Inclusion Criteria:

• OSA measures
• Average oxygen desaturation index 4 (ODI4) ≥ 7 and < 55 events/h and average SpO2≥88% during sleep from continuous home pulse oximetry recordings at screening
• AHI4 of > 10 to <60 events/h
• Patients currently using PAP will be eligible for inclusion in the study if:
• Non-compliant to CPAP (less than 4 hr/night for 5 days/week) and they express willingness to discontinue treatment for a minimum of 7 days before the baseline SpO2 assessments
• Patients who discontinued PAP
• Naïve to PAP

Exclusion Criteria:

• Sustained SpO2<93% during wakefulness or mean SpO2<88% during sleep, calculated from PSG at screening
• Dyspnea at rest or patients with heart failure class IV NYHA
• Blood pressure <90/50 mmHg or >160/100 mmHg at V1
• Recent (<3 months) episode of acute myocardial infarction or acute decompensated heart failure
• History of stroke
• History of sustained ventricular tachyarrhythmias or other severe arrhythmias without defibrillator implanted
• Heart failure primarily caused by valvular, post-partum cardiomyopathy or active myocarditis
• History of obesity-hypoventilation syndrome or respiratory disturbance due to opioids
• History of bronchiectasis and uncontrolled asthma
• History of chronic obstructive pulmonary disease (COPD) with a forced expiratory volume in 1 second (FEV1) <50% of predicted (European Respiratory Society criteria)
• Started treatment with β-blockers <3 months before the study. Patients not taking β-blockers or taking β-blockers for >3 months can be enrolled.
• Narcolepsy, restless leg syndrome requiring medication, REM sleep behavior disorder
• Pronounced anatomical abnormalities of upper airway (adenoid vegetations, grade ≥3 tonsillar hypertrophy, etc.), pronounced micrognathia, or pronounced incomplete development of the lower jaw
• History of schizophrenia, schizoaffective disorder or bipolar disorder according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) or International Classification of Disease tenth edition criteria
• Medically unexplained positive screen for drugs of abuse (excluding THC/marijuana) or history of substance use disorder as defined in DSM-V within 24 months prior to Screening Visit
• A significant illness or infection requiring medical treatment in the past 30 days as determined by investigator
• Clinically significant cognitive dysfunction as determined by investigator.
• Women who are pregnant or nursing
• Participants with reduced sodium and/or potassium blood serum levels
• Participants with suprarenal gland failure
• Participants with hyperchloremic acidosis
• Participants with a history of using devices for OSA treatment, including CPAP, oral or nasal devices, or positional devices, may enroll as long as the devices have not been used for at least 1 week prior to first PSG and are not used during participation in the study (through V7). Patients that are non-compliant to CPAP (less than 4hr/night for 5 days/week) can be enrolled, as well as patients who are naïve to PAP and patients who discontinued PAP previously. PAP compliant patients cannot be enrolled.
• History of chronic oxygen therapy are excluded
• Concomitant use of medications from the list of disallowed medications
• Hepatic transaminases >2X the upper limit of normal (ULN), total bilirubin >1.5X ULN (unless confirmed Gilbert syndrome), estimated glomerular filtration rate <40 ml/min
• Excluded Medications
• Digoxin, methyldigoxin, beta-methyldigoxin.
• Opioids
• Mecamylamine
• Methenamine
• Sodium Phosphates
• Chronic use of more than 500 mg/day of Aspirin
• GLP1 receptor agonists for weight loss, unless reached stable dose and stable weight (<4lbs weight change per month) for 3+ months
• Other carbonic anhydrase inhibitors (zonisamide, topiramate, etc)
• Lithium

Note: Other protocol defined Inclusion/Exclusion Criteria may apply.

Eligibility last updated 03/03/2025. Questions regarding updates should be directed to the study team contact.