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Acute and long-term effects of acetazolamide in presumed high loop gain sleep apnea
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 a...
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| Published in: | Sleep medicine 2023-07, Vol.107, p.137-148 |
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| container_title | Sleep medicine |
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| creator | Ni, Yue-Nan Holzer, Rena C. Thomas, Robert Joseph |
| description | 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 |
| doi_str_mv | 10.1016/j.sleep.2023.04.010 |
| format | article |
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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 < 0.001), and AHI3% (19 [7-37] vs. 11 [5-21], p < 0.001); 98 patients were responders. The non-rapid eye movement sleep (NREM) AHI3% (OR 1.031, 95%CI [1.016–1.046], p < 0.001) was a strong predictor for responder status with AZT exposure. In the 109 participants with 3-month data, both aREIFLOW and sREIFLOWwere significantly reduced after AZT.
AZT acutely and chronically reduced residual sleep apnea in presumed HLGSA; NREM AHI3% is a response predictor. AZT was well tolerated and beneficial for at least 3 months.
•Acute intra-night use of acetazolamide reduced residual high loop gain sleep apnea.•The effect of acetazolamide in reducing residual sleep apnea lasts at least 3 months.•The apnea-hypopnea index during non-rapid eye movement sleep is a response predictor.•Acetazolamide was relatively well tolerated and beneficial, but adverse events resulted in discontinuation in at least 10%.</description><identifier>ISSN: 1389-9457</identifier><identifier>EISSN: 1878-5506</identifier><identifier>DOI: 10.1016/j.sleep.2023.04.010</identifier><identifier>PMID: 37178545</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>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</subject><ispartof>Sleep medicine, 2023-07, Vol.107, p.137-148</ispartof><rights>2023 Elsevier B.V.</rights><rights>Copyright © 2023 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-2cd6f11e285675a080507b6dd440cd08ebce9cd4ed3c53acab3bf6bd6aef85923</citedby><cites>FETCH-LOGICAL-c359t-2cd6f11e285675a080507b6dd440cd08ebce9cd4ed3c53acab3bf6bd6aef85923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37178545$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ni, Yue-Nan</creatorcontrib><creatorcontrib>Holzer, Rena C.</creatorcontrib><creatorcontrib>Thomas, Robert Joseph</creatorcontrib><title>Acute and long-term effects of acetazolamide in presumed high loop gain sleep apnea</title><title>Sleep medicine</title><addtitle>Sleep Med</addtitle><description>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 < 0.001), and AHI3% (19 [7-37] vs. 11 [5-21], p < 0.001); 98 patients were responders. The non-rapid eye movement sleep (NREM) AHI3% (OR 1.031, 95%CI [1.016–1.046], p < 0.001) was a strong predictor for responder status with AZT exposure. In the 109 participants with 3-month data, both aREIFLOW and sREIFLOWwere significantly reduced after AZT.
AZT acutely and chronically reduced residual sleep apnea in presumed HLGSA; NREM AHI3% is a response predictor. AZT was well tolerated and beneficial for at least 3 months.
