Acetazolamide

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Shahrokh Javaheri - One of the best experts on this subject based on the ideXlab platform.

  • Acetazolamide for osa and central sleep apnea a comprehensive systematic review and meta analysis
    Chest, 2020
    Co-Authors: Christopher N Schmickl, Shane A Landry, Jeremy E Orr, Kazuo Chin, Kimihiko Murase, Johan Verbraecken, Shahrokh Javaheri, Bradley A Edwards
    Abstract:

    Background Therapy options for OSA and central sleep apnea (CSA) are limited, thus many patients remain untreated. Clinically, Acetazolamide is sometimes used for CSA; however, given overlapping pathophysiologic properties of OSA and CSA, we hypothesized that Acetazolamide is equally effective for both types. Prior reviews focused on specific subtypes of sleep apnea, study designs, and languages, thus including few studies (typically ≤3) limiting insights. Research Question How efficacious is Acetazolamide for sleep apnea, and is its effect modified by sleep apnea type or Acetazolamide dose? Study Design and Methods We queried MEDLINE, EMBASE, and ClinicalTrials.gov from inception until March 11, 2019. Any study in which adults with OSA/CSA received oral Acetazolamide vs no Acetazolamide (control) that reported sleep apnea-related outcomes was eligible, independent of study design or language. Two reviewers independently assessed eligibility and abstracted data. Primary outcomes were apnea-hypopnea index (AHI) and oxygen saturation nadir. Quality of evidence (QoE) was rated with the use of Grades of Recommendation Assessment, Development and Evaluation methods. Results We included 28 studies (13 OSA/15 CSA; NSubjects,Acetazolamide = 542; NSubjects,Control = 553) that enabled meta-analyses for 24 outcomes. Acetazolamide doses ranged from 36 to 1000 mg/d and treatment duration from 1 to 90 d (median, 6 d). Overall, Acetazolamide vs control lowered the AHI by −0.7 effect sizes (95% CI, −0.83 to −0.58; I2 = 0%; moderate QoE) that corresponded to a reduction of 37.7% (95% CI, −44.7 to −31.3) or 13.8/h (95% CI, −16.3 to −11.4; AHIControl = 36.5/h). The AHI reduction was similar in OSA vs CSA, but significantly greater with higher doses (at least up to 500 mg/d). Furthermore, Acetazolamide improved oxygen saturation nadir by +4.4% (95% CI, 2.3 to 6.5; I2 = 63%; no evidence of effect modification; very low QoE) and several secondary outcomes that included sleep quality measures and BP (mostly low QoE). Interpretation Short-term Acetazolamide improved both OSA and CSA. Rigorous studies with long-term follow up are warranted to assess Acetazolamide’s value for the chronic treatment of patients with sleep apnea. Clinical Trial Registration PROSPERO (CRD42019147504)

Bradley A Edwards - One of the best experts on this subject based on the ideXlab platform.

  • Acetazolamide for osa and central sleep apnea a comprehensive systematic review and meta analysis
    Chest, 2020
    Co-Authors: Christopher N Schmickl, Shane A Landry, Jeremy E Orr, Kazuo Chin, Kimihiko Murase, Johan Verbraecken, Shahrokh Javaheri, Bradley A Edwards
    Abstract:

    Background Therapy options for OSA and central sleep apnea (CSA) are limited, thus many patients remain untreated. Clinically, Acetazolamide is sometimes used for CSA; however, given overlapping pathophysiologic properties of OSA and CSA, we hypothesized that Acetazolamide is equally effective for both types. Prior reviews focused on specific subtypes of sleep apnea, study designs, and languages, thus including few studies (typically ≤3) limiting insights. Research Question How efficacious is Acetazolamide for sleep apnea, and is its effect modified by sleep apnea type or Acetazolamide dose? Study Design and Methods We queried MEDLINE, EMBASE, and ClinicalTrials.gov from inception until March 11, 2019. Any study in which adults with OSA/CSA received oral Acetazolamide vs no Acetazolamide (control) that reported sleep apnea-related outcomes was eligible, independent of study design or language. Two reviewers independently assessed eligibility and abstracted data. Primary outcomes were apnea-hypopnea index (AHI) and oxygen saturation nadir. Quality of evidence (QoE) was rated with the use of Grades of Recommendation Assessment, Development and Evaluation methods. Results We included 28 studies (13 OSA/15 CSA; NSubjects,Acetazolamide = 542; NSubjects,Control = 553) that enabled meta-analyses for 24 outcomes. Acetazolamide doses ranged from 36 to 1000 mg/d and treatment duration from 1 to 90 d (median, 6 d). Overall, Acetazolamide vs control lowered the AHI by −0.7 effect sizes (95% CI, −0.83 to −0.58; I2 = 0%; moderate QoE) that corresponded to a reduction of 37.7% (95% CI, −44.7 to −31.3) or 13.8/h (95% CI, −16.3 to −11.4; AHIControl = 36.5/h). The AHI reduction was similar in OSA vs CSA, but significantly greater with higher doses (at least up to 500 mg/d). Furthermore, Acetazolamide improved oxygen saturation nadir by +4.4% (95% CI, 2.3 to 6.5; I2 = 63%; no evidence of effect modification; very low QoE) and several secondary outcomes that included sleep quality measures and BP (mostly low QoE). Interpretation Short-term Acetazolamide improved both OSA and CSA. Rigorous studies with long-term follow up are warranted to assess Acetazolamide’s value for the chronic treatment of patients with sleep apnea. Clinical Trial Registration PROSPERO (CRD42019147504)

