Esther I Schwarz, Stéphanie Saxer, Mona Lichtblau, Simon R Schneider, Julian Müller, Laura Mayer, Konrad E Bloch, Silvia Ulrich
{"title":"乙酰唑胺对肺血管疾病患者睡眠呼吸紊乱的影响:随机对照试验。","authors":"Esther I Schwarz, Stéphanie Saxer, Mona Lichtblau, Simon R Schneider, Julian Müller, Laura Mayer, Konrad E Bloch, Silvia Ulrich","doi":"10.1183/23120541.00040-2024","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients with pulmonary vascular disease (PVD) often suffer from nocturnal hypoxaemia, but also from sleep apnoea. Short-term use of acetazolamide increases ventilation due to metabolic acidosis and also reduces loop gain. We investigated whether prolonged use of acetazolamide improves sleep disordered breathing in PVD.</p><p><strong>Methods: </strong>In a randomised controlled crossover trial, patients with PVD were randomly assigned to acetazolamide 250 mg and placebo twice daily for 5 weeks. Patients underwent respiratory polygraphy at baseline and at the end of each intervention phase. Outcomes of interest were the effect of acetazolamide on mean nocturnal oxygen saturation (<i>S</i> <sub>pO<sub>2</sub></sub> ), time with oxygen saturation <90% (<i>t</i> <sub><90</sub>), apnoea-hypopnoea index (AHI) and sleep apnoea severity.</p><p><strong>Results: </strong>In 20 patients with PVD (55% women, nine with pulmonary arterial hypertension, 11 with distal chronic thromboembolic pulmonary hypertension; mean±sd nocturnal <i>S</i> <sub>pO<sub>2</sub></sub> 88.8±3.5%, obstructive AHI 12.6±12.3 events·h<sup>-1</sup>), 5 weeks of acetazolamide resulted in a significant improvement in nocturnal oxygenation compared to placebo (mean nocturnal <i>S</i> <sub>pO<sub>2</sub></sub> +2.3% (95% CI 1.3-3.3%); p<0.001 and <i>t</i> <sub><90</sub> -18.8% (95% CI -29.6- -8.0%); p=0.001). Acetazolamide increased the proportion of patients with mean nocturnal <i>S</i> <sub>pO<sub>2</sub></sub> ≥90% from 45% to 85%. The percentage of patients with AHI >5 events·h<sup>-1</sup> was reduced from 75% to 60% and with AHI >15 events·h<sup>-1</sup> from 30% to 15%. Two patients discontinued the study because of mild side-effects.</p><p><strong>Conclusions: </strong>Acetazolamide given for 5 weeks reduces nocturnal hypoxaemia in PVD to a clinically relevant level and reduces the proportion of patients with obstructive sleep apnoea.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"10 5","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514193/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effects of acetazolamide on sleep disordered breathing in pulmonary vascular disease: a randomised controlled trial.\",\"authors\":\"Esther I Schwarz, Stéphanie Saxer, Mona Lichtblau, Simon R Schneider, Julian Müller, Laura Mayer, Konrad E Bloch, Silvia Ulrich\",\"doi\":\"10.1183/23120541.00040-2024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients with pulmonary vascular disease (PVD) often suffer from nocturnal hypoxaemia, but also from sleep apnoea. Short-term use of acetazolamide increases ventilation due to metabolic acidosis and also reduces loop gain. We investigated whether prolonged use of acetazolamide improves sleep disordered breathing in PVD.</p><p><strong>Methods: </strong>In a randomised controlled crossover trial, patients with PVD were randomly assigned to acetazolamide 250 mg and placebo twice daily for 5 weeks. Patients underwent respiratory polygraphy at baseline and at the end of each intervention phase. Outcomes of interest were the effect of acetazolamide on mean nocturnal oxygen saturation (<i>S</i> <sub>pO<sub>2</sub></sub> ), time with oxygen saturation <90% (<i>t</i> <sub><90</sub>), apnoea-hypopnoea index (AHI) and sleep apnoea severity.