In a patient on chronic stable methadone or buprenorphine for OUD who develops symptomatic central sleep apnea, do you prioritize treating the CSA (CPAP → ASV if LVEF >45%, adjunct acetazolamide/O₂) or pushing the opioid team toward dose reduction? Where does loop-gain phenotyping change your sequence?
1 Answers
Mednet Member
Pulmonology · Wayne Health
The starting point is to explore opioid dose reduction. If this is not feasible, then I would initiate CPAP, given the substantial overlap between OSA and CSA (co-morbid OSA is present in more than 2/3 of patients with CSA). If CSA persists, then I would consider adjunctive therapy with acetazolamid...