Emergence of central sleep apnea at high altitude in patients with mild obstructive sleep apnea: a case report

This case illustrates that patients with only mild obstructive sleep apnea at sea level can develop severe, predominant central sleep apnea at high altitude. It further demonstrates that such severe high-altitude central sleep apnea may be refractory to both continuous positive airway pressure and acetazolamide monotherapy but can be effectively controlled with a combination of continuous positive airway pressure and supplemental oxygen. The findings underscore the importance of re-evaluating sleep apnea phenotype at altitude and adopting a pathophysiology-guided, individualized approach to therapy.