Journal
SLEEP
Volume 46, Issue 4, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/sleep/zsac269
Keywords
altitude; sleep; apnea; healthy; acetazolamide; older
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This study assessed the sleep and nocturnal breathing disturbances in healthy lowlanders aged 40 or above at high altitudes. The results showed that preventive treatment with acetazolamide improved oxygenation and nocturnal breathing but had no significant effect on sleep duration and structure.
Study Objectives To assess altitude-induced sleep and nocturnal breathing disturbances in healthy lowlanders 40 y of age or older and the effects of preventive acetazolamide treatment. Methods Clinical examinations and polysomnography were performed at 760 m and in the first night after ascent to 3100 m in a subsample of participants of a larger trial evaluating altitude illness. Participants were randomized 1:1 to treatment with acetazolamide (375 mg/day) or placebo, starting 24 h before and while staying at 3100 m. The main outcomes were indices of sleep structure, oxygenation, and apnea/hypopnea index (AHI). Results Per protocol analysis included 86 participants (mean +/- SE 53 +/- 7 y old, 66% female). In 43 individuals randomized to placebo, mean nocturnal pulse oximetry (SpO(2)) was 94.0 +/- 0.4% at 760 m and 86.7 +/- 0.4% at 3100 m, with mean change (95%CI) -7.3% (-8.0 to -6.5); oxygen desaturation index (ODI) was 5.0 +/- 2.3 at 760 m and 29.2 +/- 2.3 at 3100 m, change 24.2/h (18.8 to 24.5); AHI was 11.3 +/- 2.4/h at 760 m and 23.5 & PLUSMN; 2.4/h at 3100 m, change 12.2/h (7.3 to 17.0). In 43 individuals randomized to acetazolamide, altitude-induced changes were mitigated. Mean differences (delta, 95%CI) in altitude-induced changes were: delta SpO(2) 2.3% (1.3 to 3.4), delta ODI -15.0/h (-22.6 to -7.4), delta AHI -11.4/h (-18.3 to -4.6). Total sleep time, sleep efficiency, and N3-sleep fraction decreased with an ascent to 3100 m under placebo by 40 min (17 to 60), 5% (2 to 8), and 6% (2 to 11), respectively. Acetazolamide did not significantly change these outcomes. Conclusions During a night at 3100 m, healthy lowlanders aged 40 y or older revealed hypoxemia, sleep apnea, and disturbed sleep. Preventive acetazolamide treatment improved oxygenation and nocturnal breathing but had no effect on sleep duration and structure.
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