Anxiety correlates with somatic symptoms and sleep status at high altitudes

Acute mountain sickness predicts the emotional state of amateur mountaineers

Research on amateur mountaineers is scarce, and this study aims to delve into the emotional experiences of ten amateur mountaineers during their ascent using the "Befindlichkeitsskala" (BFS) and Lake Louise Acute Mountain Sickness scoring system (LLS). These subjects were exposed to altitudes of 3140 m, 4300 m, and 5276 m, respectively. We found that LLS scores were negatively correlated with positive emotions (β = -27.54, p < 0.05) and positively correlated with negative emotions (β = 21.97, p < 0.05). At an altitude of 4300 m, individuals with AMS exhibited significant differences in depression, anger, excitement, and inactivity compared to climbers without AMS. Upon returning to 3140 m after completing the climb, significant differences were observed in emotions such as happiness, calmness, anger, excitement, and depression. Throughout the three-day climb, noteworthy differences emerged in activity, happiness, calmness, inactivity, positive emotions (p < 0.01), negative emotions, and overall emotional scores (p < 0.05). Our study suggests a decline in the emotional well-being of amateur climbers with increasing altitude, highlighting AMS as a pivotal predictive factor for emotional experiences while climbing.

Sleep at high altitude: A bibliometric study and visualization analysis from 1992 to 2022

Background

As an important monitoring index for adaptation to hypoxia, sleep may reflect the adaptive state of the body at high altitudes. The literature has shown a link between altitude and sleep problems, and sleep changes have become a common problem for individuals at high altitudes, negatively impacting their physical and mental health. As research on high-altitude sleep has gained attention in recent years, the publishing volume has increased worldwide, necessitating a more comprehensive understanding of this field. This manuscript evaluates the key themes and emerging trends in high-altitude sleep over the past few decades and predicts future research directions.

Methods

Articles related to high-altitude sleep published from 1992 to 2022 were retrieved from the Web of Science Core Collection, and the relevant literature characteristics were extracted after the screening. Then, bibliometric analyses and visualizations were performed using Microsoft Excel, CiteSpace, VOSviewer, and an online analysis platform (http://bibliometric.com).

Results

A total of 1151 articles were retrieved, of which 368 were included in the analysis, indicating a gradually increasing trend. The United States, Switzerland, and China have made significant contributions in this field. Bloch KE from the University of Zurich was determined to be the most productive and academically influential author in this field. The highest-yielding journal was High Altitude Medicine & Biology. Initially, altitude training was the primary research topic. Currently, research focuses on sleep disorders and sleep apnea. In the coming years, keywords such as "sleep quality," "prevalence," and "obstructive sleep apnea" will attract more attention.

Conclusion

Our findings will assist scholars to better understand the intellectual structure and emerging trends in this field. Future developments in high-altitude sleep research are highly anticipated, particularly in terms of sleep quality at high altitudes and its associated prevalence. This research is also crucial for the improvement and treatment of symptoms during nocturnal sleep in patients with chronic hypoxia due to cardiopulmonary diseases at high altitudes.

Oxygen comfort evaluation method based on symptom index for short-term internal migrants to Tibet

In Tibet, the hypobaric-hypoxic environment found at high altitudes leads to dysfunction in short-term internal migrants and has noticeable effects on physiology, psychological health, and comfort level. Therefore, it is essential to accurately determine the degree of hypoxia and improve the hypoxic environment of plateaus. Despite advances in the medical diagnosis and treatment of pathological hypoxic injuries, there are some limitations in the oxygenic evaluation of internal migrants with mild hypoxia. An oxygen comfort evaluation method (OCEM) based on typical anoxic symptomatology and physiological indices is proposed in this study. Experiments with different oxygen concentrations were conducted to measure anoxic symptomatology and physiological indices. Using item and exploratory factor analyses, 19 symptom indices were screened to predict oxygen sensation in humans. Finally, the OCEM was established using an artificial neural network and fuzzy mathematics method and its accuracy was verified through a field survey. The results showed that the artificial neural network model using symptomatologic indices could predict human oxygen sensation, with an area under the receiver operating characteristic curve of 0.630-0.913 and prediction accuracy of 93 %. Oxygen comfort can be predicted from the oxygen sensation and typical physiological indices using the fuzzy mathematics method; the weighted kappa coefficient was 0.825, indicating a strong correlation between the predicted and actual values. The proposed OCEM can help determine the oxygen comfort conditions of high-altitude internal migrants and provide a basis for indoor oxygen environment regulation in high-altitude buildings.

