Sleep Disorders Center, Pulmonary Division, University Hospital of Zurich and Center for Human Integrative Physiology, University of Zurich , Zurich, Switzerland .
High Alt Med Biol. 2011 Winter;12(4):303-7. doi: 10.1089/ham.2011.1055.
Considering the high prevalence of the obstructive sleep apnea syndrome (OSA), it is expected that many patients with the disorder are traveling to altitude. However, this may expose them to the risk of pronounced hypoxemia, exacerbation of nocturnal breathing disturbances by frequent central apneas, impaired daytime performance, and high blood pressure. Recently, randomized studies specifically investigated the effects of altitude (1630-2590 m) in OSA patients and the optimal treatment in this setting. The results indicate that patients should continue to use continuous positive airway pressure therapy (CPAP) when sleeping at altitude. Since CPAP alone does not control central sleep apnea emerging at altitude, combined treatment with acetazolamide and CPAP should be considered, in particular, in patients with severe OSA and co-morbidities. Supplemental oxygen combined with CPAP might be advantageous in patients with OSA and concomitant cardiopulmonary disease by preventing hypoxemia and central sleep apnea. In patients unable to use CPAP or if electrical power is not available, an optimally fitted mandibular advancement device might be an alternative treatment option that can be combined with acetazolamide during altitude sojourns. Acetazolamide alone is also beneficial and better than no treatment at all, since it improves oxygen saturation, breathing disturbances, and the excessive blood pressure elevation in OSA patients traveling to altitude.
考虑到阻塞性睡眠呼吸暂停综合征（OSA）的高患病率，预计许多患有这种疾病的患者都会前往高海拔地区。然而，这可能会使他们面临严重低氧血症的风险，频繁出现中枢性呼吸暂停会使夜间呼吸紊乱恶化，白天的表现能力下降，以及血压升高。最近，一些随机研究专门调查了海拔（1630-2590 米）对 OSA 患者的影响，以及在这种环境下的最佳治疗方法。研究结果表明，患者在高海拔地区睡觉时应继续使用持续气道正压通气治疗（CPAP）。由于 CPAP 本身不能控制在高海拔地区出现的中枢性睡眠呼吸暂停，因此应考虑联合使用乙酰唑胺和 CPAP 进行治疗，特别是对于严重 OSA 合并合并症的患者。补充氧气联合 CPAP 可能通过预防低氧血症和中枢性睡眠呼吸暂停对合并心肺疾病的 OSA 患者有益。对于无法使用 CPAP 的患者或在没有电力的情况下，优化适配的下颌前伸装置可能是一种替代治疗选择，在高海拔停留期间可以与乙酰唑胺联合使用。单独使用乙酰唑胺也有益，并且优于完全不治疗，因为它可以提高 OSA 患者的血氧饱和度、呼吸紊乱以及到达高海拔地区后血压升高的情况。