Christopher N Schmickl - One of the best experts on this subject based on the ideXlab platform.

  • Acetazolamide for osa and central sleep apnea a comprehensive systematic review and meta analysis
    Chest, 2020
    Co-Authors: Christopher N Schmickl, Shane A Landry, Jeremy E Orr, Kazuo Chin, Kimihiko Murase, Johan Verbraecken, Shahrokh Javaheri, Bradley A Edwards
    Abstract:

    Background Therapy options for OSA and central sleep apnea (CSA) are limited, thus many patients remain untreated. Clinically, Acetazolamide is sometimes used for CSA; however, given overlapping pathophysiologic properties of OSA and CSA, we hypothesized that Acetazolamide is equally effective for both types. Prior reviews focused on specific subtypes of sleep apnea, study designs, and languages, thus including few studies (typically ≤3) limiting insights. Research Question How efficacious is Acetazolamide for sleep apnea, and is its effect modified by sleep apnea type or Acetazolamide dose? Study Design and Methods We queried MEDLINE, EMBASE, and ClinicalTrials.gov from inception until March 11, 2019. Any study in which adults with OSA/CSA received oral Acetazolamide vs no Acetazolamide (control) that reported sleep apnea-related outcomes was eligible, independent of study design or language. Two reviewers independently assessed eligibility and abstracted data. Primary outcomes were apnea-hypopnea index (AHI) and oxygen saturation nadir. Quality of evidence (QoE) was rated with the use of Grades of Recommendation Assessment, Development and Evaluation methods. Results We included 28 studies (13 OSA/15 CSA; NSubjects,Acetazolamide = 542; NSubjects,Control = 553) that enabled meta-analyses for 24 outcomes. Acetazolamide doses ranged from 36 to 1000 mg/d and treatment duration from 1 to 90 d (median, 6 d). Overall, Acetazolamide vs control lowered the AHI by −0.7 effect sizes (95% CI, −0.83 to −0.58; I2 = 0%; moderate QoE) that corresponded to a reduction of 37.7% (95% CI, −44.7 to −31.3) or 13.8/h (95% CI, −16.3 to −11.4; AHIControl = 36.5/h). The AHI reduction was similar in OSA vs CSA, but significantly greater with higher doses (at least up to 500 mg/d). Furthermore, Acetazolamide improved oxygen saturation nadir by +4.4% (95% CI, 2.3 to 6.5; I2 = 63%; no evidence of effect modification; very low QoE) and several secondary outcomes that included sleep quality measures and BP (mostly low QoE). Interpretation Short-term Acetazolamide improved both OSA and CSA. Rigorous studies with long-term follow up are warranted to assess Acetazolamide’s value for the chronic treatment of patients with sleep apnea. Clinical Trial Registration PROSPERO (CRD42019147504)

Erik R Swenson - One of the best experts on this subject based on the ideXlab platform.

  • attenuation of human hypoxic pulmonary vasoconstriction by Acetazolamide and methazolamide
    Journal of Applied Physiology, 2018
    Co-Authors: Lindsey M Boulet, Luc J Teppema, Heather K Hackett, Paolo B Dominelli, William Spencer Cheyne, Giulio S Dominelli, David Irwin, Paul W Buehler, Jin Hyen Baek, Erik R Swenson
    Abstract:

    Both Acetazolamide and methazolamide are effective in the prevention of acute mountain sickness by inducing an increase in ventilation and oxygenation. Acetazolamide attenuates hypoxic pulmonary va...

