Risk of sleep disordered breathing and treatment dilemma while on methadone maintenance treatment in opioid use disorder patients

The first line treatment recommendation for opioid use disorder patients is to be maintained on FDA approved opioid maintenance medications (Methadone/Buprenorphine/Naltrexone) to prevent relapse on opioid. Methadone could be a lifesaving medication for opioid users and has other beneficial effects in addition to treating opioid use disorder. However, the risks of sleep architecture changes and sleep disordered breathing while on Methadone maintenance could well affect the functionality of patients and can have further impact on compliance with Methadone. The risk of central sleep apnea and hypoventilation while on Methadone could result in mortality. The treatment option is challenging and may pose a di-lemma, as a reduction in the dosage of Methadone is not free of risk, particularly considering relapse with use of opioids. The dose adjustment if required should carefully be done with the mutual agreement of Addiction and Sleep specialists. The other treatment options are therapy with PAP, BPAP (S/T) and ASV.