Acetazolamide-Assisted Weaning From Mechanical Ventilation in a Child With Mixed Sleep Apnea: A Case Report

An elevated central apnea-hypopnea index is typically considered indicative of abnormal breathing in children. Treatment of central sleep apnea (CSA) is complex, and multiple treatment options are tried with variable outcomes. Acetazolamide, a carbonic anhydrase inhibitor, is known to induce metabolic acidosis and can stimulate the respiratory drive. We report a 13-year-old boy who was having obesity and mixed apnea with an apnea-hypopnea index of 67.4/hour, who was hospitalized with hypercapnic respiratory failure. He was successfully weaned from prolonged mechanical ventilation following acetazolamide therapy. Post-discharge, he has had no apnea and continues to do well, with an improved quality of life at two months of follow-up. Acetazolamide use for central apnea/mixed apnea in children is very rare and not well established. Our case highlights the potential use of acetazolamide as an adjunct therapy in children with CSA, which needs further exploration.