Acetazolamide May Improve AHI in Obstructive and Central Sleep Apnea

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Patients with obstructive or central sleep apnea experienced improvements in apnea-hypopnea index following treatment with acetazolamide.

Patients with either obstructive or central sleep apnea experienced improvements in apnea hypopnea index (AHI) following treatment with acetazolamide, according to the results of a meta-analysis published in the journal CHEST.

The study authors searched MEDLINE, EMBASE and for studies in which adults with obstructive or central sleep apnea received oral acetazolamide vs no acetazolamide (control). Improvements in AHI and oxygen saturation nadir were compared between groups for both types of sleep apnea.

Of the 28 studies included in the analysis, 13 focused on obstructive sleep apnea, while 15 focused on central sleep apnea. A total of 542 individuals received acetazolamide and 553 individuals did not. The dosage of acetazolamide varied widely between studies, ranging from 36 to 1000 mg/d (mean, 528 mg/d). Treatment duration was similarly varied, ranging from 1 to 90 days (median, 6 days).

Overall, treatment with acetazolamide reduced AHI by 37.7% compared to the control group. While there were no significant differences in AHI reduction between the obstructive or central sleep apnea groups, the reduction was significantly greater with higher doses of acetazolamide. Additionally, acetazolamide improved oxygen saturation nadir.

“A reasonable regimen for future studies would be 125-500 mg/d (1-2 doses/d; evening dose 2 h before bedtime) with close follow-up to rule out worsening of sleep apnea,” the study authors wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Schmickl CN, Landry SA, Orr JE, et al. Acetazolamide for obstructive and central sleep apnea: a comprehensive systematic review and meta-analysis. CHEST. Published online August 5, 2020. doi:10.1016/j.chest.2020.06.078