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Título

Central apnea and opioids: report of a case treated with oxygen

Introdução

The chronic use of opioids for pain control and perioperative analgesia is the second most common cause of Central Apnea, second only to heart failure. There is a correlation between dose and central apnea index. In the last two decades the prescription of opiates has increased dramatically and there is no public policy for control in Brazil. Chronically, the use of opioids reduces the ventilatory response to hypercapnia and increases the ventilatory response to hypoxemia. The reduced response to hypercapnia increases the risk of narcosis and the increased response to hypoxia can induce central apneas. The treatment of opioid-associated central apnea is not well established.

Objetivo

We present a case that shows the relationship of respiratory events with the use of opioids, and the response to oxygen therapy.

Métodos

We present the case of a female patient, 31 years old, single, obese, with a psychiatric history of medication abuse and oxycodone dependence, methadone 7.5mg twice a day and clonazepam 40 drops a day. In March/2021 he presented an event with a lowering of the level of consciousness with the need for orotracheal intubation and extubation on the following day attributed to drug abuse. It evolved into pneumonia and PTE. The patient had excessive daytime sleepiness. BMI 36 kg/m2. Polysomnography (PSG) revealed an apnea-hypopnea index (AHI) of 71.3 events/hour (239 central apneas, 27 obstructive apneas and 322 hypopneas). Presented SpO2 below 90% during 95% TTS, minimum SpO2 78%, average 87%. The test was repeated the following day with 1.5 L/min oxygen. There was an important reduction in the AHI to 8.3 events/h (43 central apneas, 2 obstructive apneas and 43 hypopneas). A minimum SpO 89%, average 93%. Continued home oxygen therapy and reduced opioid dose were recommended.

Resultados

Patient diagnosed with central apnea secondary to opioid use and oxygen therapy effectively reduces AHI, secondary to a reduction in central respiratory events and improves oxygen saturation.

Conclusões

With this report, we draw attention to the abuse of opioids, a growing public health problem with important consequences for the morbidity and mortality of patients. We showed that nasal oxygen was able to acutely reduce the intensity of the respiratory disorder attributed to the opioid.

Palavras-chave

Central apnea, opioid prescription and use, oxygen therapy, public health problem.

Área

Relato de Caso

Autores

EDDY ALBERTO BETANCOURT FLORES, Geraldo Lorenzi Filho, Pedro Rodrigues Genta, Camila Munaro Montero, Flávia Zuccolotto dos Reis Requena, Gracielly Porte de Oliveira, Hugo Gustavo Vega Alcivar, João Victor Valinho de Moraes, Thainá Rocha Braga Machado