Is Sleep-Disordered Breathing a Major Cause of Sleep Disturbances in Methadone-Maintained Patients?

More than 75% of opioid-dependent patients receiving methadone report sleep problems. In this cross-sectional investigation, researchers sought to determine the prevalence of sleep-disordered breathing (SDB), including central and obstructive sleep apnea (CSA and OSA, respectively), in methadone-maintained patients who report sleep disturbances and also examined the association between SDB, sleep-complaint severity, methadone dose, and illicit substance use. Eligible participants (N=71) had subjective sleep complaints as defined by a validated measure. Patients with psychotic or bipolar disorders, recent trazodone use, unstable housing, chronic medical illness, or <3 months of stable methadone dose were excluded. Sleep and respirations were measured via portable polysomnography.

• Thirty participants (42%) had SDB; of these, 20 met criteria for OSA, 5 for CSA, and 5 for both OSA and CSA.

• Sleep disturbances included decreased sleep efficiency, decreased REM sleep, and increased stage-2 sleep. These did not differ among participants with and without SDB.

• Neither OSA nor CSA was associated with severity of sleep complaints.

• CSA was not associated with methadone dose or benzodiazepine use.

• Patients with SDB had received methadone for a significantly longer period of time than those without.

Comments:

Although SDB was common in this sample of methadone-maintained patients with sleep disturbances, the majority did not have SDB. Other factors must be sought to explain and guide treatment for sleep disturbances in such patients. Since medical illness was an exclusion from this sample, SDB rates observed herein may under-represent actual rates of SDB among a broader sample of methadone-maintained patients.

Hillary Kunins, MD, MPH, MS

Reference:

Sharkey KM, Kurth ME, Anderson BJ, et al. Obstructive sleep apnea is more common than central sleep apnea in methadone maintenance patients with subjective sleep complaints. Drug Alcohol Depend. 2010;108(1–2):77–83.