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The influence of opioids and nonopioid central nervous system active medications on central sleep apnea: a case-control study

In this case-control study of adults who underwent baseline PSG, we report a five-fold increased odds of CSA among patients using a combination of opioids and nonopioid CNSAMs compared with those who did not use those medications. Conversely,users of nonopioid CNSAMs in isolation(with out opioids) had lower odds of CSA, although they were not statistically significant. With opioid users, the additional use of nonopioid CNSAMs increased CSA odds by 2.7-fold.

The capacity of opioids to increase the risk of CSA is well known; however, the relationship between nonopioid CNSAMs and sleep-disordered breathing remains less clear. Our findings that opioids combined with nonopioid CNSAMs, but not opioids alone, significantly increased the odds of CSA and,in a population restricted to opioid users, co-prescribed non-opioid CNSAMs nearly tripled the odds of CSA, collectively suggest the possibility of synergy between these classes of medication.

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