Anxiety as a Risk Factor for Acute Mountain Sickness Among Young Chinese Men After Exposure at 3800 M: A cross‒sectional Study

Purpose

We aimed to explore whether anxiety is a risk factor for acute mountain sickness [AMS] in a young Chinese male population.

Patients and Methods

A total of 143 young Chinese men with a median age of 23 years (IQR, 21-25) were employed in the present study, and they were divided into the AMS+ and AMS- groups according to the Lake Louise AMS score [AMS-S] after exposure at 3800 m for two days. Participants' pulse oximeter saturation [SpO2] and heart rate [HR] were measured. AMS was evaluated using the AMS-S. The anxiety and sleep quality of the subjects were assessed using the Zung Self-Rating Anxiety Scale [SAS] and the Athens Insomnia Scale [AIS], respectively. Outcomes were analysed using Spearman's partial correlation and logistic regression analysis.

Results

After two days of exposure at 3800 m, the overall prevalence of AMS was 54% in the whole group. The HR was significantly higher in the AMS+ group than in the AMS- group, as well as the SAS score and AIS score. A converse pattern was observed for SpO2. A significant difference was observed for the change in SAS and AIS score between the AMS+ and AMS- groups. Correlation analysis showed that AMS-S was positively correlated with SAS score, AIS score, HR, ΔSAS score, ΔAIS score, and ΔHR but negatively correlated with SpO2. AIS score was positively correlated with SAS score. After logistic regression analysis was adjusted for HR, SpO2, ΔAIS and ΔHR, SAS score (OR=1.446, 95% CI 1.200-1.744, p<0.001), AIS score (OR=1.216, 95% CI 1.033-1.432) and ΔSAS score (OR=1.158, 95% CI 1.012-1.327) were identified as independent risk factors for AMS.

Conclusion

The present study suggests that anxiety is a risk factor for AMS among young Chinese men, and poor sleep quality may partially mediate the association.

Patients with palpitations experience a higher symptom burden prior to breast cancer surgery

PURPOSE

Anxiety, depression, sleep disturbance, fatigue, cognitive dysfunction, and pain are common symptoms reported by patients with breast cancer. Recent evidence suggests that palpitations, a feeling of the heart racing or pounding, may be equally common. Study purpose was to compare the severity and clinically meaningful occurrence rates of common symptoms and quality of life (QOL) outcomes between patients with breast cancer who did and did not report palpitations prior to surgery.

METHODS

Patients (n = 398) were classified as having or not having palpitations using a single item from the Menopausal Symptoms Scale. Valid and reliable measures were used to assess state and trait anxiety, depression, sleep disturbance, fatigue, energy, cognitive function, breast symptoms, and QOL. Between group differences were evaluated using parametric and non-parametric tests.

RESULTS

Patients with palpitations (15.1%) reported significantly higher severity scores for state and trait anxiety, depression, sleep disturbance, and fatigue as well as significant decrements in energy and cognitive function (all p < .05). A higher percentage of these patients had clinically meaningful levels of state anxiety, depression, sleep disturbance and decrements in cognitive function (all p < .05). Except for spiritual well-being, QOL scores were lower in the palpitations group (all p < .001).

CONCLUSION

Findings support the need for routine assessment of palpitations and management of multiple symptoms in women prior to breast cancer surgery.

