Opioid Use Disorder, Sleep Deficiency, and Ventilatory Control: Bidirectional Mechanisms and Therapeutic Targets

Opioid use continues to rise globally. So too do the associated adverse consequences. Opioid use disorder (OUD) is a chronic and relapsing brain disease characterized by loss of control over opioid use and impairments in cognitive function, mood, pain perception, and autonomic activity. Sleep deficiency, a term that encompasses insufficient or disrupted sleep due to multiple potential causes, including sleep disorders, circadian disruption, and poor sleep quality or structure due to other medical conditions and pain, is present in 75% of patients with OUD. Sleep deficiency accompanies OUD across the spectrum of this addiction. 

The focus of this concise clinical review is to highlight the bidirectional mechanisms between OUD and sleep deficiency and the potential to target sleep deficiency with therapeutic interventions to promote long-term, healthy recovery among patients in OUD treatment. 

In addition, current knowledge on the effects of opioids on sleep quality, sleep architecture, sleep-disordered breathing, sleep apnea endotypes, ventilatory control, and implications for therapy and clinical practice are highlighted. 

Finally, an actionable research agenda is provided to evaluate the basic mechanisms of the relationship between sleep deficiency and OUD and the potential for behavioral, pharmacologic, and positive airway pressure treatments targeting sleep deficiency to improve OUD treatment outcomes.

Target Audience

Pulmonologists, critical care specialists, translational researchers, and clinicians.

Learning Objectives

After reading this journal article, learners will be able to:

  • Describe new knowledge on the bidirectional physiological and mechanistic links between sleep deficiency, ventilatory control, and opioid use disorder and the potential implications for therapy.
  • Describe new findings about the disparate roles that opioids can have on sleep and breathing and the important influential factors that mediate the differential effects and implications for therapy.
  • Apply new knowledge on the important multifactorial role that sleep deficiency plays on opioid use disorder to develop new strategies to optimize sleep to better manage and improve outcomes for these patients.
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit(s)
    The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Participation
Publication Date: 
10/31/2022
Credit Expires: 
10/15/2024
Rating: 
0

Accreditation Statement

The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Disclosure Declaration

The current practice of the American Journal of Respiratory and Critical Care Medicine (AJRCCM) is to publish high quality, peer-reviewed and evidence-based original research, Concise Clinical Reviews, Guidelines and Consensus Statements. Articles published in AJRCCM include evidence-based summaries of optimal practice (Concise Clinical Reviews), evidence-based guidelines, workshop summaries and original contributions that will influence clinical practice. The publication of these articles by itself is only one piece of a multi-step process for the translation of evidence-based improvements in care to clinical practice. Articles selected for CME credit are designed to be the next step in the process of translating clinically relevant, evidence-based recommendations into clinical practice. This will be accomplished through a series of questions specifically designed by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AJRCCM editorial board will review these questions and assess the quality of the questions based on:

  • Clarity,
  • Educational content, and
  • The quality of the evidence supporting the response to the question. Posttest questions will assess if practitioners have understood the most important recommendations available for the diagnosis and treatment of pulmonary diseases, critical illness, and sleep disorders and are able to implement them into clinical practice.

Article Authorship Disclosures (as submitted to the ATS prior to article publication date)

Danny J. Eckert, Ph.D., B.Sc. (Hons), B.App.Sc. (Flinders University, Bedford Park, South Australia, Australia) reported grants from the National Health and Medical Research Council of Australia, Bayer, Apnimed, and Collaborative Research Centre; and personal fees from Bayer, Apnimed, and Takeda.

H. Klar Yaggi, M.D., M.P.H. (Yale University School of Medicine, New Haven, CT, USA) reported grants from National Institutes of Health.

Disclosures of AJRCCM CME Planners

The current practice of the American Journal of Respiratory and Critical Care Medicine (AJRCCM) is to publish high quality, peer-reviewed and evidence-based original research, Concise Clinical Reviews, Guidelines and Consensus Statements. Articles published in AJRCCM include evidence-based summaries of optimal practice (Concise Clinical Reviews), evidence-based guidelines, workshop summaries and original contributions that will influence clinical practice. The publication of these articles by itself is only one piece of a multi-step process for the translation of evidence-based improvements in care to clinical practice. Articles selected for CME credit are designed to be the next step in the process of translating clinically relevant, evidence-based recommendations into clinical practice. This will be accomplished through a series of questions specifically designed by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AJRCCM editorial board will review these questions and assess the quality of the questions based on (1) clarity, (2) educational content, and (3) the quality of the evidence supporting the response to the question. Posttest questions will assess if practitioners have understood the most important recommendations available for the diagnosis and treatment of pulmonary diseases, critical illness, and sleep disorders and are able to implement them into clinical practice.

Off-Label Usage Disclosure

Ampakines for maintaining analgesia while preventing unwanted respiratory depression that accompanies opioid use; intranasal leptin to augment hypercapnic and hypoxic sensitivity, which may be beneficial for certain people with opioid-induced sleep-disordered breathing; hypnotics and sedative medications for possible beneficial role in reducing opioid withdrawal symptoms and drug seeking.

AJRCCM CME Planners

Edward J. Schenck, M.D.
Associate Editor, AJRCCM

Dr. Schenck served as a consultant for Axle Informatics.

Instructions to Receive Credit

To receive credit for this journal article:

  1. Read the journal article. Keep track of how long it takes you to read it.
  2. Once you open the article, the Post-Test becomes available. After reading the article, answer the post-test questions. You must answer all questions correctly to earn credit. You may take the test as many times as you like.
  3. Once you pass the Post-Test, the Evaluation becomes available. Answer all the evaluation questions.
  4. Once you complete the evaluation, select the amount of credit to receive based on the time it took you to read the article.
  5. You can view, save and print your Certificate by pressing the Certificate button.
  6. To review the credits you've earned in this system and reprint certificates, go to the My Learning drop-down list. Then select Transcript.

Available Credit

  • 1.00 AMA PRA Category 1 Credit(s)
    The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Participation
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