Sleep apnea is a condition that can dramatically impact a person’s overall health. We still don’t understand all the myriad ways that the condition can impact the body’s smooth functioning. We know it increases the risk of heart failure, among other problems. Now a new study suggests that it could be linked to chronic pain. However, it doesn’t seem to be linked to the use of opioids to treat chronic pain.
Testing Patients at a Pain Clinic
This study looked at over 350 consecutive patients at a pain clinic. Of these patients, 305 met the inclusion criteria, and were given a survey asking about their chronic pain condition, their use of opioids, and demographic information. In addition, each patient was given a form of the STOP-BANG questionnaire, a common sleep apnea screening tool that bases the likelihood of sleep apnea on eight different criteria:
- Daytime Tiredness
- Observed Apneas
- High blood Pressure
- BMI greater than 35
- Age of 50+
- Neck circumference greater than 16 inches
- Gender is male
Patients are considered at risk for sleep apnea if they answer three or more of the questions yes.
Overall, 58% of patients were considered at risk for sleep apnea. Researchers didn’t confirm chronic pain diagnosis or even ask which chronic pain condition people had. Unfortunately, this means we can’t use the data to look at the sleep apnea-TMJ link.
Risk Not Related to Opioids
The study was performed to test whether the use of opioids to treat chronic pain contributed to the sleep apnea risk of patients. The thought was that opioids could contribute to obstructive sleep apnea by causing airway muscles to relax. They could also contribute to the risk of central sleep apnea by depressing the brain’s drive to signal breathing.
However, researchers found that opioids didn’t seem to have much impact on sleep apnea risk. The survey showed that 59% of opioid users were at risk for sleep apnea, while 56% of non-users were at risk for sleep apnea.
However, it seems that the study is poorly designed to test for this risk. Although the STOP-BANG questionnaire is a reasonable screening tool, it looks for people who are at high risk for sleep apnea because of other characteristics. It can’t show whether people are at risk of sleep apnea because of opioids, since this has little to do with a person’s age, BMI, and other factors.
Talk to Your Doctor about Sleep Apnea
However, the study did have one important finding: most people with chronic pain hadn’t talked to their doctor about sleep apnea, and fewer still had been tested.
Only 36% of these chronic pain patients had talked to their health care provider about sleep apnea. And only 30% of them had been tested, about half those who were at risk. And when we consider the possibility that opioid users may still have elevated sleep apnea risk, it’s an even smaller fraction.
This shows how important it is that people take the initiative in starting the sleep apnea conversation with their doctor, after recognizing the warning signs. And if you are diagnosed with sleep apnea, it may be up to you to mention that there are alternatives to CPAP treatment, which is effective, but many people find unpleasant and don’t adhere to.