Acetazolamide on REM OSA

Summary

OSA is a highly prevalent disorder that has major consequences for cardiovascular health, neurocognitive function, risk of traffic accidents, daytime sleepiness and quality of life. In particular, REM sleep is accompanied by more frequent and longer obstructive events, that yield more profound hypoxemia than during non-REM (nREM). Exaggerated OSA severity in REM is the consequence of ventilatory drive dips, particularly during phasic eye movements. Unfortunately, the leading treatment for REM and nREM OSA, CPAP-which acts to pneumatically splint the pharynx open-is intolerable for many patients. Treatment outcomes for REM OSA are burdened by further incomplete CPAP adherence later in the night, which commonly leaves REM periods undertreated. In this protocol, the investigators will test the effect of Acetazolamide on REM OSA and on ventilatory parameters such as genioglossus muscle activity and ventilatory drive.

Timeline

Start

2023-01-30

Primary completion

2025-12-01

Completion

2025-12-31

Publications

• Messineo L, Kim M, Azarbarzin A, Vena D, Preuss M, Esmaeili N, Aishah A, Lawrence NV, Gilbertson DC, White DP, Wellman A, Sands SA. Acetazolamide to prevent ventilatory drive withdrawal in REM sleep apnoea: a randomised controlled trial. Thorax. 2026 Mar 4:thorax-2025-223922. doi: 10.1136/thorax-2025-223922. Online ahead of print.

Drugs

Indications