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Purpose of review <p>We examined the relationship between sleep apnea and hypoxia, jointly defined as sleep-related breathing disorders (SRBD), and pain, seeking to answer (a) whether SRBD are associated with specific pain phenotypes and pathophysiologies, and (b) whether pain syndromes are associated with specific SRBD. Finally, (c) we reviewed treatment opportunities at their interface.</p> Recent findings <p>Individuals with SRBD are 3–4 times more likely to suffer from tension type or morning headache, chronic widespread pain, or temporomandibular disorder. Two mechanisms explain how SRBD might lead to pain: (i) Sleep fragmentation and deprivation, and (ii) SRBD-associated hypoxia-hypercapnia. Treating SRBD improves chronic pain by 38–92%. Instead, there are no case–control studies supporting pain as a risk factor for SRBD. Finally, opioid use is primarily associated with obstructive, rather than central, apnea, likely through central inhibition of hypoglossal nerve activity.</p> Summary <p>Clinicians should inquire for co-existence of pain and SRBD symptoms, especially since SRBD therapy improves pain. Optimal results are achieved through prolonged compliance of targeted positive airway pressure / non-invasive ventilation therapy. Findings also inform future research towards novel therapies for pain across SRBD-associated mechanisms of hypoxia-hypercapnia and sleep fragmentation and deprivation.</p>

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Sleep Apnea, Hypoxia, and Pain

  • 期刊论文

  • 发表日期：

    2025年4月16日

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  • Elissaios Karageorgiou,
  • Athanasia Giannopoulou,
  • Klimentini E. Karageorgiou,
  • Anthony G. Doufas

摘要

Purpose of review

We examined the relationship between sleep apnea and hypoxia, jointly defined as sleep-related breathing disorders (SRBD), and pain, seeking to answer (a) whether SRBD are associated with specific pain phenotypes and pathophysiologies, and (b) whether pain syndromes are associated with specific SRBD. Finally, (c) we reviewed treatment opportunities at their interface.

Recent findings

Individuals with SRBD are 3–4 times more likely to suffer from tension type or morning headache, chronic widespread pain, or temporomandibular disorder. Two mechanisms explain how SRBD might lead to pain: (i) Sleep fragmentation and deprivation, and (ii) SRBD-associated hypoxia-hypercapnia. Treating SRBD improves chronic pain by 38–92%. Instead, there are no case–control studies supporting pain as a risk factor for SRBD. Finally, opioid use is primarily associated with obstructive, rather than central, apnea, likely through central inhibition of hypoglossal nerve activity.

Summary

Clinicians should inquire for co-existence of pain and SRBD symptoms, especially since SRBD therapy improves pain. Optimal results are achieved through prolonged compliance of targeted positive airway pressure / non-invasive ventilation therapy. Findings also inform future research towards novel therapies for pain across SRBD-associated mechanisms of hypoxia-hypercapnia and sleep fragmentation and deprivation.