OBJECTIVES: Preliminary evidence suggests that opioid use indicated for chronic pain may exacerbate obstructive sleep apnea (OSA). The purpose of the present study was to evaluate the association between opioid utilization and healthcare use (HCU) among individuals with comorbid chronic non-cancer pain (CNCP) and OSA.

METHODS: This retrospective study used a 10% random sample of commercially insured enrollees in the IQVIA^TM Health Plans Claims Data. We identified individuals aged 18-64 diagnosed with comorbid CNCP and OSA between 2007 - 2014. We identified three groups of individuals based on opioid use patterns: chronic, non-chronic, and no opioid use in the 12-months prior to index OSA diagnosis. We quantified the association between opioid use and binary outcomes of inpatient hospitalization and emergency department (ED) visits in the 12-months post OSA diagnosis. We also quantified the association between opioid use and HCU counts (physician office visits, outpatient visits, and number of unique drugs prescribed) using generalized linear models.

RESULTS: We identified 46,921 individuals with comorbid CNCP and OSA during our study period. Compared to non-chronic opioid users, chronic opioid users were more likely to have an inpatient visit (adjusted odds ratio [AOR]: 1.71; 95% CI: 1.57, 1.86) and an ED visit (AOR: 1.34; 95% CI: 1.25, 1.45). They also had higher rates of outpatient visits (incident rate ratios [IRR]: 1.20; 95% CI: 1.17, 1.22), physician office visits (IRR: 1.20; 95% CI: 1.17, 1.24) and drug use (IRR: 1.80; 95% CI: 1.74, 1.86) compared to non-chronic users. Finally, relative to non-users, both chronic and non-chronic opioid users consistently displayed increased HCU across all points of service.

CONCLUSIONS: This study provides evidence that chronic-opioid exposure in individuals with comorbid CNCP and OSA is associated with increased HCU. These findings can guide healthcare planners to target allocation of resources effectively toward this at-risk subgroup of OSA patients with CNCP.