TY - JOUR
T1 - The association of obstructive sleep apnea and pain outcomes in adults
T2 - A systematic review
AU - Charokopos, Antonios
AU - Card, Mary E.
AU - Gunderson, Craig
AU - Steffens, Catherine
AU - Bastian, Lori A.
N1 - Funding Information:
Funding sources: This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and Health Services Research and Development (IIR 15-092 and CIN 13-407).
Publisher Copyright:
© Oxford University Press. All rights reserved.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Objective. The specific link between obstructive sleep apnea (OSA) and pain is unknown, but it has been hypothesized that OSA patients are hyperalgesic because of fragmented sleep and hypoxemia that enhance sensitivity to pain, promote inflammation, and increase spontaneous pain. We conducted a systematic review of the literature assessing whether OSA is a risk factor for subjective pain intensity and experimental pain tolerance and threshold. Design/Participants. A search of published studies in English in MEDLINE, PubMed, Embase, and the Cochrane Database of Systematic Reviews from database inception through May 2017 was performed. Search terms included "sleep apnea," "continuous positive airway pressure," "CPAP," "pain," and "chronic pain." Methods. We included any study that reported an association between OSA or polysomnogram assessments with pain outcomes or reported the effect of CPAP on pain outcomes. Controlled studies, cohort studies, and casecontrol studies were included. Results. We identified 448 studies from PubMed and 959 studies from Embase, giving a combined 1,333 studies after removing duplicates. After detailed selection, 28 articles were reviewed in full and 12 met study inclusion criteria. Whereas several studies found an association between OSA and pain intensity or experimental pain, there was considerable variability among study outcomes. Delivery of CPAP may improve pain and decrease opioid use, although the exact nature of the relationship between pain and the various pathophysiologic components of OSA is unclear. Conclusions. This systematic review summarizes the current evidence for the association of OSA and pain outcomes. Further research is needed to identify the differential effects of nocturnal hypoxemia and fragmented sleep on pain intensity. Clinicians might consider screening patients with chronic pain for OSA.
AB - Objective. The specific link between obstructive sleep apnea (OSA) and pain is unknown, but it has been hypothesized that OSA patients are hyperalgesic because of fragmented sleep and hypoxemia that enhance sensitivity to pain, promote inflammation, and increase spontaneous pain. We conducted a systematic review of the literature assessing whether OSA is a risk factor for subjective pain intensity and experimental pain tolerance and threshold. Design/Participants. A search of published studies in English in MEDLINE, PubMed, Embase, and the Cochrane Database of Systematic Reviews from database inception through May 2017 was performed. Search terms included "sleep apnea," "continuous positive airway pressure," "CPAP," "pain," and "chronic pain." Methods. We included any study that reported an association between OSA or polysomnogram assessments with pain outcomes or reported the effect of CPAP on pain outcomes. Controlled studies, cohort studies, and casecontrol studies were included. Results. We identified 448 studies from PubMed and 959 studies from Embase, giving a combined 1,333 studies after removing duplicates. After detailed selection, 28 articles were reviewed in full and 12 met study inclusion criteria. Whereas several studies found an association between OSA and pain intensity or experimental pain, there was considerable variability among study outcomes. Delivery of CPAP may improve pain and decrease opioid use, although the exact nature of the relationship between pain and the various pathophysiologic components of OSA is unclear. Conclusions. This systematic review summarizes the current evidence for the association of OSA and pain outcomes. Further research is needed to identify the differential effects of nocturnal hypoxemia and fragmented sleep on pain intensity. Clinicians might consider screening patients with chronic pain for OSA.
KW - Hypoxemia
KW - Obstructive Sleep Apnea
KW - Opioids
KW - Pain
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U2 - 10.1093/pm/pny140
DO - 10.1093/pm/pny140
M3 - Article
C2 - 30203008
AN - SCOPUS:85057443904
SN - 1526-2375
VL - 19
SP - S69-S75
JO - Pain Medicine (United States)
JF - Pain Medicine (United States)
ER -