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The polysomnography recordings were scored by experienced technologists and reviewed by sleep physicians (CMR, CFPG). A technologist was in attendance throughout the study. The polysomnography was performed at the University Health Network (Toronto) or the London Health Sciences (London, Canada) sleep study laboratories. The participants then underwent an inlaboratory polysomnogram. The Pulsox-300i oximeter has 1 Hz of sampling frequency, 3 s of averaging time and 0.1% SpO 2 of resolution. Patients were rested and seated for 5–10 min before SpO 2 was obtained. In each pain clinic, eligible participants completed the STOP-Bang questionnaire 8 9 and the Epworth Sleepiness Scale (a self-reported measure of daytime sleepiness), 11 and underwent a clinical assessment of the Mallampati score, 12 thyromental distance 13 and resting daytime SpO 2 (Pulsox-300, Konica Minolta). The secondary objective was to identify predictive factors for Central Apnoea Index (CAI) ≥5 using the STOP-Bang questionnaire, daytime SpO 2 and MME. 8–10 The primary objective of this study was to determine whether the STOP-Bang questionnaire, 8 9 Epworth Sleepiness Scale, 11 Mallampati score, 12 thyromental distance, 13 resting daytime oxyhaemoglobin saturation (SpO 2) and calculated daily morphine milligram equivalent (MME) approximations are predictive factors for sleep apnoea (AHI ≥15) in patients on opioids for chronic pain.
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The STOP-Bang questionnaire (a screening tool for sleep apnoea Snoring, Tiredness, Observed apnoea, high blood Pressure, Body mass index, age, neck circumference and male gender) has been validated to screen for sleep apnoea in different populations. Polysomnography, the reference standard for diagnosing sleep apnoea, comes with high costs and restricted access. 7Īt present, no clinical tool allows the ready identification of sleep apnoea in patients on opioids for chronic pain. 7 Appropriate screening, diagnostic testing and treatment of opioid-associated sleep-disordered breathing were recommended to improve patients’ health and quality of life. 3 5 6 The recent American Academy of Sleep Medicine Position Statement indicated that opioids are associated with several types of sleep-disordered breathing, including obstructive sleep apnoea (OSA), central sleep apnoea (CSA) and sleep-related hypoventilation. 3 Although sleep apnoea is highly prevalent in patients on opioids for chronic pain and is implicated as an important contributor to opioid-related deaths, 4 patients are not routinely screened for the disease. 1 The potential for acute respiratory depression and death triggered by opioids is well known, 2 but the synergism between sleep apnoea and chronic opioid use was only recently recognised. Over the past two decades, the prescription of opioids for chronic pain has increased dramatically, triggering an opioid crisis in North America, with heavy societal and economic impacts.