The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

SUCCESSFUL APPLICATION OF ADAPTIVE SERVOVENTILATION IN A PATIENT WITH SLEEP DISORDERED BREATHING SECONDARY TO CHRONIC OPIOID USAGE

Vichaya Arunthari, Joseph Kaplan; Pulmonary Medicine, Mayo Clinic Florida, Jacksonville, FL

Introduction: Adaptive servoventilation (ASV) has been effective in Cheyne-Stokes respiration and complex sleep apnea. However, data regarding ASV and sleep disordered breathing (SDB) related to chronic opioid usage are lacking. We describe a case with SDB related to chronic opioid usage where ASV shown to normalize the underlying breathing pattern. Case Summary: A 66 year old lady was seen in our sleep center due to insomnia and excessive daytime sleepiness for years despite sleeping 12-14 hours a day. Occasional apneas and snoring has been observed without parasomnias or abnormal leg movements. Past medical history includes diabetes mellitus, hypothyroidism, hypertension, dyslipidemia, depression, and chronic back pain on four different narcotics. Physical examination was unremarkable except for elevated blood pressure, body mass index of 28, and a Mallampati IV classification. A polysomnogram was performed and revealed a moderate degree of SDB with an overall apnea hypopnea index of 21.6. However, the underlying breathing pattern was consistent with ataxic breathing or Biot’s breathing secondary to opioid usage. An oxygen trial and continuous positive airway pressure (CPAP) plus oxygen supplementation failed to improve the underlying breathing disorder. Eventually the patient had a separate titration trial with ASV which improved the underlying breathing pattern. Discussion: Ataxic breathing or Biot’s breathing is an irregular ventilatory pattern of rate and tidal volume. Previously was described in neurological diseases such as meningitis is currently more recognized with chronic opioid usage. Oxygen therapy alone is usually ineffective and CPAP therapy has shown variable results. There are conflicting data with the usage of ASV in sleep disordered breathing related to chronic opioid therapy [1, 2]. We demonstrate a case where ASV successfully improved the underlying SDB and well tolerated by the patient. Further studies with larger number of patients are needed to provide insight on the best modality for SBD secondary to chronic opioid therapy. Sponsored Research - None