Additional Safety Considerations Before Prescribing Opioids to Manage Restless Legs Syndrome/Reply

Chronic opioid use is a risk factor forthe development of central sleep apnea and ataxic breathing [published correction appears in J Clin Sleep Med. 2007;3(6): table of contents].J Clin Sleep Med. 2007;3(5):455-461. https://doi.org/10.1016/j.mayocp.2018.03.022 In Reply-Additional Safety Considerations Before Prescribing Opioids to Manage Restless Legs Syndrome We thank Dr Geller for his interest in our article on the appropriate use of opioids in refractory restless legs syndrome (RLS).Michael H. Silber, MBChB Mayo Clinic Rochester, MN Philip M. Becker, MD Sleep Medicine Associates Dallas, TX Mark J. Buchfuhrer, MD Stanford University Stanford, CA Christopher J. Earley, MBBCh, PhD Johns Hopkins University Baltimore, MD William G. Ondo, MD Methodist Research Institute and Weill Cornell Medical School Houston, TX Arthur S. Walters, MD Vanderbuilt University Medical School Nashville, TN John W. Winkelman, MD, PhD Massachusetts General Hospital and Harvard University Boston, MA Potential Competing Interests: Dr Silber receives royalties from UpToDate and payment for development of educational presentations from the American Academy of Sleep Medicine and American Academy of Neurology.Dr Winkelman receives consultancy fees from Merck and Flex Pharma and grants from Restless Legs Syndrome Foundation, Luitpold Pharmaceuticals, NeuroMetrix, National Institute of Mental Health, and UCB Pharma; he is an employee of Massachusetts General Hospital. 1.Silber MH, Becker PM, Buchfuhrer MJ, et al; Scientific and Medical Advisory Board, Restless Legs Syndrome Foundation.