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Sleep Med Clin. 2017 Dec;12(4):573-586. doi: 10.1016/j.jsmc.2017.07.007. Epub 2017 Oct 3.

Sleep Disordered Breathing Caused by Chronic Opioid Use: Diverse Manifestations and Their Management.

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Sleep Medicine Section, John D. Dingell VA Medical Center, 11 M, 4646 John R Street, Detroit, MI 48201, USA. Electronic address:
Medical Director, Montgomery Sleep Laboratory, Cincinnati, OH 45242, USA; University of Cincinnati, College of Medicine, Cincinnati, OH, USA; Division of Cardiology, Department of Internal Medicine, College of Medicine, Ohio State University, Columbus, OH, USA.


Opioid-induced sleep disordered breathing presents a therapeutic predicament with the increasing incidence of prescription opioid use for noncancer chronic pain in the United States. Central sleep apnea with a Biot or cluster breathing pattern is characteristic of polysomnography studies; however, long-term clinical outcomes and the impact of therapy remain unknown. Novel ampakine-based therapies are being investigated. Randomized controlled trials with therapies that target the underlying pathophysiologic mechanisms of opioid-induced sleep disordered breathing are required.


Ampakines; Ataxic breathing; Biot breathing; Central sleep apnea; Hypoglossal nerve; Obstructive sleep apnea; Positive airway pressure; Pre-Bötzinger complex

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