Summary of findings 1. Carbonic anhydrase inhibitors versus inactive control for central sleep apnoea associated with heart failure in adults .
| Acetazolamide 250 mg or 3.5 mg/kg (once daily) compared to placebo/no acetazolamide for central sleep apnoea in adults | |||||
| Patient or population: adults with central sleep apnoea associated with heart failure Setting: outpatients Intervention: acetazolamide 250 mg or 3.5 mg/kg (once daily) Comparison: placebo/no acetazolamide | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with placebo/no acetazolamide | Risk with acetazolamide | ||||
|
cAHI Follow‐up: mean 4 weeks (short‐term) |
Mean cAHI was 49 events/hour | MD 26.00 events/hour lower (43.84 lower to 8.16 lower) |
— | 12 (1 RCT) |
⊕⊝⊝⊝ Very lowa,b |
|
Cardiovascular mortality Follow‐up: mean 12 months |
Study population | OR 0.21 (0.02 to 2.48) | 18 (1 RCT) | ⊕⊝⊝⊝ Very lowa,c |
|
| 40 per 100 | 12 per 100 (1 to 62) | ||||
| Serious adverse events | Not reported | ||||
| Quality of sleep | Not reported | ||||
| Quality of life | Not reported | ||||
| AHI Follow‐up: mean 4 weeks (short‐term) | Mean AHI was 57 events/hour | MD 23.00 events/hour lower (37.70 lower to 8.30 lower) | — | 12 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b |
| AHI Follow‐up: mean 12 months (intermediate‐term) | Mean AHI was 21.68 events/hour | MD 6.98 events/hour lower (10.66 lower to 3.30 lower) | — | 18 (1 RCT) | ⊕⊝⊝⊝ Very lowa,c |
| All‐cause mortality | Not reported | ||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). AHI: apnoea‐hypopnoea index; cAHI: central apnoea‐hypopnoea index; CI: confidence interval; MD: mean difference; OR: odds ratio; RCT: randomised controlled trial. | |||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
a Downgraded one level due to serious study limitations (risk of selection bias, performance bias, detection bias and reporting bias. b Downgraded two levels due to very serious imprecision (very small sample size). c Downgraded two levels due to very serious imprecision (few events and wide CI, including both null effect and appreciable benefit).