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.
- Wilderness and Environmental Medicine 06/2012; 23(2):196-7. DOI:10.1016/j.wem.2012.01.012 · 1.20 Impact Factor
Article: Sleep disturbance at altitude[Show abstract] [Hide abstract]
ABSTRACT: The aim is to describe the impact of altitude upon sleep, the physiology that underpins these changes and the therapeutic solutions that are currently in place. On ascending to altitude, lowland residents commonly experience some degree of sleep disturbance. Occasionally, this can prove very uncomfortable and impact upon daytime activities. Historically, the underlying cause of sleep disturbance was thought to be due to the effect of periodic breathing. However, recent research has shown that the link between periodic breathing, lighter stages of sleep and arousals is far from convincing. Instead, it appears that hypoxia has a far wider effect upon sleep at altitude than was previously thought. A number of new approaches to the treatment of sleep disturbance at altitude have recently been identified. Whereas some treat the underlying hypoxia through pharmacological or technological means, others seek to address the symptoms of sleep disturbance more directly. Many of the current approaches to treating sleep disturbance at altitude have been shown to be well tolerated and successful, although few comparisons have been made. Future research is likely to focus upon matching the safest and most successful approach to the individual and their environment.Current opinion in pulmonary medicine 09/2012; 18(6):554-60. DOI:10.1097/MCP.0b013e328359129f · 2.76 Impact Factor
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ABSTRACT: Many patients with obstructive sleep apnea syndrome (OSA) living near sea level travel to altitude, but this may expose them to hypoxemia and exacerbation of sleep apnea. The treatment in this setting is not established. To evaluate whether acetazolamide and autoadjusted continuous positive airway pressure (autoCPAP) control breathing disturbances in OSA patients at altitude. Randomized, placebo-controlled, double-blind, crossover trial involving 51 patients with OSA living below an altitude of 800 m and receiving CPAP therapy who underwent studies at a university hospital at 490 m and resorts in Swiss mountain villages at 1630 m and 2590 m in summer 2009. Patients were studied during 2 sojourns of 3 days each in mountain villages, 2 days at 1630 m, 1 day at 2590 m, separated by a 2-week washout period at less than 800 m. At altitude, patients either took acetazolamide (750 mg/d) or placebo in addition to autoCPAP. Primary outcomes were nocturnal oxygen saturation and the apnea/hypopnea index; secondary outcomes were sleep structure, vigilance, symptoms, adverse effects, and exercise performance. Acetazolamide and autoCPAP treatment was associated with higher nocturnal oxygen saturation at 1630 m and 2590 m than placebo and autoCPAP: medians, 94% (interquartile range [IQR], 93%-95%) and 91% (IQR, 90%-92%) vs 93% (IQR, 92%-94%) and 89% (IQR, 87%-91%), respectively. Median increases were 1.0% (95% CI, 0.3%-1.0%) and 2.0% (95% CI, 2.0%-2.0). Median night-time spent with oxygen saturation less than 90% at 2590 m was 13% (IQR, 2%-38%) vs 57% (IQR, 28%-82%; P < .001). Acetazolamide and autoCPAP resulted in better control of sleep apnea at 1630 m and 2590 m than placebo and autoCPAP: median apnea/hypopnea index was 5.8 events per hour (5.8/h) (IQR, 3.0/h-10.1/h) and 6.8/h (IQR, 3.5/h-10.1/h) vs 10.7/h (IQR, 5.1/h-17.7/h) and 19.3/h (IQR, 9.3/h-29.0/h), respectively; median reduction was 3.2/h (95% CI, 1.3/h-7.5/h) and 9.2 (95% CI, 5.1/h-14.6/h). Among patients with OSA spending 3 days at moderately elevated altitude, a combination of acetazolamide and autoCPAP therapy, compared with autoCPAP alone, resulted in improvement in nocturnal oxygen saturation and apnea/hypopnea index. clinicaltrials.gov Identifier: NCT00928655.JAMA The Journal of the American Medical Association 12/2012; 308(22):2390-8. DOI:10.1001/jama.2012.94847 · 35.29 Impact Factor