Treatment of sleep-disordered breathing in opioid users with adaptive servo-ventilation: a subgroup analysis of the European READ-ASV registry.

Study objectives: Central sleep-disordered breathing (SDB) is associated with negative health outcomes. Intake of opioids influences stability of breathing and can cause central apneas. Screening for and treatment of SDB is recommended for individuals who use opioids. This subanalysis of the READ-ASV (Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with Adaptive Servo-Ventilation) investigated the effects of adaptive servo-ventilation therapy (ASV) on SDB symptoms in people using opioids.

Methods: Patients initiated on ASV who reported intake of opioids at baseline were included in this analysis of real-world registry data. Patients were prospectively followed-up for 12 months. Disease-specific quality of life was assessed with the Functional Outcomes of Sleep Questionnaire. Sleepiness was measured with the Epworth Sleepiness Scale. Symptomatic patients were defined as having a Functional Outcomes of Sleep Questionnaire score of < 17.9 and an Epworth Sleepiness Scale score of > 10.

Results: Eighty-six patients who reported opioid use were included. The population had severe SDB (median apnea-hypopnea index: 55 events/h), the majority (n = 75 [87%]) had comorbidities, and 81.6% (40/49 with follow-up available questionnaires) were symptomatic at baseline. ASV effectively treated SDB (residual median apnea-hypopnea index from device data [apnea-hypopnea index flow]: 1.5 events/h). The Functional Outcomes of Sleep Questionnaire (+1.4 points; P = .003) and Epworth Sleepiness Scale (-3 points; P = .029) scores improved significantly at follow-up compared with baseline, and improvements in disease-specific quality of life were more pronounced in symptomatic patients.

Conclusions: ASV treatment of central breathing disorders in individuals using opioids resolved SDB and was associated with significant improvements in disease-specific quality of life and sleepiness. ASV treatment may therefore be an actionable intervention to counteract the negative effects of opioids on SDB and quality of life.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Registry on the Treatment of Central and Complex Sleep-Disordered Breathing With Adaptive Servo-Ventilation (READ-ASV); URL: https://www.clinicaltrials.gov/study/NCT03032029; Identifier: NCT03032029.

Citation: Pepin J-L, Benjafield AV, Munt O, Woehrle H, Heinzer R, Arzt M; for the READ-ASV Investigators. Treatment of sleep-disordered breathing in opioid users with adaptive servo-ventilation: a subgroup analysis of the European READ-ASV registry. J Clin Sleep Med. 2025;21(7):1227-1232.