Oct 2, 2019·Annals of the American Thoracic Society·David WangRonald R Grunstein
Mar 14, 2020·The European Respiratory Journal·Rodrigo T MartinsDanny J Eckert
Apr 16, 2021·Anesthesia and Analgesia·Thomas J AltreeDanny J Eckert

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