Opioids for OSA should be used with caution

The results of a review support using opioids sparingly in patients with obstructive sleep apnea (OSA) who are vulnerable to opioid-induced respiratory depression. A search of the literature from 1946 to 2017 yielded 40 qualifying studies that reported on postoperative outcomes in OSA patients receiving short-term opioid therapy.

The results of a review support using opioids sparingly in patients with obstructive sleep apnea (OSA) who are vulnerable to opioid-induced respiratory depression. A search of the literature from 1946 to 2017 yielded 40 qualifying studies that reported on postoperative outcomes in OSA patients receiving short-term opioid therapy. The included investigations were found to have major limitations, including risk of bias; and the quality of the evidence was not considered high. Even so, there was some measure of consistency in the finding that opioid analgesics may be harmful in patients with OSA—especially in the first 24 hours of use. "While more research is needed, retrospective analyses suggest that opioid-related serious adverse events may be largely preventable with a more cautious approach to opioid use," the researchers wrote in Anesthesia & Analgesia. "This includes the utilization of multimodal analgesia to reduce opioid requirement, caution, or avoidance of concurrent administration of sedatives and opioids by multiple pathways (eg, [patient-controlled analgesia] plus background infusion)."