The Deleterious Impact of Opioids on Sleep-Related Respiration During Acute Inpatient Rehabilitation From Moderate to Severe

Research Objectives To identify differences sleep related respiration between those receiving and not receiving opioid medications. Design Cross-sectional, secondary analyses. Setting Acute inpatient rehabilitation for moderate to severe TBI. Participants 248 consecutive admissions who underwent level-1 polysomnography. Interventions Receipt of opioid medications on the day of polysomnography (PSG). Main Outcome Measures PSG including respiratory measures: oxygen saturation, central apneas events per hour, obstructive apneas and hypopnea events per hour, and total apnea-hypopnea index (AHI). Results After adjustment for number of prescribed medications, those receiving opioids on day of PSG experienced increased frequency of central sleep apnea events and higher frequency of obstructive sleep apnea events. Compared to those who did not, receiving opioids was associated with lower oxygen saturation nadir during and a greater number of oxygen desaturations across. Greater total AHI was observed for those receiving opioids. Conclusions Opioid use early after TBI appears to impact important sleep parameters and sleep related respiration that may influence recovery. Further investigation is needed to understand the impact of opioid medications, alone or in combination with other medications, on functional outcomes both early after TBI and in the chronic phase to develop recommendations on how and when to use these medications given their usage in managing pain after injury. Author(s) Disclosures Research reported in this article was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CER-1511-33005). This research was sponsored by VHA Central Office VA TBI Model Systems Program of Research; Subcontract from General Dynamics Information Technology (W91YTZ13-C-0015; HT0014-19-C-0004) from the Defense Health Agency TBI Center of Excellence and National Institute on Disability, Independent Living, and Rehabilitation Research (University of Texas Southwestern Medical Center, 90DPTB0013-01-03; Indiana University School of Medicine, Rehabilitation Hospital of Indiana, 90DRTB0002; Division of Rehabilitation Psychology, Department of Rehabilitation Medicine, University of Washington School of Medicine, 90DPTB0008). The TBI Model Systems is a funded collaboration between the Department of Veterans Affairs and the Department of Health and Human Services: National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). Clinicaltrial.gov Registration Number: NCT03033901.