Altitude-Associated Central Apnea in Continuous Positive Airway Pressure Therapy.

At high altitudes, hypobaric hypoxia leads to central apneas in both healthy adults and patients with obstructive sleep apnea. This condition correlates with intermittent desaturation and disruption of sleep.  The clinical case of a patient evaluated during a sleep medicine outpatient consultation at the Fundación Neumológica Colombiana (Bogotá, Colombia, 2,600 masl) is reported.  We present a 64-year-old male patient living in a high-altitude city, who was an aircrew member and was on continuous positive airway pressure (CPAP) therapy for severe obstructive sleep apnea (OSA). The patient had symptoms and central apneas only when he slept at high altitudes. Other causes of central apnea were ruled out, and these events were corrected with the administration of supplemental oxygen. Altitude-associated central apnea is a common disorder that can occur at altitudes higher than 1,600 m above sea level. Currently, the first-line treatments are acetazolamide and oxygen supplementation.  Changes in altitude should be considered in patients with OSA in PAP therapy, as it can occur in many occupations and in recreational travels.