Correlates and consequences of central sleep apnea in a national sample of US veterans

AbstractThe prevalence and consequences of central sleep apnea (CSA) in adults are not well described. By utilizing the large Veterans Health Administration (VHA) national administrative databases, we sought to determine the incidence, clinical correlates, and impact of CSA on healthcare utilization in Veterans. Analysis of a retrospective cohort of patients with sleep disorders was performed from outpatient visits and inpatient admissions from fiscal years 2006 through 2012. The CSA group, defined by International Classification of Diseases-9, was compared with a comparison group. The number of newly diagnosed CSA cases increased fivefold during this timeframe; however, the prevalence was highly variable depending on the VHA site. The important predictors of CSA were male gender (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.94–2.76, p < 0.0001), heart failure (HF) (OR = 1.78, 95% CI: 1.64–1.92, p < 0.0001), atrial fibrillation (OR = 1.83, 95% CI: 1.69–2.00, p < 0.0001), pulmonary hypertension (OR = 1.38, 95% CI:1.19–1.59, p < 0.0001), stroke (OR = 1.65, 95% CI: 1.50–1.82, p < 0.0001), and chronic prescription opioid use (OR = 1.99, 95% CI: 1.87–2.13, p < 0.0001). Veterans with CSA were at an increased risk for hospital admissions related to cardiovascular disorders compared with the comparison group (incidence rate ratio [IRR] = 1.50, 95% CI: 1.16–1.95, p = 0.002). Additionally, the effect of prior HF on future admissions was greater in the CSA group (IRR: 4.78, 95% CI: 3.87–5.91, p < 0.0001) compared with the comparison group (IRR = 3.32, 95% CI: 3.18–3.47, p < 0.0001). Thus, CSA in veterans is associated with cardiovascular disorders, chronic prescription opioid use, and increased admissions related to the comorbid cardiovascular disorders. Furthermore, there is a need for standardization of diagnostics methods across the VHA to accurately diagnose CSA in high-risk populations.

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Prescription opioid use during pregnancy and risk for preterm birth or term low birthweight

Journal of Opioid Management ◽

10.5055/jom.2021.0632 ◽

2021 ◽

Vol 17 (3) ◽

pp. 215-225

Author(s):

Julia D. Interrante, MPH ◽

Stacey L. P. Scroggs, PhD ◽

Carol J. Hogue, PhD ◽

Jan M. Friedman, MD ◽

Jennita Reefhuis, PhD ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Low Birthweight ◽

Opioid Analgesic ◽

Population Based ◽

Prescription Opioid ◽

Opioid Use ◽

Increased Risk ◽

Potential Risks ◽

Prescription Opioid Use

Objective: Examine the relationship between prescription opioid analgesic use during pregnancy and preterm birth or term low birthweight.Design, setting, and participants: We analyzed data from the National Birth Defects Prevention Study, a US multisite, population-based study, for births from 1997 to 2011. We defined exposure as self-reported prescription opioid use between one month before conception and the end of pregnancy, and we dichotomized opioid use duration by ≤7 days and 7 days.Main outcome measures: We examined the association between opioid use and preterm birth (defined as gestational age 37 weeks) and term low birthweight (defined as 2500 g at gestational age ≥37 weeks).Results: Among 10,491 singleton mother/infant pairs, 470 (4.5 percent) reported opioid use. Among women reporting opioid use, 236 (50 percent) used opioids for 7 days; codeine (170, 36 percent) and hydrocodone (163, 35 percent) were the most commonly reported opioids. Opioid use was associated with slightly increased risk for preterm birth [adjusted odds ratio, 1.4; 95 percent confidence interval, 1.0, 1.9], particularly with hydrocodone [1.6; 1.0, 2.6], meperidine [2.5; 1.2, 5.2], or morphine [3.0; 1.5, 6.1] use for any duration; however, opioid use was not significantly associated with term low birthweight.Conclusions: Preterm birth occurred more frequently among infants of women reporting prescription opioid use during pregnancy. However, we could not determine if these risks relate to the drug or to indications for use. Patients who use opioids during pregnancy should be counseled by their practitioners about this and other potential risks associated with opioid use in pregnancy.

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Prescription Opioid Use Among Seriously Mentally Ill Veterans Nationally in the Veterans Health Administration

Community Mental Health Journal ◽

10.1007/s10597-015-9939-4 ◽

2015 ◽

Vol 52 (2) ◽

pp. 165-173 ◽

Cited By ~ 3

Author(s):

Nickie Mathew ◽

Robert A. Rosenheck

Keyword(s):

Mentally Ill ◽

Veterans Health Administration ◽

Prescription Opioid ◽

Veterans Health ◽

Health Administration ◽

Opioid Use ◽

Seriously Mentally Ill ◽

Prescription Opioid Use

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Prescription Opioid Use and Laboratory Value Derangements: A Cross-Sectional Analysis of NHANES Data

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e95-e100 ◽

2020 ◽

Vol 1;24 (1;1) ◽

pp. E95-E100

Keyword(s):

