In surgical patients, a retrospective study showed a worrying rate of opioid prescribing (86%) at hospital discharge in patients with known or suspected Obstructive Sleep Apnea (OSA).
Such patients, many of whom are morbidly obese, are at increased risk of respiratory obstruction and depression, and guidelines (such as from the ASA) recommend closer monitoring as well as using multimodal non-opioid analgesia. Where opioid analgesia is required, the Society for Ambulatory Anesthesia advises against ambulatory surgery if pain control cannot be provided with predominantly non-opioid techniques in such patients. Even in-patients with OSA are frequently not properly monitored in high dependency units.
There is still clearly ample room for prescriber education in opioid risk evaluation and mitigation, and OSA patients are at special risk when discharged on opioids (and indeed even as in-patients).