WEST HAVEN, CT — Does sleep disruption caused by obstructive sleep apnea lead to hyperalgesia and contribute to poor pain control and use of prescription opioids?

An article in the journal Pain pointed out that the answer to that question is not clear because the relationship between OSA and opioid prescription is not well described.1

In an effort to resolve that issue, researchers from the Yale School of Medicine and the VA Connecticut Healthcare System and colleagues examined the association using cross-sectional data from a national cohort of recent veterans enrolled from Oct. 1, 2001, to Oct. 7, 2014.

Defined as the primary outcome was the relative risk ratio of receiving opioid prescriptions for acute—less than 90 days/year—and chronic—90 or more days/year—durations compared to no opioid prescriptions. The primary exposure was a diagnosis of OSA.

Researchers advised that, of the 1.1 million patients included in the study, with a mean age of 38, 88.1% had no opioid prescriptions, 9.4% had acute prescriptions, and 2.5% had chronic prescriptions. One in 10 had a diagnosis of OSA.

According to the study, patients with OSA were more likely to be older, male, nonwhite, obese, current or former smokers, have higher pain intensity and have medical and psychiatric comorbidities.

Controlling for these differences, results indicated that patients with OSA were more likely to receive acute (RRR 2.02 [95% CI 1.98, 2.06]) or chronic (RRR 2.15 [2.09, 2.22]) opioids. “Further dividing opioid categories by high versus low dosage did not yield substantially different results,” the authors wrote, adding, “OSA is associated with a twofold likelihood of being prescribed opioids for pain. Clinicians should consider incorporating OSA treatment into multi-modal pain management strategies; OSA as a target for pain management should be further studied.”

  1. Chen K, Yaggi HK, Fiellin DA, et al. Associations between obstructive sleep apnea and prescribed opioids among veterans [published online ahead of print, 2020 Apr 29]. Pain. 2020;10.1097/j.pain.0000000000001906. doi:10.1097/j.pain.0000000000001906