</p><p><strong>Results: </strong>In 20 patients with PVD (55% women, nine with pulmonary arterial hypertension, 11 with distal chronic thromboembolic pulmonary hypertension; mean±sd nocturnal <i>S</i> <sub>pO<sub>2</sub></sub> 88.8±3.5%, obstructive AHI 12.6±12.3 events·h<sup>-1</sup>), 5 weeks of acetazolamide resulted in a significant improvement in nocturnal oxygenation compared to placebo (mean nocturnal <i>S</i> <sub>pO<sub>2</sub></sub> +2.3% (95% CI 1.3-3.3%); p<0.001 and <i>t</i> <sub><90</sub> -18.8% (95% CI -29.6- -8.0%); p=0.001). Acetazolamide increased the proportion of patients with mean nocturnal <i>S</i> <sub>pO<sub>2</sub></sub> ≥90% from 45% to 85%. The percentage of patients with AHI >5 events·h<sup>-1</sup> was reduced from 75% to 60% and with AHI >15 events·h<sup>-1</sup> from 30% to 15%. 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引用次数: 0
摘要
背景:肺血管疾病(PVD)患者经常会出现夜间低氧血症,也会出现睡眠呼吸暂停。短期服用乙酰唑胺会因代谢性酸中毒而增加通气量,同时也会减少循环增量。我们研究了长期使用乙酰唑胺是否能改善 PVD 患者的睡眠呼吸障碍:在一项随机对照交叉试验中,PVD 患者被随机分配到乙酰唑胺 250 毫克和安慰剂,每天两次,持续 5 周。患者在基线和每个干预阶段结束时均接受呼吸测谎。研究结果显示,乙酰唑胺对夜间平均血氧饱和度(S pO2)、血氧饱和度时间(t)、呼吸暂停-低通气指数(AHI)和睡眠呼吸暂停严重程度均有影响:对 20 名 PVD 患者(55% 为女性,9 人患有肺动脉高压,11 人患有远端慢性血栓栓塞性肺动脉高压;平均值(±sd)夜间 S pO2 为 88.8±3.5%,阻塞性 AHI 为 12.6±12.3。与安慰剂相比,服用乙酰唑胺 5 周可显著改善夜间氧合(平均夜间 S pO2 +2.3% (95% CI 1.3-3.3%); pt -18.8% (95% CI -29.6- -8.0%); p=0.001)。乙酰唑胺将夜间 S pO2 平均值≥90%的患者比例从 45% 提高到 85%。AHI>5次/小时-1的患者比例从75%降至60%,AHI>15次/小时-1的患者比例从30%降至15%。两名患者因出现轻微副作用而中止了研究:结论:持续 5 周服用乙酰唑胺可将 PVD 患者的夜间低氧血症降至临床相关水平,并降低阻塞性睡眠呼吸暂停患者的比例。
Effects of acetazolamide on sleep disordered breathing in pulmonary vascular disease: a randomised controlled trial.
Background: Patients with pulmonary vascular disease (PVD) often suffer from nocturnal hypoxaemia, but also from sleep apnoea. Short-term use of acetazolamide increases ventilation due to metabolic acidosis and also reduces loop gain. We investigated whether prolonged use of acetazolamide improves sleep disordered breathing in PVD.
Methods: In a randomised controlled crossover trial, patients with PVD were randomly assigned to acetazolamide 250 mg and placebo twice daily for 5 weeks. Patients underwent respiratory polygraphy at baseline and at the end of each intervention phase. Outcomes of interest were the effect of acetazolamide on mean nocturnal oxygen saturation (SpO2 ), time with oxygen saturation <90% (t<90), apnoea-hypopnoea index (AHI) and sleep apnoea severity.
Results: In 20 patients with PVD (55% women, nine with pulmonary arterial hypertension, 11 with distal chronic thromboembolic pulmonary hypertension; mean±sd nocturnal SpO2 88.8±3.5%, obstructive AHI 12.6±12.3 events·h-1), 5 weeks of acetazolamide resulted in a significant improvement in nocturnal oxygenation compared to placebo (mean nocturnal SpO2 +2.3% (95% CI 1.3-3.3%); p<0.001 and t<90 -18.8% (95% CI -29.6- -8.0%); p=0.001). Acetazolamide increased the proportion of patients with mean nocturnal SpO2 ≥90% from 45% to 85%. The percentage of patients with AHI >5 events·h-1 was reduced from 75% to 60% and with AHI >15 events·h-1 from 30% to 15%. Two patients discontinued the study because of mild side-effects.
Conclusions: Acetazolamide given for 5 weeks reduces nocturnal hypoxaemia in PVD to a clinically relevant level and reduces the proportion of patients with obstructive sleep apnoea.
期刊介绍:
ERJ Open Research is a fully open access original research journal, published online by the European Respiratory Society. The journal aims to publish high-quality work in all fields of respiratory science and medicine, covering basic science, clinical translational science and clinical medicine. The journal was created to help fulfil the ERS objective to disseminate scientific and educational material to its members and to the medical community, but also to provide researchers with an affordable open access specialty journal in which to publish their work.