乙酰唑胺治疗成人睡眠呼吸暂停的疗效：随机对照试验的系统评价

文献信息

中文摘要

背景与目的： 睡眠呼吸障碍（SDB）包括阻塞性睡眠呼吸暂停（OSA）和中枢性睡眠呼吸暂停（CSA），影响全球数百万成年人，并与显著的心血管疾病负担相关。传统疗法，尤其是持续气道正压通气（CPAP），在某些人群中存在局限性，特别是患有CSA或复杂性睡眠呼吸暂停的患者。鉴于碳酸酐酶抑制在稳定通气控制方面的新兴机制学依据，本系统评价旨在通过随机对照试验（RCTs）评估乙酰唑胺治疗成人睡眠呼吸暂停的疗效。
方法： 对PubMed、Scopus、Web of Science和Cochrane Library进行了全面检索，共识别出462条记录。在去除重复文献并筛选后，17项RCT符合纳入标准。使用Cochrane偏倚风险2.0评估工具评价研究质量，由于存在显著异质性而无法进行荟萃分析，故对数据进行了叙述性综合。
结果： 乙酰唑胺总体上改善了夜间氧合并减少了呼吸事件负担，但效应幅度在不同临床情境中有所差异。在低海拔OSA中，报告的AHI降低幅度约为42-69.4%，而在心力衰竭相关CSA中，CAI降低约53%。在暴露于高海拔的健康成年人中，报告的改善包括AHI降低约11次/小时、ODI降低15次/小时以及夜间氧合提高2-5%。这些发现支持乙酰唑胺具有情境和表型依赖性的作用，而非一致的治疗效应。
结论： 乙酰唑胺可能是某些类型SDB的有用药物辅助治疗，尤其是CSA和高海拔相关通气不稳定，以及寻求非CPAP替代方案的OSA患者。未来需要大规模、长期试验来优化给药方案并识别应答者内型。

英文摘要

BACKGROUND AND OBJECTIVES: Sleep-disordered breathing (SDB), encompassing obstructive sleep apnea (OSA) and central sleep apnea (CSA), affects millions of adults worldwide and is associated with significant cardiovascular morbidity. Conventional therapies, particularly continuous positive airway pressure (CPAP), have limitations in certain populations, especially those with CSA or complex sleep apnea. Given the emerging mechanistic rationale for carbonic anhydrase inhibition in stabilizing ventilatory control, this systematic review aimed to evaluate the efficacy of acetazolamide in adult sleep apnea across randomized controlled trials (RCTs).
METHODS: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library identified 462 records. After duplicate removal and screening, 17 RCTs met inclusion criteria. Study quality was assessed using the Cochrane Risk of Bias 2.0 assessment, and data were synthesized narratively due to substantial heterogeneity precluding meta-analysis.
RESULTS: Acetazolamide generally improved nocturnal oxygenation and reduced respiratory event burden, although effect magnitudes varied across clinical contexts. In low-altitude OSA, reported AHI reductions ranged from approximately 42-69.4%, while in heart failure-associated CSA, CAI decreased by approximately 53%. In healthy adults exposed to altitude, reported improvements included approximately 11 events/h reduction in AHI, 15 events/h reduction in ODI, and 2-5% increases in nocturnal oxygenation. These findings support a context- and phenotype-dependent role for acetazolamide rather than a uniform treatment effect.
CONCLUSIONS: Acetazolamide may be a useful pharmacological adjunct for selected forms of SDB, particularly CSA and altitude-related ventilatory instability, and OSA patients seeking non-CPAP alternatives. Future large-scale, long-term trials are needed to optimize dosing and identify responder endotypes.