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Original Research: OCCUPATIONAL AND ENVIRONMENTAL LUNG DISEASES |

Patients With Obstructive Sleep Apnea Syndrome Benefit From Acetazolamide During an Altitude SojournObstructive Sleep Apnea Therapy at Altitude: A Randomized, Placebo-Controlled, Double-Blind Trial

Yvonne Nussbaumer-Ochsner, MD; Tsogyal D. Latshang, MD; Silvia Ulrich, MD; Malcolm Kohler, MD; Robert Thurnheer, MD, FCCP; Konrad E. Bloch, MD, FCCP
Author and Funding Information

From the Sleep Disorders Center (Drs Nussbaumer-Ochsner, Latshang, Ulrich, Kohler, and Bloch), Pulmonary Division, University Hospital of Zurich, Zurich; the Center for Human Integrative Physiology (Drs Nussbaumer-Ochsner, Latshang, Ulrich, Kohler, and Bloch), University of Zurich, Zurich; and the Pulmonary Division (Dr Thurnheer), Cantonal Hospital Munsterlingen, Munsterlingen, Switzerland.

Correspondence to: Konrad E. Bloch, MD, FCCP, Pulmonary Division, University Hospital of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland; e-mail konrad.bloch@usz.ch; pneubloc@usz.unizh.ch


Funding/Support: This study was supported by the Swiss National Science Foundation [Grant 32003B-122081]; the Lung League of Zurich and Schaffhausen; the Center for Clinical Research, University Hospital of Zurich; and the University of Zurich, Switzerland.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):131-138. doi:10.1378/chest.11-0375
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Background:  Many patients with obstructive sleep apnea syndrome (OSA) are unable or unwilling to use continuous positive airway pressure (CPAP) therapy when traveling to the mountains for work or recreation even though they risk pronounced hypoxemia and exacerbation of sleep apnea. Because the treatment of OSA at altitude has not been established, we tested the hypothesis that acetazolamide improves hypoxemia, sleep, and breathing disturbances in otherwise untreated patients with OSA at altitude.

Methods:  Forty-five patients with OSA on long-term CPAP, median age 64 years, living at < 600 m underwent a placebo-controlled, double-blind, crossover trial randomized for the sequence of drug and altitude exposure (490 m, 1,860 m, and 2,590 m). Patients spent two 3-day periods at altitude and a 2-week wash-out period at < 600 m. At altitude, patients discontinued CPAP and received acetazolamide 2 × 250 mg daily or placebo. Polysomnography, vigilance, and symptoms were evaluated.

Results:  At 490 m, off CPAP, median nocturnal oxygen saturation was 93%, and the apnea/hypopnea index was 51.2/h. On placebo at 1,860 m and 2,590 m, the corresponding values were 89% and 85% and 63.6/h and 86.2/h, respectively (P < .01 vs 490 m, both instances). On acetazolamide at 1,860 m and 2,590 m, oxygen saturation was higher (91% and 88%) and apnea/hypopnea indices were lower (48.0/h and 61.4/h) than on placebo (P < .01 all instances). Acetazolamide reduced nocturnal transcutaneous Pco2, improved sleep efficiency and subjective insomnia, and prevented excessive BP elevations at altitude.

Conclusions:  In patients with OSA discontinuing CPAP during an altitude sojourn, acetazolamide improves oxygenation, breathing disturbances, and sleep quality by stimulating ventilation. Therefore, patients with OSA may benefit from acetazolamide at altitude if CPAP therapy is not feasible.

Trial registry:  ClinicalTrials.gov; No.: NCT00714740; URL: www.clinicaltrials.gov

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