Obstructive Sleep Apnea, Pain, and Opioid Analgesia in the Postoperative Patient

Abstract

Obstructive sleep apnea (OSA) is a common health problem among surgical patients. Human evidence supports that important components of OSA like sleep fragmentation and intermittent hypoxia may enhance pain behavior and also increase sensitivity to opioid analgesia. To the extent that these effects might affect postoperative opioid pharmacology, OSA may impact the risk for opioid-induced ventilatory impairment (OIVI), a potentially serious complication in the postoperative patient. On the other hand, certain pathophysiological features of OSA might promote the development of OIVI due to enhancing respiratory compromise and/or through suppressing arousal from sleep in response to an airway obstruction event. Nonetheless, possible determinants of OIVI are not limited to factors associated with sleep-disordered breathing and current evidence does not support a direct relationship between an isolated preoperative diagnosis of OSA and increased risk for OIVI during postoperative analgesic therapy. Older age, comorbidity burden, and increased postoperative sedation, seem to be important promoters of potentially severe OIVI in the postoperative patient. Accepted strategies to prevent OIVI without interfering with postoperative analgesia include adopting opioid-sparing analgesic techniques, as well as establishing intense patient monitoring with emphasis on the respiratory and mental capacities.