—Shore and Millman, together with Sharp et al,1 have observed three patients with central sleep apnea that converted to obstructive apnea with acetazolamide administration. This phenomenon has several possible explanations. First, as suggested by Sharp et al,1 the subclassification of apneas into obstructive and central may be inappropriate, as a patient's condition may convert from one form of apnea to another with changes in central respiratory drive. This, however, is not always the case, as our six patients demonstrated. A second explanation might be that the three patients of Shore and Millman and Sharp et al had a predisposition to obstructive apnea, with decreased upper-airway caliber.2 As a result, with the increased respiratory drive produced by acetazolamide, greater inspiratory pressure developed, causing upper-airway collapse and obstruction.Finally, these three patients may originally have had obstructive sleep apnea. Over time, the recurrent hypoxia and hypercapnia resulting
White DP. Central Sleep Apnea and Acetazolamide Therapy-Reply. Arch Intern Med. 1983;143(6):1278–1280. doi:10.1001/archinte.1983.00350060210041
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