Patients With Obstructive Sleep Apnea Syndrome Benefit From Acetazolamide During an Altitude Sojourn

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Bloch, Konrad E., Tsogyal D. Latshang, and Silvia Ulrich. Patients with obstructive sleep apnea at altitude. High Alt Med Biol 16:110-116, 2015.--Obstructive sleep apnea (OSA) is highly prevalent in the general population, in particular in men and women of older age. In OSA patients sleeping near sea level, the apneas/hypopneas associated with intermittent hypoxemia are predominantly due to upper airway collapse. When OSA patients stay at altitudes above 1600 m, corresponding to that of many tourist destinations, hypobaric hypoxia promotes frequent central apneas in addition to obstructive events, resulting in combined intermittent and sustained hypoxia. This induces strong sympathetic activation with elevated heart rate, cardiac arrhythmia, and systemic hypertension. There are concerns that these changes expose susceptible OSA patients, in particular those with advanced age and co-morbidities, to an excessive risk of cardiovascular and other adverse events during a stay at altitude. Based on data from randomized trials, it seems advisable for OSA patients to use continuous positive airway pressure treatment with computer controlled mask pressure adjustment (autoCPAP) in combination with acetazolamide during an altitude sojourn. If CPAP therapy is not feasible, acetazolamide alone is better than no treatment at all, as it improves oxygenation and sleep apnea and prevents excessive blood pressure rises of OSA patients at altitude.

Section: How To Treat Patients With Osa At Altitudementioning

confidence: 99%

Patients with Obstructive Sleep Apnea at Altitude

Bloch

Latshang

Ulrich

2015

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“…Studies involving acetazolamide typically show significant improvement in oxygen saturation (Hackett et al, 1987;Nussbaumer-Ochsner et al, 2012a;Sutton et al, 1979Sutton et al, , 1980, whereas studies of temazepam demonstrate either no change (Dubowitz, 1998) or a slight decrease in oxygen saturation (Nickol et al, 2006). Although dosing in this study follows current recommendations (Hackett and Roach, 2007;Luks, 2008), all of the aforementioned studies have used higher doses of acetazolamide (250 mg) and temazepam (10 mg).…”

Section: Discussionmentioning

confidence: 90%

A Randomized Trial of Temazepam versus Acetazolamide in High Altitude Sleep Disturbance

Tanner

Thapa

et al. 2013

. A randomized trial of temazepam versus acetazolamide in high-altitude sleep disturbance. High Alt Med Biol 14: [234][235][236][237][238][239] 2013.-This study is the first comparative trial of sleep medications at high altitude. We performed a randomized, double-blind trial of temazepam and acetazolamide at an altitude of 3540 meters. 34 healthy trekkers with self-reports of highaltitude sleep disturbance were randomized to temazepam 7.5 mg or acetazolamide 125 mg taken at bedtime for one night. The primary outcome was sleep quality on a 100 mm visual analog scale. Additional measurements were obtained with actigraphy; pulse oximetry; and questionnaire evaluation of sleep, daytime drowsiness, daytime sleepiness, and acute mountain sickness. Sixteen subjects were randomized to temazepam and 18 to acetazolamide. Sleep quality on the 100 mm visual analog scale was higher for temazepam (59.6, SD 20.1) than acetazolamide (46.2, SD 20.2; p = 0.048). Temazepam also demonstrated higher subjective sleep quality on the Groningen Sleep Quality Scale (3.5 vs. 6.8, p = 0.009) and sleep depth visual analog scale (60.3 vs. 41.4, p = 0.028). The acetazolamide group reported significantly more awakenings to urinate (1.8 vs. 0.5, p = 0.007). No difference was found with regards to mean nocturnal oxygen saturation (84.1 vs. 84.4, p = 0.57), proportion of the night spent in periodic breathing, relative desaturations, sleep onset latency, awakenings, wake after sleep onset, sleep efficiency, Stanford Sleepiness Scale scores, daytime drowsiness, or change in self-reported Lake Louise Acute Mountain Sickness scores. We conclude that, at current recommended dosing, treatment of high-altitude sleep disturbance with temazepam is associated with increased subjective sleep quality compared to acetazolamide.

“…We recently performed a randomized, placebo-controlled, double-blind trial evaluating acetazolamide as a treatment for OSA at altitude (Nussbaumer-Ochsner et al, 2011). The study confirmed that acetazolamide (250 mg twice a day) significantly improved nocturnal oxygen saturation, reduced central apneas/hypopneas and sleep disturbances at 1860 m and 2590 m, when compared to no treatment at all (NussbaumerOchsner et al, 2011).…”

Section: Treatment Of Osa At Altitudementioning

confidence: 88%

“…However, in OSA patients, a higher dose of 2 · 250 mg or 250 mg in the morning and 500 mg in the evening is recommended to treat sleep apnea at altitudes (Latshang et al, 2010). In settings where CPAP therapy is not feasible, OSA patients may benefit from acetazolamide alone since it is better than no treatment at all and mitigates hypoxemia and sleep-related breathing disturbances and improves subjective well-being at altitude (Nussbaumer-Ochsner et al, 2011).…”

Section: Recommended Osa Treatment During Altitude Sojournsmentioning

confidence: 99%

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

Latshang

Bloch

2011

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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.