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SDB in stable methadone patients

 SLEEP DISORDERED BREATHING IN STABLE METHADONE MAINTENANCE TREATMENT PATIENT

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David Wang1,3, Harry Teichtahl13, Olaf Drummer4, Cathy Goodman2, Gaye Cherry1, Andy Prodromidis2, David Cunnington1 & Ian Kronborg2
(1) Department of Respiratory & Sleep Disorders Medicine, and (2) Drug and Alcohol Service, Western Hospital (3) Department of Medicine (Royal Melbourne Hospital and Western Hospital), The University of Melbourne, Victoria, 3011. (4) Victorian Institute of Forensic Medicine, Victoria, 3006.

Methadone maintenance treatment (MMT) is the most effective treatment for heroin addiction. Preliminary data from our group has shown that 5 out of 10 MMT patients have central sleep apnoea (CSA) 1. This study aimed to confirm these results and to investigate the pathogenesis of CSA. Methods: 50 stable MMT patients (25M, 25F) and 20 age, sex and BMI matched control subjects (10M, 10F) were tested with two overnight polysomnography (the first being acclimatization night), blood toxicology (methadone, benzodiazepines, THC, antidepressant, alcohol and other opiates) and ventilatory responses to hypoxia (HVR) and hypercapnia (HCVR). Resting cardiorespiratory function tests including spirometry, DLCO, ABG, Chest X-ray, Echocardiogram and ECG were performed on MMT patients. Multiple linear regression was applied to determine parameters contributing to CSA. Results: The median central apnoea index (CAI) for MMT patients was 1.7 (0-93.2) and the median CAI for control subjects was 0.15 (0-1.1) (p<0.001). 30% of MMT patients had CAI>5 and 20% had CAI>10. No significant difference was found in obstructive apnoea-hypopnea index between the MMT and control groups. Methadone blood concentration was the only statistically significant predictor variable (t=2.33, p=0.025) and explains 12% of CAI. PaCO2, antidepressant use, HCVR and A-aPO2 explain a further 17% of CAI. Conclusions: 30% of stable MMT patients have CSA. Although we found that methadone blood concentration is the most significant predictor variable for CSA, further research needs to be done to define other factors involved in CSA in MMT patients.

Supported by: Australian Postgraduate Awards, Western Hospital Equipment, Education and Research Fund and Western Hospital Liver Research Fund.

Reference: 1. Teichtahl H, Prodromidis A, et al. Addiction (2001) 96(3): 395-403.

Key words: Methadone, central sleep apnoea, sleep disordered breathing, cardiorespiratory function, blood toxicology.

Nomination for Awards: New Investigator Award

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