How to Treat Patients with Obstructive Sleep Apnea Syndrome during an Altitude Sojourn

Abstract

Considering the high prevalence of the obstructive sleep apnea syndrome (OSA), it is expected that many patients with the disorder are traveling to altitude. However, this may expose them to the risk of pronounced hypoxemia, exacerbation of nocturnal breathing disturbances by frequent central apneas, impaired daytime performance, and high blood pressure. Recently, randomized studies specifically investigated the effects of altitude (1630-2590 m) in OSA patients and the optimal treatment in this setting.The results indicate that patients should continue to use continuous positive airway pressure therapy (CPAP) when sleeping at altitude. Since CPAP alone does not control central sleep apnea emerging at altitude, combined treatment with acetazolamide and CPAP should be considered, in particular, in patients with severe OSA and co-morbidities. Supplemental oxygen combined with CPAP might be advantageous in patients with OSA and concomitant cardiopulmonary disease by preventing hypoxemia and central sleep apnea. In patients unable to use CPAP or if electrical power is not available, an optimally fitted mandibular advancement device might be an alternative treatment option that can be combined with acetazolamide during altitude sojourns. Acetazolamide alone is also beneficial and better than no treatment at all, since it improves oxygen saturation, breathing disturbances, and the excessive blood pressure elevation in OSA patients traveling to altitude. , it is expected that many patients with the disorder are traveling to altitude. However, this may expose them to the risk of pronounced hypoxemia, exacerbation of nocturnal breathing disturbances by frequent central apneas, impaired daytime performance, and high blood pressure. Recently, randomized studies specifically investigated the effects of altitude (1630-2590 m) in OSA patients and the optimal treatment in this setting. The results indicate that patients should continue to use continuous positive airway pressure therapy (CPAP) when sleeping at altitude. Since CPAP alone does not control central sleep apnea emerging at altitude, combined treatment with acetazolamide and CPAP should be considered, in particular, in patients with severe OSA and co-morbidities. Supplemental oxygen combined with CPAP might be advantageous in patients with OSA and concomitant cardiopulmonary disease by preventing hypoxemia and central sleep apnea. In patients unable to use CPAP or if electrical power is not available, an optimally fitted mandibular advancement device might be an alternative treatment option that can be combined with acetazolamide during altitude sojourns. Acetazolamide alone is also beneficial and better than no treatment at all, since it improves oxygen saturation, breathing disturbances, and the excessive blood pressure elevation in OSA patients traveling to altitude.

Patients with Obstructive Sleep Apnea at Altitude

“…Corresponding peaks (C1, S1) and nadirs of CTO and SpO 2 (C2, S2) are marked. Figure short altitude sojourns as reviewed recently in this journal (Latshang and Bloch, 2011) and graphically illustrated in Figure 1, panels B and C.…”

Neurology and altitude illness

“…Any disadvantages of using oxygen in patients with OSAS are eased since if their travel is by vehicle, transport of oxygen bottles will be simple, and if by airplane, they will be traveling to a city where oxygen could be obtained locally. Finally, the use of CPAP in the automatic mode (autopap) with an extended pressure range 34 while taking acetazolamide can also be beneficial. 35…”

Effect of Acetazolamide and AutoCPAP Therapy on Breathing Disturbances Among Patients With Obstructive Sleep Apnea Syndrome Who Travel to Altitude

“…Because CPAP alone does not optimally control central sleep apnea and other potentially effective treatments, such as adaptive servo-ventilation or CPAP combined with supplemental oxygen, are impractical to carry along during altitude travel and entail considerable additional costs, a simple treatment of OSA at altitude is needed. 10 Therefore, the current study was designed to evaluate the hypothesis that acetazolamide combined with autoadjusted CPAP (autoCPAP, computercontrolled continuous mask pressure adjustment) provides a better oxygenation and control of sleep-related breathing disturbances than autoCPAP alone in patients with OSA spending a few days at moderate altitude.…”