Acute and long-term effects of acetazolamide in presumed high loop gain sleep apnea

• Published in: Sleep medicine 2023-07, Vol.107, p.137-148
• Main Authors: Ni, Yue-Nan, Holzer, Rena C., Thomas, Robert Joseph
• Format: Article
• Language: English
• Subjects: Acetazolamide; Acetazolamide - pharmacology; Acetazolamide - therapeutic use; Aged; Apnea hypopnea index; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Positive airway pressure; Respiration; Retrospective Studies; Sleep Apnea Syndromes - drug therapy; Sleep Apnea, Obstructive - drug therapy
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2023.04.010

The acute effect during positive pressure titration and long term efficacy of acetazolamide (AZT) in high loop gain sleep apnea (HLGSA) is inadequately assessed. We predicted that AZT may improve HLGSA in both conditions. A retrospective analysis of polysomnograms from patients with presumed HLGSA and residual respiratory instability administered AZT (125 or 250 mg) about 3 h into an initially drug-free positive pressure titration. A responder was defined as ≥ 50% reduction of the apnea hypopnea index(AHI 3% or arousal) before and after AZT. A multivariable logistic regression model estimated responder predictors. Long term efficacy of AZT was assessed by comparing both auto-machine (aREIFLOW) and manually scored respiratory events (sREIFLOW) extracted from the ventilator, prior to and after 3 months of AZT, in a subset. Of the 231 participants (median age of 61[51–68] years) and 184 (80%) males in the acute effect testing: 77 and 154 patients were given 125 mg and 250 mg AZT. Compared to PAP alone, PAP plus AZT was associated with a lower breathing related arousal index (8 [3-16] vs. 5 [2-10], p