Acetazolamide for OSA and Central Sleep Apnea

Schmickl, Christopher N.; Landry, Shane A.; Orr, Jeremy E.; Chin, Kazuo; Murase, Kimihiko; Verbraecken, Johan; Javaheri, Shahrokh; Edwards, Bradley A.; Owens, Robert L.; Malhotra, Atul

doi:10.1016/j.chest.2020.06.078

Cited by 81 publications

(18 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Data showed short-term acetazolamide leads to a total reduction in AHI of 37.7%. Moreover, there is a dose-dependent relationship between acetazolamide and AHI reduction (Schmickl et al, 2020).…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

“…Data showed short‐term acetazolamide leads to a total reduction in AHI of 37.7%. Moreover, there is a dose‐dependent relationship between acetazolamide and AHI reduction (Schmickl et al, 2020). As for targeting improvement in pharyngeal collapsibility, the combination of atomoxetine plus oxybutynin or reboxetine plus oxybutynin were administered to ameliorate upper airway muscle function (Kinouchi et al, 2023; Taranto‐Montemurro et al, 2019; Taranto‐Montemurro et al, 2020).…”

Section: Heart Rate Variability In Osa Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring

Qin,

Fietze,

Mazzotti

et al. 2023

Journal of Sleep Research

View full text Add to dashboard Cite

SUMMARYObstructive sleep apnea is a highly prevalent sleep‐related breathing disorder, resulting in a disturbed breathing pattern, changes in blood gases, abnormal autonomic regulation, metabolic fluctuation, poor neurocognitive performance, and increased cardiovascular risk. With broad inter‐individual differences recognised in risk factors, clinical symptoms, gene expression, physiological characteristics, and health outcomes, various obstructive sleep apnea subtypes have been identified. Therapeutic efficacy and its impact on outcomes, particularly for cardiovascular consequences, may also vary depending on these features in obstructive sleep apnea. A number of interventions such as positive airway pressure therapies, oral appliance, surgical treatment, and pharmaceutical options are available in clinical practice. Selecting an effective obstructive sleep apnea treatment and therapy is a challenging medical decision due to obstructive sleep apnea heterogeneity and numerous treatment modalities. Thus, an objective marker for clinical evaluation is warranted to estimate the treatment response in patients with obstructive sleep apnea. Currently, while the Apnea–Hypopnea Index is used for severity assessment of obstructive sleep apnea and still considered a major guide to diagnosis and managements of obstructive sleep apnea, the Apnea–Hypopnea Index is not a robust marker of symptoms, function, or outcome improvement. Abnormal cardiac autonomic modulation can provide additional insight to better understand obstructive sleep apnea phenotyping. Heart rate variability is a reliable neurocardiac tool to assess altered autonomic function and can also provide cardiovascular information in obstructive sleep apnea. Beyond the Apnea–Hypopnea Index, this review aims to discuss the role of heart rate variability as an indicator and predictor of therapeutic efficacy to different modalities in order to optimise tailored treatment for obstructive sleep apnea.

show abstract

Section: Pharmacological Interventionsmentioning

confidence: 99%

Section: Heart Rate Variability In Osa Treatmentmentioning

confidence: 99%

Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring

Qin,

Fietze,

Mazzotti

et al. 2023

Journal of Sleep Research

View full text Add to dashboard Cite

show abstract

“…Acetazolamide is an alternative approach for reducing the central apnea index. In response to metabolic acidosis, which occurs after acetazolamide administration, there is are increases in the Pa CO 2 reserve (difference between eupnea Pa CO 2 and apnea threshold) and alterations in loop gain that are associated with a reduction in the central apnea index ( 12 , 13 ). Lastly, transvenous phrenic nerve stimulators ensure stable ventilation, and prospective studies in CSA have demonstrated improved physical performance and hypoxemia ( 14 ).…”

