Newly Published
Correspondence  |   November 2019
Opioid-induced Miosis Is Unaltered by Obstructive Sleep Apnea: Comment
Author Notes
  • University of Rochester School of Medicine and Dentistry, Rochester, New York (A.M.W.). audra_webber@urmc.rochester.edu
  • Michael M. Todd, M.D., served as Handling Editor for this correspondence.
    Michael M. Todd, M.D., served as Handling Editor for this correspondence.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Accepted for publication October 10, 2019.
    Accepted for publication October 10, 2019.×
Article Information
Correspondence
Correspondence   |   November 2019
Opioid-induced Miosis Is Unaltered by Obstructive Sleep Apnea: Comment
Anesthesiology Newly Published on November 13, 2019. doi:https://doi.org/10.1097/ALN.0000000000003041
Anesthesiology Newly Published on November 13, 2019. doi:https://doi.org/10.1097/ALN.0000000000003041
We read with interest the article by Montana et al.1  “Opioid Sensitivity in Children with and without Obstructive Sleep Apnea.” The authors are to be commended on their measurement of in vivo remifentanil concentrations—which interestingly were higher and more variable in their patient group with presumed obstructive sleep apnea—instead of pharmacologic extrapolation. This article provides evidence that serum remifentanil concentrations may not be constant independent of age or weight.
However, from the points of view of a pediatric anesthesiologist and a sleep apnea researcher, we have concerns regarding the presentation of the study findings. The study, while adding to our fund of knowledge regarding opioid effect on the pupillary sphincter in awake patients, was unable to draw any conclusions regarding the two groups’ sensitivity to opioid-induced respiratory depression. Although addressed in the discussion, this fact is not exactly highlighted in the abstract or in the Editor’s Perspective and is open to unintentional misinterpretation. We fear it may provide a false sense of security to those administering or prescribing opioids to children with obstructive sleep apnea and/or obesity.