Endotypic Traits and Obstructive Sleep Apnea Surgery

Inclusion criteria are: 1. age ≥21 years; 2. moderate to severe OSA (obstructive AHI ≥ 15 events/hour); 3. central/mixed apnea index \<5 events/hour; 4. intolerance of positive airway pressure (defined as use \< 2 hours/night at least 5 nights/week); 5. intolerance or poor candidate for oral appliance; 6. participant has provided informed consent for palate surgery as part of their standard of care; 7. tonsil size 0-2+ (without markedly enlarged tonsils that have high surgical success rates); 8. DISE without evidence of complete tongue-related obstruction (reflecting poorer results with isolated palate surgery); 9. medications stable for ≥2 months; 10. body mass index \<35 kg/m2; 11. absence of uncontrolled nasal obstruction; 12. no prior pharyngeal surgery other than tonsillectomy; 13. no neurologic, cardiac or pulmonary disorders; 14. absence of psychiatric disorder except for treated depression or mild anxiety; 15. no co-existing sleep disorder, such as narcolepsy, chronic insomnia, or restless legs syndrome; 16. no use of hypnotics, anxiolytics, stimulants, or sedating antidepressants; 17. no near-miss or prior motor vehicle crash due to sleepiness in past 12 months; and 18. \<3 caffeinated beverages daily. Exclusion criteria are: 1. history of allergic reaction to either of the study drugs; 2. subjects with prior serious allergic reaction (such as Stevens-Johnson syndrome) to sulfonamides; 3. subjects with a history of hypersensitivity to either of the two study drugs; 4. subjects who are on high-dose aspirin therapy due to risk of severe metabolic acidosis; 5. subjects with severe kidney disease or severe liver disease; 6. subjects with a history of electrolyte imbalance or adrenal insufficiency (due to risks related to acetazolamide); 7. subjects on ketoconazole or other strong CYP3A4 inhibitors (these will increase eszopiclone blood levels); 8. pregnancy; and 9. alcohol or substance abuse.