Opioid Induced Sleep Disordered Breathing in Sickle Cell Patient

Opioid Induced Sleep Disordered Breathing in Sickle Cell Patient

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.