Summary of recommendations for ventilatory disorders
| Obesity hypoventilation |
| Counsel against high-altitude travel |
| If high-altitude travel cannot be avoided, administer supplemental oxygen for day- and night-time use |
| Counsel patients about the risks for and symptoms of AMS and prophylax with acetazolamide 125 mg or 250 mg b.i.d. |
| In patients with pre-existing CPAP prescription, travel to altitude with CPAP unit and make necessary adjustments in set pressure for machines lacking pressure compensation |
| Obstructive and central sleep apnoea |
| Travel to altitude with CPAP machine and make necessary adjustments in set pressure for machines lacking pressure compensation |
| For patients with central sleep apnoea, consider acetazolamide 250 mg b.i.d. |
| Continue pre-existing nocturnal oxygen therapy during high-altitude sojourn |
| Evaluate patients with daytime hypoxaemia for the presence of pulmonary hypertension and, if present, prophylax with nifedipine SR 20 mg b.i.d. |
| Optimise heart-failure regimen for patients with central sleep apnoea due to cardiomyopathy |
| Prior carotid artery surgery |
| Avoid high-altitude travel in patients with preceding bilateral carotid resection |
| If travel cannot be avoided administer supplemental oxygen |
| Assess hypoxic ventilatory response in patients with prior history of carotid endarterectomy and administer supplemental oxygen if response is suppressed |
| Neuromuscular disorders |
| Screen for the presence of sleep-disordered breathing and, if present, treat with bilevel positive airway pressure at altitude |
| Screen for baseline hypoventilation and, if present, travel to high altitude with bilevel positive airway pressure |
| Administer nocturnal supplemental oxygen in patients with history of nocturnal desaturations, but avoid “over-oxygenation” to prevent suppression of ventilatory drive |
| Screen kyphoscoliosis patients for pre-existing pulmonary hypertension and, if present, administer supplemental oxygen and prophylax with nifedipine SR 20 mg b.i.d. |
| Counsel patients with bilateral diaphragmatic paralysis against high-altitude travel; If travel cannot be avoided, administer bilevel positive airway pressure |
AMS: acute mountain sickness; CPAP: continuous positive airway pressure.