Sleep, chronic pain, and opioid risk for apnea
| Autor: | Ronald Denis, Gilles Lavigne, Marc Baltzan, Serguei Marshansky, Pierre Mayer, Dorrie Rizzo |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Sleep Wake Disorders
medicine.medical_specialty Oral appliance Sleep Bruxism Hypnic headache 03 medical and health sciences 0302 clinical medicine Insomnia medicine Humans 030212 general & internal medicine Biological Psychiatry Pharmacology Sleep disorder Sleep hygiene business.industry Chronic pain Sleep apnea medicine.disease Analgesics Opioid Physical therapy Chronic Pain medicine.symptom Sleep business 030217 neurology & neurosurgery |
| Zdroj: | Progress in Neuro-Psychopharmacology and Biological Psychiatry. 87:234-244 |
| ISSN: | 0278-5846 |
| DOI: | 10.1016/j.pnpbp.2017.07.014 |
| Popis: | Pain is an unwelcome sleep partner. Pain tends to erode sleep quality and alter the sleep restorative process in vulnerable patients. It can contribute to next-day sleepiness and fatigue, affecting cognitive function. Chronic pain and the use of opioid medications can also complicate the management of sleep disorders such as insomnia (difficulty falling and/or staying asleep) and sleep-disordered breathing (sleep apnea). Sleep problems can be related to various types of pain, including sleep headache (hypnic headache, cluster headache, migraine) and morning headache (transient tension type secondary to sleep apnea or to sleep bruxism or tooth grinding) as well as periodic limb movements (leg and arm dysesthesia with pain). Pain and sleep management strategies should be personalized to reflect the patient's history and ongoing complaints. Understanding the pain-sleep interaction requires assessments of: i) sleep quality, ii) potential contributions to fatigue, mood, and/or wake time functioning; iii) potential concomitant sleep-disordered breathing (SDB); and more importantly; iv) opioid use, as central apnea may occur in at-risk patients. Treatments include sleep hygiene advice, cognitive behavioral therapy, physical therapy, breathing devices (continuous positive airway pressure - CPAP, or oral appliance) and medications (sleep facilitators, e.g., zolpidem; or antidepressants, e.g., trazodone, duloxetine, or neuroleptics, e.g., pregabalin). In the presence of opioid-exacerbated SDB, if the dose cannot be reduced and normal breathing restored, servo-ventilation is a promising avenue that nevertheless requires close medical supervision. |
| Databáze: | OpenAIRE |
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