Acute Mountain Sickness and the Risk of Subsequent Psychiatric Disorders-A Nationwide Cohort Study in Taiwan

We aim to explore if there is a relationship between acute mountain sickness (AMS) and the risk of psychiatric disorders in Taiwan by using the National Health Insurance Research Database for to the rare studies on this topic. We enrolled 127 patients with AMS, and 1270 controls matched for sex, age, monthly insured premiums, comorbidities, seasons for medical help, residences, urbanization level, levels of care, and index dates were chosen from 1 January 2000 to 31 December 2015. There were 49 patients with AMS and 140 controls developed psychiatric disorders within the 16-year follow-up. The Fine-Gray model analyzed that the patients with AMS were prone to have a greater risk for the development of psychiatric disorders with an adjusted sub-distribution hazard ratio (sHRs) of 10.384 (95% confidence interval [CI]: 7.267-14.838, p < 0.001) for psychiatric disorders. The AMS group was associated with anxiety disorders, depressive disorders, bipolar disorder, sleep disorders, posttraumatic stress disorder/acute stress disorder, psychotic disorder, and substance-related disorder (SRD). The relationship between anxiety, depression, sleep disorders, SRD, and AMS still persisted even after we excluded the psychiatric disorders within the first five years after AMS. There was an association between AMS and the rising risk of psychiatric disorders in the 16 years of long-term follow-up research.

Effect of Carnatic raga-Bilahari based music therapy on anxiety, sleep disturbances and somatic symptoms among caregivers of cancer patients

Carnatic raga-Bilahari based intervention is a music therapy technique that enhances relaxation and positivity by reducing anxiety. With extensive empirical evidence pointing out the detrimental challenges faced by the caregivers of cancer patients, the present study intends to find out the effectiveness of a Carnatic raga based music therapy on reducing anxiety, sleep disturbances, somatic symptoms and distress level among this population A single group pre-post research design was was used to conduct the study. General Health Questionnaire (GHQ-28) was used as a screening tool to select participants, and 30 participants were chosen using the purposive sampling. These individuals received instruction in listening to Carnatic music (raga-Bilahari), 5 days a week. The vocal and instrumental recordings were given on alternative days with each session lasting 15–30 min over a month of standard care. From the findings it is observed that there is significant decrease in the anxiety (p < 0.001), sleep disturbances (p < 0.001), somatic symptoms (p < 0.001) and distress level (p < 0.001) after the intervention.The study result thus indicates that Carnatic raga-Bilahari-based music intervention is effective among caregivers of cancer patients to reduce anxiety, sleep disturbances, somatic symptoms presentation, and their distress level.

The interplay of hypoxic and mental stress: Implications for anxiety and depressive disorders

Adequate oxygen supply is essential for the human brain to meet its high energy demands. Therefore, elaborate molecular and systemic mechanism are in place to enable adaptation to low oxygen availability. Anxiety and depressive disorders are characterized by alterations in brain oxygen metabolism and of its components, such as mitochondria or hypoxia inducible factor (HIF)-pathways. Conversely, sensitivity and tolerance to hypoxia may depend on parameters of mental stress and the severity of anxiety and depressive disorders. Here we discuss relevant mechanisms of adaptations to hypoxia, as well as their involvement in mental stress and the etiopathogenesis of anxiety and depressive disorders. We suggest that mechanisms of adaptations to hypoxia (including metabolic responses, inflammation, and the activation of chemosensitive brain regions) modulate and are modulated by stress-related pathways and associated psychiatric diseases. While severe chronic hypoxia or dysfunctional hypoxia adaptations can contribute to the pathogenesis of anxiety and depressive disorders, harnessing controlled responses to hypoxia to increase cellular and psychological resilience emerges as a novel treatment strategy for these diseases.

A Large Sample Survey of Tibetan People on the Qinghai-Tibet Plateau: Current Situation of Depression and Risk Factors

BACKGROUND

A depressive state is a negative emotional state characterized by abnormal dejection and unpleasant mood. Long-term depressive symptoms can result in psychological disorders such as depression. However, little is known about the depression status and risk factors of the Tibetan people on the Qinghai-Tibet Plateau.

OBJECTIVE

This study explores the depression status of the Tibetan people to better promote ethnic minorities' physical and mental health.

PARTICIPANTS AND SETTING

The Center for Epidemiologic Studies Depression Scale (CES-D) was administered to 24,141 Tibetan people from Yushu Prefecture; the average age was 34.33 years (SD = 9.18, range = 18-94 years).

MATERIALS AND METHODS

Participants completed questionnaires collecting demographic information and evaluating symptoms of depression.

