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April 19, 2026

Prevention of severe nocturnal hypoxemia in COPD patients at high altitude. (Results of a randomized controlled trial)

Key Points

To evaluate the effectiveness of acetazolamide in preventing severe nocturnal hypoxemia in COPD patients at high altitude.
Conducted a randomized, double-blind, placebo-controlled trial with 176 COPD patients.
Patients received either acetazolamide (125 mg morning and 250 mg evening) or placebo for two days at 3100 m.
Primary outcome assessed was the occurrence of severe nocturnal hypoxemia defined as SpO2<80% for >30 minutes.
Monitoring involved respiratory polygraphy, spirometry, and clinical examination.
Severe nocturnal hypoxemia occurred in 12% of the acetazolamide group compared to 48% in the placebo group (p<0.001).
Mean nocturnal SpO2 was significantly improved in the acetazolamide group (86±2%) versus placebo (84±2%; p<0.001).
Desaturation index (DI) was significantly lower in those taking acetazolamide (13.8±14.4) compared to placebo (26.3±26.6; p<0.001).
Minimal adverse effects were reported with no serious events.

Abstract

Objective. To assess the efficacy of acetazolamide in preventing severe nocturnal hypoxemia in patients with chronic obstructive pulmonary disease (COPD) during a short-term stay at an altitude of 3100 m. Material and methods. In a randomized, double-blind, placebo-controlled trial, 176 patients with COPD (FEV1 40—80% of predicted, SpO2≥92%, PaCO230 min). Secondary outcomes included nocturnal oxygen saturation (SpO2) and desaturation index (DI). Monitoring was performed using respiratory polygraphy, spirometry, and clinical examination. Results. Severe nocturnal hypoxemia occurred in 12% of patients in the acetazolamide group (10/86) versus 48% in the placebo group (43/90; p<0.001). Mean nocturnal SpO2 at 3100 m was 86±2% (acetazolamide) versus 84±2% (placebo; p<0.001), with a DI of 13.8±14.4 versus 26.3±26.6 per hour (p<0.001). Adverse effects were minimal, with no serious adverse events reported. Conclusion. Prophylactic use of acetazolamide significantly reduces the incidence of severe nocturnal hypoxemia in COPD patients at 3100 m, improving oxygenation and reducing the desaturation index. Acetazolamide can be recommended as an effective and safe measure for COPD patients traveling to high altitudes.

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