Section: Pathophysiology and Treatment Of Central Sleep Apneamentioning

confidence: 99%

ATS Core Curriculum 2021. Adult Sleep Medicine: Sleep Apnea

et al. 2021

View full text Add to dashboard Cite

The American Thoracic Society Sleep Core Curriculum updates clinicians on important sleep topics, presented during the annual meeting, and appearing in summary here. This year’s sleep core theme is sleep-disordered breathing and its management. Topics range from pathophysiological mechanisms for the association of obstructive sleep apnea (OSA) and metabolic syndrome, surgical modalities of OSA treatment, comorbid insomnia and OSA, central sleep apnea, and sleep practices during a pandemic. OSA has been associated with metabolic syndrome, independent of the role of obesity, and the pathophysiology suggests a role for sleep fragmentation and intermittent hypoxia in observed metabolic outcomes. In specific patient populations, surgical treatment modalities for OSA have demonstrated large reductions in objective disease severity compared with no treatment and may facilitate adherence to positive airway pressure treatment. Patient-centered approaches to comorbid insomnia and sleep apnea include evaluating for both OSA and insomnia simultaneously and using shared-decision making to determine the order and timing of positive airway pressure therapy and cognitive behavioral therapy for insomnia. The pathophysiology of central sleep apnea is complex and may be due to the loss of drive to breathe or instability in the regulatory pathways that control ventilation. Pandemic-era sleep practices have evolved rapidly to balance safety and sustainability of care for patients with sleep-disordered breathing.

show abstract

“…Ferroptosis has demonstrated tremendous promise as a cancer therapy, and OSAS not only relates to metabolic and cardiovascular illnesses but also to the progression of cancer (15). OSAS is a prevalent form of respiratory illness (16). There are few findings on the association between ferroptosis and OSAS, but there are numerous correlation studies between ferroptosis and other respiratory illnesses.…”

Section: Introductionmentioning

confidence: 99%

Identification and validation of ferroptosis-related hub genes in obstructive sleep apnea syndrome

Liu

Zhao²,

Zhou³

et al. 2023

Front. Neurol.

View full text Add to dashboard Cite

BackgroundBy 2020, the prevalence of Obstructive Sleep Apnea Syndrome (OSAS) in the US has reached 26. 6–43.2% in men and 8.7–27.8% in women. OSAS promotes hypertension, diabetes, and tumor growth through unknown means. Chronic intermittent hypoxia (CIH), sleep fragmentation, and increased pleural pressure are central mechanisms of OSAS complications. CIH exacerbates ferroptosis, which is closely related to malignancies. The mechanism of ferroptosis in OSAS disease progression remains unknown.MethodsOSAS-related datasets (GSE135917 and GSE38792) were obtained from the GEO. Differentially expressed genes (DEGs) were screened using the R software and intersected with the ferroptosis database (FerrDb V2) to get ferroptosis-related DEGs (f-DEGs). GO, DO, KEGG, and GSEA enrichment were performed, a PPI network was constructed and hub genes were screened. The TCGA database was used to obtain the thyroid cancer (THCA) gene expression profile, and hub genes were analyzed for differential and survival analysis. The mechanism was investigated using GSEA and immune infiltration. The hub genes were validated with RT-qPCR, IHC, and other datasets. Sprague-Dawley rats were randomly separated into normoxia and CIH groups. ROS, MDA, and GSH methods were used to detect CIH-induced ferroptosis and oxidative stress.ResultsGSEA revealed a statistically significant difference in ferroptosis in OSAS (FDR < 0.05). HIF1A, ATM, HSPA5, MAPK8, MAPK14, TLR4, and CREB1 were identified as hub genes among 3,144 DEGs and 74 f-DEGs. HIF1A and ATM were the only two validated genes. F-DEGs were mainly enriched in THCA. HIF1A overexpression in THCA promotes its development. HIF1A is associated with CD8 T cells and macrophages, which may affect the immunological milieu. The result found CIH increased ROS and MDA while lowering GSH indicating that it could cause ferroptosis. In OSAS patients, non-invasive ventilation did not affect HIF1A and ATM expression. Carvedilol, hydralazine, and caffeine may be important in the treatment of OSAS since they suppress HIF1A and ATM.ConclusionsOur findings revealed that the genes HIF1A and ATM are highly expressed in OSAS, and can serve as biomarkers and targets for OSAS.

show abstract

Acetazolamide for OSA and Central Sleep Apnea

Cited by 81 publications

References 65 publications

Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring

Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring

ATS Core Curriculum 2021. Adult Sleep Medicine: Sleep Apnea

Identification and validation of ferroptosis-related hub genes in obstructive sleep apnea syndrome

Contact Info

Product

Resources

About