This protocol applies to patients with central sleep apnoea driven by high-altitude periodic breathing — exposure above 1600 m — who have not achieved adequate control with the initial pharmacological approach.
High altitude promotes respiratory instability during sleep, a pattern known as high-altitude periodic breathing (HAPB). It can occur above 1600 m even in otherwise healthy individuals, and its frequency rises with increasing altitude. The result is recurrent central apnoeic episodes with disrupted nocturnal oxygenation.
The prior treatment — acetazolamide — was aimed at reducing nocturnal hypoxaemia, shortening periodic breathing time, lowering the apnoea-hypopnoea index, and improving nocturnal oxygen saturation. When these goals are not sufficiently reached, the current protocol becomes the indicated next step.
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.
In patients with OSA, central events not addressed by their CPAP device can emerge.
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