Opioid use and initiation of positive airway pressure treatment in adults referred for sleep disorder assessment: an explanatory population-based study

Objectives — We conducted a retrospective population-based study to explore: (i) the prevalence of opioid use among adults referred for a sleep disorder assessment and (ii) the relationship between opioid use and initiation of positive airway pressure (PAP) treatment.

Methods — All adults who underwent an initial diagnostic sleep study (index date) in Ontario (Canada) between 2013 and 2016 were identified through provincial health administrative data. Opioid use was identified as active or recent opioid prescriptions (at or close to the index date) and being on opioids at any time in the last year. Cause specific hazard models were utilized.

Results — Of 268,293 adults, about 5% had an active or recent opioid prescription, 25% were on opioids in the last year, and 39% initiated PAP in a median of 17.4 months. Among active opioid users, 12% were treated with a daily dose ≥200 mg morphine equivalent, 37% were treated with long-acting opioids, and 38% were on benzodiazepines in the last year. Only opioid use in the last year was significantly associated with PAP initiation (1.08; 1.06–1.09), but not an active or recent opioid prescription. Among active opioid users, long-acting opioid users and those on high opioid daily dosage were less likely to initiate PAP.

Conclusions — We found a high degree of prior opioid exposure among people referred for a sleep disorder assessment with a large proportion on long-acting opioids, higher opioid dosages and on benzodiazepines among active opioid users. However, active opioid treatment was not associated with a higher likelihood of PAP initiation; active opioid users at higher risk of impaired breathing in sleep were less likely to initiate PAP.