Acetazolamide to prevent ventilatory drive withdrawal in REM sleep apnoea: a randomised controlled trial.
ThoraxSep 15, 2026 (epub)
Ludovico Messineo, Molly Kim, Ali Azarbarzin et al.
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In 30 seconds
This randomized controlled trial evaluated the effects of acetazolamide on REM-predominant obstructive sleep apnoea (OSA) in 11 participants. Acetazolamide significantly reduced the apnoea hypopnoea index (AHI) by 35.5% and hypoxic burden by 35.9% compared to placebo (p<0.001), indicating its potential benefit in managing REM OSA severity.
Key findings
- Acetazolamide reduced AHI by 35.5% vs placebo (95% CI 23.1% to 46.3%).
- Hypoxic burden decreased by 35.9% with acetazolamide compared to placebo (95% CI 21.1% to 48.4%).
- Acetazolamide increased ventilation at eupneic drive by +1.4 L/min.
- Muscle responsiveness improved with acetazolamide, with a +32% increase in ventilation/drive slope.
Why it matters
The findings suggest that acetazolamide may be a useful adjunct in the management of REM-predominant OSA, potentially improving patient outcomes by enhancing upper airway physiology despite not addressing ventilatory drive dips.