乙酰唑胺治疗快速眼动睡眠期为主的阻塞性睡眠呼吸暂停
阻塞性睡眠呼吸暂停(OSA)的药物治疗正从广谱方法转向针对特定生理内型的靶向治疗。快速眼动睡眠期为主的OSA(REM-OSA)患者对持续气道正压通气(CPAP)依从性较差，碳酸酐酶抑制剂乙酰唑胺可调节通气驱动，可能为REM相关病理生理为主的患者提供靶向治疗。Thorax发表的Messineo等研究首次直接检验了该治疗策略。
要点
- 快速眼动睡眠期OSA的特点是通气驱动下降和上气道更易塌陷，导致阻塞事件更频繁和持久
- 乙酰唑胺作为碳酸酐酶抑制剂可调节通气驱动，可能对REM相关病理生理为主的OSA患者有靶向治疗作用
- OSA药物治疗正从单一方案转向根据生理内型的个体化精准治疗
核心结论
- 乙酰唑胺可能为快速眼动睡眠期为主的阻塞性睡眠呼吸暂停患者提供靶向治疗选择
研究设计与样本
- Messineo等发表在Thorax的研究是首个直接检验乙酰唑胺治疗REM-OSA的临床试验
主要发现
- 快速眼动睡眠期阻塞事件因通气驱动下降和上气道脆弱性增加而更频繁和持久
临床怎么用
- 持续气道正压通气(CPAP)仍是阻塞性睡眠呼吸暂停的标准治疗
- 对CPAP依从性差的REM-OSA患者可考虑使用碳酸酐酶抑制剂乙酰唑胺
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Pharmacotherapy for obstructive sleep apnoea (OSA) has entered a new phase in which the focus is shifting from broad, one-size-fits-all approaches to targeted treatments matched to specific physiological endotypes. While continuous positive airway pressure (CPAP) remains the standard of care, many individuals, particularly those with rapid eye movement (REM)-predominant OSA (REM-OSA), struggle with adherence. 1 REM sleep is characterised by more frequent and prolonged obstructive events due to dips in ventilatory drive and greater upper-airway vulnerability, 2 making this subgroup uniquely challenging to treat. Against this backdrop, interest has grown in the use of medications such as the carbonic anhydrase inhibitor acetazolamide, which modulates ventilatory drive and potentially offers targeted benefit where REM-related pathophysiology dominates. In this issue of Thorax , it is therefore with great interest that we read the recent study by Messineo et al 3 which is the first trial to directly test the...
引用
- Thorax：Is acetazolamide a 'REMedy for rapid eye movement-predominant obstructive sleep apnoea?
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。