Pain Management ◽

Reference Range ◽

Comparison Group ◽

Prescription Opioid ◽

Prescription Opioids ◽

Opioid Use ◽

Cross Sectional ◽

Laboratory Values ◽

The Us ◽

Prescription Opioid Use

BACKGROUND: The use of opioids for the treatment of pain is a risk versus benefit analysis and metabolic disease is an often overlooked variable in the equation and may lead to increased risk of comorbidities of cardiovascular and cerebrovascular disease and diabetes. OBJECTIVES: Our objective was to identify and describe abnormalities among the comprehensive metabolic and lipid panels of individuals taking prescription opioids. STUDY DESIGN: We performed a cross-sectional study of the laboratory values with 3 cycles (2011–2016) of the National Health and Nutrition Examination Survey (NHANES) in March 2020. SETTING: NHANES sampling is conducted using a multistaged, stratified, cluster sampling technique to create a representative sample of the United States. METHODS: We excluded patients with histories of cancer and under the age of 25 years. Our final sample size was 11,061 (n = 162,547,635), with 797 reportedly using a prescription opioid in the past 30 days—a weighted percent representing 22.95% of the US population. Our analyses identified mean differences in biomarkers between individuals taking prescription opioids and the US population. RESULTS: Laboratory values from the comprehensive metabolic panel were all within reference ranges for both groups, with only bilirubin levels being statistically lower in the group currently taking prescription opioids. Values from the lipid panel of both the opioid using and comparison groups were above reference range for total cholesterol and fasting glucose. The opioid using group was also higher than the reference range for triglycerides (mean [M] = 165.4, standard deviation [SD] = 14.2) and insulin (M = 15.5, SD = 2.2), whereas the comparison group was not. The oral glucose measure was within normal ranges for both groups; however, the opioid using group was 13.7 points higher than the comparison group (M = 122.3, SD = 1.8; M = 108.6, SD = 4.0; P < 0.01). LIMITATIONS: While our study uses a large sample for a robust generalizable analysis it is a correlation study and a longitudinal cohort would provide better evidence linking potential disease states to prescription opioid use. CONCLUSIONS: Although all Americans should be alarmed at the lipid levels reported in this study, specific combinations of heightened lipid laboratory values among prescription opioid users accelerate the trajectories toward comorbidities—heart disease, cerebrovascular disease, and diabetes—leading to diminished quality of life. Therefore pain management and comprehensive drug recovery programs should include nutritional counseling and physical activity as part of their overall treatment plan. KEY WORDS: Opioid use, NHANES, pain management, lab values, analgesics

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Prevalence and correlates of coprescribing anxiolytic medications with extensive prescription opioid use in Veterans Health Administration patients with metastatic cancer

Journal of Opioid Management ◽

10.5055/jom.2016.0341 ◽

2016 ◽

Vol 12 (4) ◽

pp. 259 ◽

Cited By ~ 4

Author(s):

Declan T. Barry, PhD ◽

Mehmet Sofuoglu, MD ◽

Robert D. Kerns, PhD ◽

Ilse R. Wiechers, MD ◽

Robert A. Rosenheck, MD

Keyword(s):

Multivariate Analyses ◽

Metastatic Cancer ◽

Veterans Health Administration ◽

Fiscal Year ◽

Prescription Opioid ◽

Veterans Health ◽

Health Administration ◽

Opioid Use ◽

Medical Indication ◽

Prescription Opioid Use

Objective: To examine the prevalence and correlates of concomitant anxiolytic prescription fills in Veterans Health Administration (VHA) patients with metastatic cancer who have extensive prescription opioid use.Design, Setting, and Participants: National VHA data for fiscal year 2012 were used to identify veterans diagnosed with metastatic cancer (ICD-9 codes 196-199) who also had extensive prescription opioid use (at least 10 opioid prescriptions during the year, comprising the highest 29 percent of opioid users). Bivariate and multivariate analyses were used to examine correlates of receiving anxiolytic medication among veterans with metastatic cancer and extensive prescription opioid use.Results: Of the 5,950 veterans with metastatic cancer and extensive prescription opioid use, 51 percent also received anxiolytic medication, of whom 64 percent had a medical indication and 85 percent had a psychiatric or medical indication for psychotropics. Of those with extensive prescription opioid use who filled an anxiolytic, 64 percent also received antidepressants and 38 percent received three or more classes of psychotropic medication (ie, polypharmacy). In multivariate analyses, factors associated with receipt of an anxiolytic included any anxiety disorder, insomnia, the prescription of antidepressants or antipsychotics, bipolar disorder, younger age, more emergency department visits, and greater number of opioid prescriptions.Conclusions: VHA patients with metastatic cancer and extensive prescription opioid use who are prescribed anxiolytics are likely to have a Food and Drug Administration-approved indication for psychotropics, and anxiolytics in particular, but represent a clinically vulnerable group which merits careful monitoring.

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Abnormal Glycemic Control, Obesity, and Increased Infection Risk in Patients on Chronic Opioid Therapy

Journal of Addiction Research ◽

10.33140/jar/02/02/00004 ◽

2018 ◽

Vol 2 (2) ◽

Keyword(s):

Glycemic Control ◽

Opioid Therapy ◽

Prescription Opioid ◽

Opioid Use ◽

Care Workers ◽

Increased Risk ◽

Potential Risks ◽

Prescription Opioid Use ◽

Relationship Of ◽

The Relationship

Since 2007, the rate of opioids prescribing has steadily increased among physicians more likely to manage acute and chronic pain. Most health care workers are well aware of prescription opioid-related risks of addiction and overdose; however, the recent studies have shown other potential risks such as: abnormal glycemic control, obesity, and increased risk of infections. In this review, we discuss the latest available evidence examining the relationship of prescription opioid use with increased obesity, abnormal glycemic control, and risk of infections.

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