Researchers have found that respiratory compromise may occur with obstructive sleep apnea (OSA) patients receiving opioids.
Research conducted by Yamini Subramani, MD et al, “Death or near-death in patients with obstructive sleep apnoea: a compendium of case reports of critical complications” found 5 reasons why the risk of death is higher in patients with obstructive sleep apnea (OSA).
After removing for duplicates, the researchers analyzed more than 1,000 patient cases.
# 1 Fact – Patients can have obstructive sleep apnea and not know it
While 83% of the patients the researchers found had been diagnosed with OSA, 17% were undiagnosed before surgery. The researchers in discussing undiagnosed OSA said:
“Undiagnosed OSA may play a role in the occurrence of death or near-death events. Seventeen percent of the OSA patients in our analysis were undiagnosed. A large proportion (80-90%) of surgical patients with moderate-to-severe OSA could be undiagnosed and untreated at the time of surgery. It has been shown that patients with undiagnosed OSA may have higher cardiopulmonary complications than patients with diagnosed OSA and CPAP prescription.”Patients can have obstructive #sleepapnea and not know it Click To Tweet
# 2 Fact – Opioids increase the risk of life-threatening complications
The researchers found that 75% of the patients with OSA who suffered severe life threatening complications received opioids. They discussed the difficulty of predicting the affects that opioid administration may have on an OSA patient:
“Opioids interfere with the chemical, behavioral and motor control of respiration, and can lead to severe hypoxia, alveolar hypoventilation and death …
“Some patients with OSA have a high threshold for arousal, whereas others with a low arousal threshold wake up frequently to minimal oxygen desaturation. It has been postulated that a delay in arousal caused by opioids or other sedative medications can precipitate an arousal arrest(complete arousal failure) leading to sudden unexpected death as a result of respiratory failure. These patients are in a state of “arousal dependent survival”. At present, there is no conventional way to identify patients with a high arousal threshold preoperatively.”#Opioids increase the risk of life-threatening complications #patientsafety Click To Tweet
# 3 Fact – An adverse event or death may occur with a relatively small opioid dose
The researchers found that an adverse event or death may occur with a relatively small opioid dose, noting that severe life threatening complications occurred with “small doses of opioids of MEDD [morphine equivalent daily dose] <10 mg in 81% of the patients, regardless of the route of administration.”Even a small #opioid dose can cause an adverse event or #patient #death #patientsafety Click To Tweet
# 4 Fact – The general care floor ward can be dangerous
The general care floor is usually where patients who require less care go – these patients may be recovering from successful surgery or been transferred from the ICU because their health is improving. Although being on the general care floor would seem to indicate that the patient is on the “road to recovery,” the researchers found:
“Eighty percent of deaths or near-deaths occurred in the first 24 h and nearly 67% took place on the general hospital ward.”The general care floor ward can be dangerous - 67% of deaths or near-deaths occurred on the general care floor Click To Tweet
# 5 Fact – Patient deaths might have been prevented with better patient monitoring
The researchers found that the majority of patient deaths might have been prevented with better patient monitoring and comment on the need for better monitoring of patients, in accordance with recommendations of the Anesthesia Patient Safety Foundation:
“lack of appropriate postoperative monitoring were the risk factors identified to predispose an OSA patient to critical complications …
“The Anaesthesia Patient Safety Foundation has recommended continuous electronic monitoring of postoperative patients on opioids with high resolution pulse oximetry and possibly capnography to detect early desaturation and initiate treatment. Continuous monitoring of patients with OSA, recurrent PACU respiratory events and those who require narcotic analgesics for pain are recommended.”Obstructive #sleepapnea research: #Patient deaths might have been prevented with better #patientmonitoring #patientsafety Click To Tweet
The valuable research by Dr. Subramani and her colleagues could save the lives of both diagnosed and yet undiagnosed patients with OSA. In the comment section below, please tell us what practices and recommendations do you use for preventing adverse and deaths in patients with OSA (diagnosed or undiagnosed)?