This protocol addresses central sleep apnoea in the specific context of high-altitude periodic breathing (HAPB) — a pattern of respiratory instability during sleep that emerges with exposure to altitude above 1600 m.

Clinical scenario

High altitude promotes respiratory instability during sleep. HAPB can be observed at altitudes above 1600 m even in otherwise healthy subjects, and its occurrence increases with greater elevation. The resulting central apnoeic events contribute to nocturnal hypoxaemia and disrupted sleep architecture.

Treatment approach

Oral pharmacotherapy — specifically acetazolamide — is central to the management of HAPB-related central sleep apnoea. The full protocol specifies the relevant dosing strategy and addresses the distinct approach for patients already receiving positive airway pressure therapy who develop central events.

Treatment targets

Reduction in nocturnal hypoxaemia, periodic breathing time, and apnoea-hypopnoea index; improved nocturnal oxygen saturation.

References

DOI: 10.1183/20734735.0235-2023

High altitude can promote respiratory instability during sleep (also known as high altitude periodic breathing (HAPB)).
HAPB may be observed in altitudes >1600 m in healthy subjects, and the rates increase with increasing altitude.
Meta-analysis data indicates the beneficial effects of acetazolamide in nocturnal hypoxaemia, periodic breathing time and AHI, potentially more apparent in healthy subjects and even at relatively small oral doses of 250 mg per day.
Adding acetazolamide (750 mg·day−1) to auto-titrating CPAP improved nocturnal oxygen saturation and better controlled sleep disordered breathing than auto-titrating CPAP alone.

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Treatment of Central Sleep Apnea Due to High-Altitude Periodic Breathing

Clinical scenario

Treatment approach

Treatment targets

References