Development of an Innovative Opioid Safety Program in Pain Clinics (Op-Safe): A Multi-Centre project

Mental Health, Children and Community Care


Frances Chung

frances.chung@uhn.ca

416 603 5800 ext 5433

University Health Network and Women’s College Hospital


Jean Wong

jean.wong@uhn.ca

416-603-5118

University Health Network


Highlights

MSU-15-003 The risk of death and other serious complications is elevated in patients taking opioids for chronic non-cancer pain. Respiratory depression is the main cause of death due to opioids and sleep apnea is an important associated risk factor. We have developed and validated a novel risk index for identifying sleep apnea in patients taking opioids for chronic, non-cancer pain. This risk index provides a user-friendly, cost-effective and much-needed new screening tool for health care professionals in pain and family-practice clnics . The early identification of patients at risk for sleep apnea can lead to risk mitigation strategies to reduce the risks of opioid-related complications and death. This tool can be widely adopted for use locally, nationally, and internationally increasing the safety of patients taking opioids for chronic pain.

Abstract

MSU-15-003 Background: The risk of death and other serious complications is elevated in patients taking opioids for chronic non-cancer pain. Respiratory depression is the main cause of death due to opioids and sleep apnea is an important associated risk factor. The synergism between sleep apnea, a common but often unrecognized sleep disorder, has only recently been recognized. Sleep apnea is more prevalent in opioid-using patients, yet , at present, patients on chronic opioid therapy are not routinely screened for sleep apnea. In this study, we sought to develop and evaluate a sleep apnea risk index for patients taking opioids for chronic non-cancer pain. Methods: We conducted a prospective cohort study at five Canadian chronic pain clinics. All participants completed the STOP-Bang questionnaire, and Epworth Sleepiness Scale. The Mallampti classification, thyromental distance, daytime oxygen saturation and morphine milligram equivalents were measured. The participants had an in-laboratory polysomnogram. The primary outcome was the development and internal validation of a sleep apnea risk index for patients on chronic opioid therapy using multivariable logistic regression models. Results: Of 332 consented participants, 204 underwent polysomnography, and 120 (58.8%) had sleep apnea (72% obstructive, 20% central, and 8% indeterminate sleep apnea). The sleep apnea risk index was composed of 3 predictors: STOP-Bang, daytime oxygen saturation, and daily morpine milligram equivalent (“SOM”). Conclusions: We developed and internally validated the SOM risk index for identifying sleep apnea using the STOP-Bang questionnaire, daytime oxygen saturation and daily morphine milligram equivalent.

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