Abstract：
The acute effect during positive pressure titration and long term efficacy of acetazolamide (AZT) in high loop gain sleep apnea (HLGSA) is inadequately assessed. We predicted that AZT may improve HLGSA in both conditions.
A retrospective analysis of polysomnograms from patients with presumed HLGSA and residual respiratory instability administered AZT (125 or 250 mg) about 3 h into an initially drug-free positive pressure titration. A responder was defined as ≥ 50% reduction of the apnea hypopnea index(AHI 3% or arousal) before and after AZT. A multivariable logistic regression model estimated responder predictors. Long term efficacy of AZT was assessed by comparing both auto-machine (aREIFLOW) and manually scored respiratory events (sREIFLOW) extracted from the ventilator, prior to and after 3 months of AZT, in a subset.
Of the 231 participants (median age of 61[51-68] years) and 184 (80%) males in the acute effect testing: 77 and 154 patients were given 125 mg and 250 mg AZT. Compared to PAP alone, PAP plus AZT was associated with a lower breathing related arousal index (8 [3-16] vs. 5 [2-10], p < 0.001), and AHI3% (19 [7-37] vs. 11 [5-21], p < 0.001); 98 patients were responders. The non-rapid eye movement sleep (NREM) AHI3% (OR 1.031, 95%CI [1.016-1.046], p < 0.001) was a strong predictor for responder status with AZT exposure. In the 109 participants with 3-month data, both aREIFLOW and sREIFLOWwere significantly reduced after AZT.
AZT acutely and chronically reduced residual sleep apnea in presumed HLGSA; NREM AHI3% is a response predictor. AZT was well tolerated and beneficial for at least 3 months.
A retrospective analysis of polysomnograms from patients with presumed HLGSA and residual respiratory instability administered AZT (125 or 250 mg) about 3 h into an initially drug-free positive pressure titration. A responder was defined as ≥ 50% reduction of the apnea hypopnea index(AHI 3% or arousal) before and after AZT. A multivariable logistic regression model estimated responder predictors. Long term efficacy of AZT was assessed by comparing both auto-machine (aREIFLOW) and manually scored respiratory events (sREIFLOW) extracted from the ventilator, prior to and after 3 months of AZT, in a subset.
Of the 231 participants (median age of 61[51-68] years) and 184 (80%) males in the acute effect testing: 77 and 154 patients were given 125 mg and 250 mg AZT. Compared to PAP alone, PAP plus AZT was associated with a lower breathing related arousal index (8 [3-16] vs. 5 [2-10], p < 0.001), and AHI3% (19 [7-37] vs. 11 [5-21], p < 0.001); 98 patients were responders. The non-rapid eye movement sleep (NREM) AHI3% (OR 1.031, 95%CI [1.016-1.046], p < 0.001) was a strong predictor for responder status with AZT exposure. In the 109 participants with 3-month data, both aREIFLOW and sREIFLOWwere significantly reduced after AZT.
AZT acutely and chronically reduced residual sleep apnea in presumed HLGSA; NREM AHI3% is a response predictor. AZT was well tolerated and beneficial for at least 3 months.
摘要：
背景：在正压滴定过程中的急性效应和乙酰唑胺（AZT）在高环路增益睡眠呼吸暂停（HLGSA）中的长期疗效未得到充分评估。我们预测AZT可以在两种条件下改善HLGSA。
方法：对推测为HLGSA和残余呼吸不稳定的患者的多导睡眠图进行回顾性分析，将AZT（125或250mg）应用于初始无药正压滴定约3小时。响应者定义为AZT前后呼吸暂停低通气指数降低≥50％（AHI3％或唤醒）。多变量逻辑回归模型估计应答者预测因子。通过比较从呼吸机提取的自动机器（aREIFLOW）和手动评分的呼吸事件（sREIFLOW）来评估AZT的长期疗效。在AZT之前和之后3个月，在一个子集。
结果：在急性效应测试中，231名参与者（中位年龄为61[51-68]岁）和184名（80％）男性：77和154名患者分别给予125mg和250mgAZT。与PAP相比，PAP加AZT与较低的呼吸相关唤醒指数相关（8[3-16]vs.5[2-10],p<0.001)，和AHI3%(19[7-37]vs.11[5-21],p<0.001）；98名患者是应答者。非快速眼动睡眠（NREM）AHI3%（OR1.031，95CI[1.016-1.046]，p<0.001)是AZT暴露反应者状态的强预测因子。在109名具有3个月数据的参与者中，AZT后aREIFLOW和sREIFLOW均显著降低。
结论：AZT急性和慢性降低了推测的HLGSA的残余睡眠呼吸暂停；NREMAHI3%是反应预测因子。AZT在至少3个月内具有良好的耐受性和益处。
方法：对推测为HLGSA和残余呼吸不稳定的患者的多导睡眠图进行回顾性分析，将AZT（125或250mg）应用于初始无药正压滴定约3小时。响应者定义为AZT前后呼吸暂停低通气指数降低≥50％（AHI3％或唤醒）。多变量逻辑回归模型估计应答者预测因子。通过比较从呼吸机提取的自动机器（aREIFLOW）和手动评分的呼吸事件（sREIFLOW）来评估AZT的长期疗效。在AZT之前和之后3个月，在一个子集。
结果：在急性效应测试中，231名参与者（中位年龄为61[51-68]岁）和184名（80％）男性：77和154名患者分别给予125mg和250mgAZT。与PAP相比，PAP加AZT与较低的呼吸相关唤醒指数相关（8[3-16]vs.5[2-10],p<0.001)，和AHI3%(19[7-37]vs.11[5-21],p<0.001）；98名患者是应答者。非快速眼动睡眠（NREM）AHI3%（OR1.031，95CI[1.016-1.046]，p<0.001)是AZT暴露反应者状态的强预测因子。在109名具有3个月数据的参与者中，AZT后aREIFLOW和sREIFLOW均显著降低。
结论：AZT急性和慢性降低了推测的HLGSA的残余睡眠呼吸暂停；NREMAHI3%是反应预测因子。AZT在至少3个月内具有良好的耐受性和益处。
