C21-09 Resolution of Central Sleep Apnea With Combined Therapy: Effect of CPAP Plus Oxygen or Acetazolamide

Abstract Rationale Effective Treatment of central apnea (CSA) remains elusive. CPAP may be an efficacious treatment of CSA, it rarely eliminates CSA. Other options include acetazolamide and low-flow oxygen. The purpose of this investigation was to determine the efficacy of adding acetazolamide, low-flow oxygen, or both to CPAP therapy for the treatment of central sleep apnea. Methods A controlled, double-blinded, crossover study evaluated the efficacy of acetazolamide, supplemental oxygen, and their combination in reducing sleep-disordered breathing compared with standard PAP therapy. All 82 participants completed full polysomnography under five conditions: (1) Baseline, (2) Baseline PAP, (3) Acetazolamide at 250 mg at bedtime, (4) low flow Oxygen ( 2-4 L/min), and (5) Acetazolamide plus Oxygen, with conditions (3) and (4) administered in a randomized order. Primary outcomes include the Central Apnea-Hypopnea Index (CAHI), Central Apnea Index (CAI), Obstructive Apnea Index (OAI), Obstructive Hypopnea Index (OHI), Central Hypopnea Index (CHI), and Total Apnea-Hypopnea Index (AHI). An analysis of variance (ANOVA) model compared intervention effects across groups, with “Baseline” and “Baseline PAP” as reference categories. Results We randomized 35 male participants (Age = 65 ± 12.5 years, BMI = 32.2 ± 5.3 kg/m²) with diagnosed central sleep apnea, as defined by an AHI ≥ 10/hour and a CAHI ≥ 5/hour. The AHI, CAI, and CAHI through each treatment intervention are listed in Figure 1. CPAP therapy resulted in amelioration of central apnea. The addition of acetazolamide, or supplement oxygen to CPAP therapy, resulted in the resolution of CSA, evidenced by a substantial decrease in AHI, CAI, and CAHI. Conclusion 1. Nasal CPAP therapy resulted in amelioration of central sleep apnea. 2) The addition of acetazolamide or low-flow oxygen resulted in further improvement and normalization of respiratory indices. 3) These findings support the use of combined therapy with PAP plus a pharmacologic intervention. This abstract is funded by: CSR&D