Bloch Konrad E, Latshang Tsogyal D, Ulrich Silvia
1 Sleep Disorders Center, Pulmonary Division, University Hospital of Zurich , Switzerland .
2 Center for Human Integrative Physiology, and Zurich Center for Interdisciplinary Sleep Research, University of Zurich , Switzerland .
High Alt Med Biol. 2015 Jun;16(2):110-6. doi: 10.1089/ham.2015.0016. Epub 2015 May 14.
Bloch, Konrad E., Tsogyal D. Latshang, and Silvia Ulrich. Patients with obstructive sleep apnea at altitude. High Alt Med Biol 16:110-116, 2015.--Obstructive sleep apnea (OSA) is highly prevalent in the general population, in particular in men and women of older age. In OSA patients sleeping near sea level, the apneas/hypopneas associated with intermittent hypoxemia are predominantly due to upper airway collapse. When OSA patients stay at altitudes above 1600 m, corresponding to that of many tourist destinations, hypobaric hypoxia promotes frequent central apneas in addition to obstructive events, resulting in combined intermittent and sustained hypoxia. This induces strong sympathetic activation with elevated heart rate, cardiac arrhythmia, and systemic hypertension. There are concerns that these changes expose susceptible OSA patients, in particular those with advanced age and co-morbidities, to an excessive risk of cardiovascular and other adverse events during a stay at altitude. Based on data from randomized trials, it seems advisable for OSA patients to use continuous positive airway pressure treatment with computer controlled mask pressure adjustment (autoCPAP) in combination with acetazolamide during an altitude sojourn. If CPAP therapy is not feasible, acetazolamide alone is better than no treatment at all, as it improves oxygenation and sleep apnea and prevents excessive blood pressure rises of OSA patients at altitude.
布洛赫，康拉德·E.，措杰尔·D.·拉尚，以及西尔维娅·乌尔里希。高原地区阻塞性睡眠呼吸暂停患者。《高海拔医学与生物学》16:110 - 116，2015年。——阻塞性睡眠呼吸暂停（OSA）在普通人群中高度流行，尤其是在老年男性和女性中。在海平面附近睡眠的OSA患者中，与间歇性低氧血症相关的呼吸暂停/低通气主要是由于上气道塌陷。当OSA患者身处海拔1600米以上（许多旅游目的地的海拔高度）时，除了阻塞性事件外，低压性缺氧会促使频繁出现中枢性呼吸暂停，导致间歇性和持续性低氧血症同时存在。这会引发强烈的交感神经激活，伴有心率加快、心律失常和系统性高血压。人们担心这些变化会使易感的OSA患者，特别是那些年龄较大且患有合并症的患者，在高原停留期间面临心血管及其他不良事件的过度风险。基于随机试验的数据，对于OSA患者而言，在高原停留期间使用计算机控制面罩压力调节的持续气道正压通气治疗（自动CPAP）并联合乙酰唑胺似乎是可取的。如果CPAP治疗不可行，单独使用乙酰唑胺也比不治疗要好，因为它能改善氧合和睡眠呼吸暂停，并防止OSA患者在高原时血压过度升高。
