The Effects of Altitude Associated Central Apnea on the Diagnosis and Treatment of Obstructive Sleep Apnea: Comparative Data from Three Different Altitude Locations in the Mountain West

Pagel, J.F.; Kwiatkowski, Carol F.; Parnes, Bennet

doi:10.5664/jcsm.1462

Cited by 29 publications

(13 citation statements)

References 31 publications

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“…It is known that at significant altitudes, chronic hypocapnia, and hypoxemia generate certain instabilities of the respiratory system during sleep. This can increase the presence of central apnea and periodic breathing [9], and it has been proposed to be a risk factor for central apnea with positive pressure [10]. The aims of the present study were to establish CompSA prevalence in people with OSA who have been long-term residents in Bogota, Colombia, and to establish which variables in the baseline polysomnogram (PSG) or in the comorbidities are related to its appearance.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m

et al. 2015

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“…One other possibility is the difference in the mean final altitude between the two participant groups: 4687 m in healthy participants and 2590 m in OSA patients. As oxygen levels are much lower at higher altitude, the severity of sleep apnea may increase and require longer times for acclimatization, thus enhancing the effect of acetazolamide [ Pagel et al 2011 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of acetazolamide on sleep apnea at high altitude: a systematic review and meta-analysis

Liu

Chiang

Kuo

et al. 2016

Ther Adv Respir Dis

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Background:Acetazolamide has been investigated for treating sleep apnea in newcomers ascending to high altitude. This study aimed to assess the effect of acetazolamide on sleep apnea at high altitude, determine the optimal therapeutic dose, and compare its effectiveness in healthy trekkers and obstructive sleep apnea (OSA) patients.Methods:PubMed, Embase, Scopus, Cochrane Library, and Airiti Library databases were searched up to July 2015 for randomized controlled trials (RCTs) performed above 2500 m in lowlanders and that used acetazolamide as intervention in sleep studies. Studies including participants with medical conditions other than OSA were excluded.Results:Eight studies of 190 adults were included. In healthy participants, the pooled mean effect sizes of acetazolamide on Apnea–Hypopnea Index (AHI), percentage of periodic breathing time, and nocturnal oxygenation were 34.66 [95% confidence interval (CI) 25.01–44.30] with low heterogeneity (p = 0.7, I2 = 0%), 38.56% (95% CI 18.92–58.19%) with low heterogeneity (p = 0.24, I2 = 28%), and 4.75% (95% CI 1.35–8.15%) with high heterogeneity (p < 0.01, I2 = 87%), respectively. In OSA patients, the pooled mean effect sizes of acetazolamide on AHI and nocturnal oxygenation were 13.18 (95% CI 9.25–17.1) with low heterogeneity (p = 0.33, I2 = 0%) and 1.85% (95% CI 1.08–2.62%) with low heterogeneity (P = 0.56, I2 = 0%).Conclusions:Acetazolamide improves sleep apnea at high altitude by decreasing AHI and percentage of periodic breathing time and increasing nocturnal oxygenation. Acetazolamide is more beneficial in healthy participants than in OSA patients, and a 250 mg daily dose may be as effective as higher daily doses for healthy trekkers.

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“…Although it was not an objective of our study, it is important to mention that one out of ten drivers had OSA. It is well known and published by Pagel et al, 36 that the high loop gain has been associated with CPAP titration failures.…”

Section: Discussionmentioning

confidence: 99%

Ventilatory Cycle Measurements and Loop Gain in Central Apnea in Mining Drivers Exposed to Intermittent Altitude

Castro

Liendo²,

Ortiz

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: By measuring the apnea length, ventilatory phase, respiratory cycle length, and loop gain, we can further characterize the central apneas of high altitude (CAHA). Methods: Sixty-three drivers of all-terrain vehicles, working in a Peruvian mine located at 2,020 meters above sea level (MASL), were evaluated. A respiratory polygraph was performed in the first night they slept at high altitude. None of the subjects were exposed to oxygen during the test or acetazolamide in the preceding days of the test. Results: Sixty-three respiratory polygraphs were performed, and 59 were considered for analysis. Forty-six (78%) were normal, 6 (10%) had OSA, and 7 (12%) had CAHA. Key data from subjects include: residing altitude: 341 ± 828 MASL, Lake Louise scoring: 0.4 ± 0.8, Epworth score: 3.4 ± 2.7, apneahypopnea index: 35.7 ± 19.3, CA index: 13.4 ± 14.2, CA length: 14.4 ± 3.6 sec, ventilatory length: 13.5 ± 2.9 sec, cycle length: 26.5 ± 4.0 sec, ventilatory length/CA length ratio 0.9 ± 0.3 and circulatory delay 13.3 ± 2.9 sec. Duty ratio media [ventilatory duration/cycle duration] was 0.522 ± 0 0.128 [0.308-0.700] and loop gain was calculated from the duty ratio utilizing this formula: LG = 2π / [(2πDR-sin(2πDR)]. All subjects have a high loop gain media 2.415 ± 1.761 [1. 175-6.260]. Multiple correlations were established with loop gain values, but the only significant correlation detected was between central apnea index and loop gain. Conclusions: Twelve percent of the studied population had CAHA. Measurements of respiratory cycle in workers with CAHA are more similar to idiopathic central apneas rather than Hunter-Cheyne-Stokes respiration. Also, there was a high degree of correlation between severity of central apnea and the degree of loop gain. The abnormal breathing patterns in those subjects could affect the sleep quality and potentially increase the risk for work accidents. Keywords: driver, sleep, central apnea, high altitude, loop gain Citation: Rey de Castro J, Liendo A, Ortiz O, Rosales-Mayor E, Liendo C. Ventilatory cycle measurements and loop gain in central apnea in mining drivers exposed to intermittent altitude.

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The Effects of Altitude Associated Central Apnea on the Diagnosis and Treatment of Obstructive Sleep Apnea: Comparative Data from Three Different Altitude Locations in the Mountain West

Cited by 29 publications

References 31 publications

Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m

Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m

The effect of acetazolamide on sleep apnea at high altitude: a systematic review and meta-analysis

Ventilatory Cycle Measurements and Loop Gain in Central Apnea in Mining Drivers Exposed to Intermittent Altitude

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