Treatment-emergent central sleep apnoea managed by CPAP with adjunctive acetazolamide: A case report

Treatment-emergent central sleep apnoea (TECSA) refers to the emergence of central apnoea during treatment for obstructive sleep apnoea (OSA), most commonly continuous positive airway pressure (CPAP). It has been reported in 8% of OSA patients treated with CPAP and spontaneous resolution rate varies between 60% and 80%. Management options include watchful waiting with continuation of CPAP, bi-level positive pressure ventilation, adaptive servo-ventilation and CPAP with supplemental oxygen. Acetazolamide has been shown to be effective in other forms of central sleep apnoea; its use as adjunct to CPAP in TECSA is sparsely reported. We report a 74-year-old man with severe OSA who developed moderate central apnoea upon CPAP initiation. Subsequent addition of acetazolamide led to gratifying resolution of the TECSA. In TECSA patients with significant symptoms and high central apnoea index, treatment with acetazolamide as adjunct to CPAP may be considered, particularly in patients in whom CPAP adherence is imperative.