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Sleep Disorders : Treatment and Care
Case Report
Opioid Induced Sleep Disordered Breathing in Sickle Cell Patient
 
Division of Pulmonary, Critical Care & Sleep Medicine, East Carolina University, Greenville, NC, USA MD. Monirul Islam, Division of Pulmonary, Critical Care & Sleep Medicine, East Carolina University, Greenville, NC, USA Omar Albustami, Division of Pulmonary, Critical Care & Sleep Medicine, East Carolina University, Greenville, NC, USA Jacqueline Judy, Division of Pulmonary, Critical Care & Sleep Medicine, East Carolina University, Greenville, NC, USA Peter C Boettger Darla K Liles, Division of Pulmonary, Critical Care & Sleep Medicine, East Carolina University, Greenville, NC, USA Charles L Knupp and Division of Pulmonary, Critical Care & Sleep Medicine, East Carolina University, Greenville, NC, USA Sunil Sharma*
 
Corresponding author : Sunil Sharma, M.D, D’ABSM, Assistant Professor of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Brody School of Medicine, 600 Moye Boulevard, 3E-149, East Carolina University, Greenville, NC 27834, USA, Tel: 252-744-4653; Fax: 252-744-4887; E-mail: sharmas@ecu.edu
 
Received: August 02, 2012 Accepted: August 18, 2012 Published: August 22, 2012
 
Citation: Islam MM, Albustami O, Judy J, Boettger PC, Liles DK, et al. (2012) Opioid Induced Sleep Disordered Breathing in Sickle Cell Patient. J Sleep Disor: Treat Care 1:1. doi:10.4172/2325-9639.1000101
 
Abstract
 
Chronic opioid use is a risk factor for sleep disordered breathing (SDB) like obstructive sleep apnea (OSA), Biot’s or ataxic breathing, central sleep apnea and sleep related hypoventilation. Withdrawal of opioids may be the optimal management but it is not always feasible. Continuous positive airway pressure (CPAP) therapy, which is effective treatment for OSA, may not resolve central events. Opioid induced sleep disordered breathing has been described mostly in patients with chronic back pain on narcotics. We present a case of sickle cell disease who is a 37 year old male on short and long acting Morphine presenting with excessive daytime sleepiness, fatigue and memory loss. Baseline nocturnal polysomnography (NPSG) showed central sleep apnea (Biot’s breathing) with AHI of 27. After initial failure of CPAP, ASV at IPAPmax/ EPAPmin (inspiratory and expiratory positive airway pressures) of 25/7 cm of H2O with a pressure support setting of 0-15 and auto back-up rate was applied with complete resolution of Biot’s breathing and symptoms. This case highlights the increased risk of central sleep apnea induced by opioids in a population with improving life expectancy and chronic use of narcotics. It also adds to the small but growing body of evidence suggesting the beneficial role of ASV in opioid induced sleep disordered breathing where narcotics /opioids cannot be discontinued.
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