Do you snore, wakeup throughout the night, or feel tired all the time? If so, you might have sleep apnea. Are you obese or have a thick neck? If so, you might have sleep apnea. In fact, 80 to 90 percent of people with sleep apnea do not even know that they have this respiratory problem. Gone undiagnosed, this nocturnal problem can lead to an unintentional death especially in those who are given opioids to treat pain. A person can literally stop breathing in his/her sleep as the driving force that keeps a person breathing, called the respiratory drive, is slowed. Those with sleep apnea may already have a reduced respiratory drive. Those who take opioids may also have a reduced respiratory drive. Thus, the combination of sleep apnea and opioid use can be fatal.
Cases of fatalities have been reported both in and outside the hospital. In the hospital, many cases of post-operative respiratory depression have been linked to people at risk for sleep apnea, undiagnosed with sleep apnea, and given opioids for post-operative pain. The typical scenario involves an obese patient hospitalized for some type of surgery, given opioids in the recovery room, and found dead within a matter of hours. Now, with the incidence of these cases rising, hospitals and insurance companies are calling for improved screening measures to find those at risk for sleep apnea and diagnose the problem earlier. The association between sleep apnea and opioids is not new. In 2007, a study found that those who continuously used opioids for chronic pain have a much higher risk for developing sleep apnea. Methadone in particular has been linked to many deaths relating to respiratory failure. And the mixture of opioids and benzodiazepines is also known to put people at risk for fatalities.
How can these fatalities be prevented? Proper risk assessment is a key component of safety. Two major risk factors for obstructive sleep apnea are the body mass index (BMI) and neck circumference. A BMI over 30 is equated with obesity and 50% or more of obese people have sleep apnea. A neck circumference of greater than 17 inches is also associated with a higher risk for sleep apnea. High risk individuals should undergo a sleep study, especially those who are also using opioids or planning for an operation. Assessing all the risk factors and talking with a doctor before taking pain medications or having surgery can help identify undiagnosed sleep apnea and prevent unintentional fatalities.