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Theophylline and acetazolamide reduce sleep-disordered breathing at high altitude

¹ Dept of Medicine, Division of Pneumology, Medizinische Klinik - Innenstadt, University of Munich, Munich, and ² Klinik Bad Reichenhall, Bad Reichenhall, Germany.

CORRESPONDENCE: R. Fischer, Pneumology, Medizinische Klinik - Innenstadt, LMU München, Ziemssenstrasse 1, D-80336, München, Germany. Fax: 49 8951604905. E-mail: rainald.fischer@med.uni-muenchen.de

Keywords: acetazolamide, high altitude, sleep-disordered breathing, theophylline

Received: December 6, 2002
Accepted June 27, 2003

This study was supported by Deutsche Akademie für Flug- und Reisemedizin, Frankfurt and Radiometer Inc., Munich, Germany.

A randomised, double-blind, placebo-controlled study was conducted to evaluate the effects of theophylline and acetazolamide in the treatment of sleep-disordered breathing (SDB) after fast ascent to high altitude (3,454 m).

The study was conducted at a high-altitude research laboratory and included 30 healthy male volunteers. Study medication was either oral slow release theophylline (2x250 mg·day^–1), oral acetazolamide (2x250 mg·day^–1) or a matched placebo tablet. Polysomnographic measurements were performed during two consecutive nights, and acute mountain sickness, pulse rate, oxyhaemoglobin saturation and arterial blood gases were assessed three times a day.

Without active medication, the apnoea/hypopnoea index (AHI) was highly pathological (median 16.2·h^–1, range 2–92). Both theophylline and acetazolamide normalised SDB (median AHI 2.5·h^–1, range 0–11; 4.2·h^–1, range 0–19, respectively) and reduced oxyhaemoglobin desaturations during sleep (median desaturation index placebo 41.5·h^–1, range 6–114; acetazolamide 6.5·h^–1, range 3–28; theophylline 8.5·h^–1, range 3–32). Compared with the high amount of central apnoeas or hypopnoeas, the number of obstructive events during sleep was very low in all groups (<4·h^–1). In contrast to theophylline, acetazolamide significantly improved basal oxyhaemoglobin saturation during sleep (86.2±1.7% versus 81.0±3.0%).

The authors conclude that both oral slow release theophylline and acetazolamide are effective to normalise high-altitude sleep-disordered breathing.

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