  • benzolamide improves oxygenation and reduces acute mountain sickness during a high altitude trek and has fewer side effects than Acetazolamide at sea level
    Pharmacology Research & Perspectives, 2016
    Co-Authors: David Collier, C B Wolff, Annemarie Hedges, John Nathan, R J Flower, James S Milledge, Erik R Swenson
    Abstract:

    Acetazolamide is the standard carbonic anhydrase (CA) inhibitor used for acute mountain sickness (AMS), however some of its undesirable effects are related to intracellular penetrance into many tissues, including across the blood-brain barrier. Benzolamide is a much more hydrophilic inhibitor, which nonetheless retains a strong renal action to engender a metabolic acidosis and ventilatory stimulus that improves oxygenation at high altitude and reduces AMS. We tested the effectiveness of benzolamide versus placebo in a first field study of the drug as prophylaxis for AMS during an ascent to the Everest Base Camp (5340 m). In two other studies performed at sea level to test side effect differences between Acetazolamide and benzolamide, we assessed physiological actions and psychomotor side effects of two doses of Acetazolamide (250 and 1000 mg) in one group of healthy subjects and in another group compared Acetazolamide (500 mg), benzolamide (200 mg) and lorazepam (2 mg) as an active comparator for central nervous system (CNS) effects. At high altitude, benzolamide-treated subjects maintained better arterial oxygenation at all altitudes (3-6% higher at all altitudes above 4200 m) than placebo-treated subjects and reduced AMS severity by roughly 50%. We found benzolamide had fewer side effects, some of which are symptoms of AMS, than any of the Acetazolamide doses in Studies 1 and 2, but equal physiological effects on renal function. The psychomotor side effects of Acetazolamide were dose dependent. We conclude that benzolamide is very effective for AMS prophylaxis. With its lesser CNS effects, benzolamide may be superior to Acetazolamide, in part, because some of the side effects of Acetazolamide may contribute to and be mistaken for AMS.

  • Acetazolamide and inhaled carbon dioxide reduce periodic breathing during exercise in patients with chronic heart failure
    Journal of Cardiac Failure, 2014
    Co-Authors: Anna Apostolo, Piergiuseppe Agostoni, Mauro Contini, Laura Antonioli, Erik R Swenson
    Abstract:

    Abstract Background Periodic breathing (PB) during sleep and exercise in heart failure (HF) is related to respiratory acid-base status, CO2 chemosensitivity, and temporal dynamics of CO2 and O2 sensing. We studied inhaled CO2 and Acetazolamide to alter these factors and reduce PB. Methods and Results We measured expired and arterial gases and PB amplitude and duration in 20 HF patients during exercise before and after Acetazolamide given acutely (500 mg intravenously) and prolonged (24 hours, 2 g orally), and we performed overnight polysomnography. We studied CO2 inhalation (1%–2%) during constant workload exercise. PB disappeared in 19/20 and 2/7 patients during 2% and 1% CO2. No changes in cardiorespiratory parameters were observed after acute Acetazolamide. With prolonged Acetazolamide at rest: ventilation +2.04 ± 4.0 L/min (P = .001), tidal volume +0.11 ± 1.13 L (P = .003), respiratory rate +1.24 ± 4.63 breaths/min (NS), end-tidal PO2 +4.62 ± 2.43 mm Hg (P = .001), and end-tidal PCO2 −2.59 ± 9.7 mm Hg (P Conclusions In HF, inhaled CO2 and Acetazolamide reduce exercise PB with additional benefits of Acetazolamide on sleep PB.

Craig B Langman - One of the best experts on this subject based on the ideXlab platform.

  • hyperphosphatemic familial tumoral calcinosis response to Acetazolamide and postulated mechanisms
    American Journal of Medical Genetics Part A, 2014
    Co-Authors: Gal Finer, Heather E Price, Richard M Shore, Kenneth E White, Craig B Langman
    Abstract:

    Hyperphosphatemic familial tumoral calcinosis (HFTC) is characterized by enhanced renal phosphate absorption, hyperphosphatemia, and tumor-like extraosseous calcifications due to inactivating mutations in FGF23 or associated proteins. Surgical excision is needed when low phosphate diet and phosphate binders are ineffective. Sporadic reports have supported Acetazolamide use. We report on a 7-year-old African American boy who presented with severe HFTC requiring numerous surgical excisions. Tumors continued to appear and others reoccurred despite phosphate restriction and sevelamer carbonate. At the age of 9.5 years, Acetazolamide (40 mg/kg/day) was added and resulted in mild metabolic acidosis (bicarbonate 25.3 mEq/L vs. 21.4 mEq/L, P < 0.001; serum pH 7.38 vs. 7.31, P = 0.013, pre- and post-Acetazolamide, respectively) but no change in tubular reabsorption of phosphate (TRP) (96.9% vs. 95.9%, P = 0.34) or serum phosphate (6.6 mg/dl vs. 6.9 mg/dl, P = 0.52 pre- and post-Acetazolamide, respectively). Following the initiation of Acetazolamide therapy, the patient experienced significant improvement in disease course as indicated by resolution of localized bone pain, cessation of tumor formation, and no tumor recurrence. Despite mild metabolic acidosis, our patient had improved linear growth and did not develop any other side effects related to therapy. Intact FGF23 remained abnormally low throughout disease course, while C-terminal FGF23 increased with Acetazolamide. We conclude that Acetazolamide can control severe HFTC by inducing mild metabolic acidosis despite no change in serum phosphate or TRP. This effect may be exerted though improved calcium-phosphate complex solubility and increased FGF23 locally.