•Acute intra-night use of acetazolamide reduced residual high loop gain sleep apnea.•The effect of acetazolamide in reducing residual sleep apnea lasts at least 3 months.•The apnea-hypopnea index during non-rapid eye movement sleep is a response predictor.•Acetazolamide was relatively well tolerated and beneficial, but adverse events resulted in discontinuation in at least 10%.</description><subject>Acetazolamide</subject><subject>Acetazolamide - pharmacology</subject><subject>Acetazolamide - therapeutic use</subject><subject>Aged</subject><subject>Apnea hypopnea index</subject><subject>Continuous Positive Airway Pressure</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Positive airway pressure</subject><subject>Respiration</subject><subject>Retrospective Studies</subject><subject>Sleep Apnea Syndromes - drug therapy</subject><subject>Sleep Apnea, Obstructive - drug therapy</subject><issn>1389-9457</issn><issn>1878-5506</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kEtLxTAQhYMovn-BIFm6aZ00TZsuXIj4AsGFug5pMr03l75MWkF_vbneq0tXMwznzMz5CDljkDJgxeUqDS3imGaQ8RTyFBjskEMmS5kIAcVu7LmskioX5QE5CmEFwEom831ywEtWSpGLQ_JybeYJqe4tbYd-kUzoO4pNg2YKdGioNjjpr6HVnbNIXU9Hj2Hu0NKlWyyjZxjpQsf5zy9Ujz3qE7LX6Dbg6bYek7e729ebh-Tp-f7x5vopMVxUU5IZWzSMYSZFUQoNEgSUdWFtnoOxILE2WBmbo-VGcG10zeumqG2hsZGiyvgxudjsHf3wPmOYVOeCwbbVPQ5zUJlkXBQgZRWlfCM1fgjBY6NG7zrtPxUDtaapVuongVrTVJCrSDO6zrcH5jpG_vP84ouCq40AY8wPh14F47A3aJ2PBJUd3L8HvgGfTofN</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Ni, Yue-Nan</creator><creator>Holzer, Rena C.</creator><creator>Thomas, Robert Joseph</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202307</creationdate><title>Acute and long-term effects of acetazolamide in presumed high loop gain sleep apnea</title><author>Ni, Yue-Nan ; Holzer, Rena C. ; Thomas, Robert Joseph</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-2cd6f11e285675a080507b6dd440cd08ebce9cd4ed3c53acab3bf6bd6aef85923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acetazolamide</topic><topic>Acetazolamide - pharmacology</topic><topic>Acetazolamide - therapeutic use</topic><topic>Aged</topic><topic>Apnea hypopnea index</topic><topic>Continuous Positive Airway Pressure</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Positive airway pressure</topic><topic>Respiration</topic><topic>Retrospective Studies</topic><topic>Sleep Apnea Syndromes - drug therapy</topic><topic>Sleep Apnea, Obstructive - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ni, Yue-Nan</creatorcontrib><creatorcontrib>Holzer, Rena C.</creatorcontrib><creatorcontrib>Thomas, Robert Joseph</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Sleep medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ni, Yue-Nan</au><au>Holzer, Rena C.</au><au>Thomas, Robert Joseph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute and long-term effects of acetazolamide in presumed high loop gain sleep apnea</atitle><jtitle>Sleep medicine</jtitle><addtitle>Sleep Med</addtitle><date>2023-07</date><risdate>2023</risdate><volume>107</volume><spage>137</spage><epage>148</epage><pages>137-148</pages><issn>1389-9457</issn><eissn>1878-5506</eissn><abstract>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 < 0.001), and AHI3% (19 [7-37] vs. 11 [5-21], p < 0.001); 98 patients were responders. The non-rapid eye movement sleep (NREM) AHI3% (OR 1.031, 95%CI [1.016–1.046], p < 0.001) was a strong predictor for responder status with AZT exposure. In the 109 participants with 3-month data, both aREIFLOW and sREIFLOWwere significantly reduced after AZT.
AZT acutely and chronically reduced residual sleep apnea in presumed HLGSA; NREM AHI3% is a response predictor. AZT was well tolerated and beneficial for at least 3 months.
•Acute intra-night use of acetazolamide reduced residual high loop gain sleep apnea.•The effect of acetazolamide in reducing residual sleep apnea lasts at least 3 months.•The apnea-hypopnea index during non-rapid eye movement sleep is a response predictor.•Acetazolamide was relatively well tolerated and beneficial, but adverse events resulted in discontinuation in at least 10%.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>37178545</pmid><doi>10.1016/j.sleep.2023.04.010</doi><tpages>12</tpages></addata></record> |
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| 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 |
| title | Acute and long-term effects of acetazolamide in presumed high loop gain sleep apnea |
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