RESULTS

The depression prevalence was higher at high altitudes, and there may be a significant positive correlation between depression rates and altitude. Significant differences were found for each demographic variable. Participants with depressive symptoms (scores ≥8) accounted for 52.3% of the total sample, and participants with depression (scores ≥14) accounted for 28.6%. The binary logistic regression results showed that alcohol drinkers, unmarried participants, participants with high self-assessed socioeconomic status, participants with a high income level, and those with a middle-school education were more likely to be depressed.

CONCLUSIONS

The results provide the first evidence that the prevalence of depression in Tibetans of the Qinghai-Tibet Plateau is higher than that in the general Chinese population and that reported in Western studies, a finding that may be related to cultural differences and chronic hypoxia caused by the high altitude. This paper offers insight into the mental health status of people living in plateau areas and provides a basis for formulating pertinent mental health policy.

Going to Altitude with a Preexisting Psychiatric Condition

Psychiatric disorders have a high lifetime prevalence affecting about 30% of the global population. Not much is known about high altitude (HA) sojourns in individuals living with a psychiatric condition. This lack of scientific evidence contrasts with the anticipated increase in numbers of individuals with preexisting psychiatric conditions seeking medical advice on HA exposure. Not only are there risks associated with a HA climb, but physical activity in general is known to improve symptoms of many psychiatric disorder and enhance measures of mental well-being like quality of life and resilience. There are additional positive effects of alpine environments on mental health beyond those of physical activity. All individuals going to HA with a preexisting psychiatric condition should be in a state of stable disease with no recent change in medication. Specific considerations and recommendations apply to individual psychiatric disorders. During the HA sojourn the challenge is to separate altitude-related symptoms such as insomnia from prodromal symptoms of the underlying disorder (e.g., depressive episode) or altitude-related hyperventilation from panic attacks. In case an individual with preexisting anxiety disorder decides to go to HA there might be a predisposition toward acute mountain sickness (AMS), but it should always be considered that many symptoms of anxiety and AMS overlap. Any medication that is anticipated to be taken during ascent or at HA should be tested for compatibility with the psychiatric condition and medication before the trip.

The onset of sleep disturbances and their associations with anxiety after acute high-altitude exposure at 3700 m

Sleep disturbances and psychiatric repercussions pose great challenges at high altitude; however, few studies have investigated sleep disturbance and anxiety profiles and their associations after acute exposure in consecutive patients. Thus, we aimed to study the profiles of sleep disturbances in consecutive patients after high-altitude exposure and the association of such disturbances with anxiety. A total of 668 participants were recruited at sea level and 3700 m. The trials were performed at sea level (1 week prior to a 2-h flight to a high-altitude destination) and at 3700 m (24, 72, and 168 h). Sleep disturbances were assessed by self-reported sleep patterns and scores on the Athens Insomnia Scale (AIS). State anxiety was assessed using the Self-Rating Anxiety Scale (SAS). In our study, the incidence of sleep disturbances increased significantly after acute high-altitude exposure (65.3%, 434/668) and then gradually decreased after 72 h (50%, 141/282) and 168 h (44%, 124/282). The sleep assessments AIS [2.0 (4.0) vs. 4.0 (5.0)] and ESS [4.0 (4.0) vs. 5.0 (5.0)] increased significantly (p < 0.05). Also, the SAS increased significantly from 26.25 (3.75) to 28.75 (7.5). The SAS was significantly high in sleep disturbance group [31.25 (7.5) vs. 27.5 (5), p < 0.001] than in the non-sleep- disturbance group. The baseline SAS and AIS scores were significantly higher in participants with sleep disturbances than in those without (p < 0.01). Age, baseline insomnia, sleepiness, fatigue, and higher SAS were predictors of sleep disturbances in univariate regression (all p values < 0.05). However, only an older age (p = 0.045) and a higher baseline SAS (p = 0.018) remained independent predictors of sleep disturbances. Our findings indicated that acute high-altitude exposure triggers the onset of sleep disturbances, which are closely associated with anxiety. Furthermore, baseline state anxiety and age are independent predictors of sleep disturbances at high altitude.

Trimetazidine attenuates high-altitude fatigue and cardiorespiratory fitness impairment: A randomized double-blinded placebo-controlled clinical trial

Trimetazidine (TMZ) has been shown to optimize myocardial energy metabolism and is a common anti-ischemic agent. Our trial (ChiCTR-TRC-13003298) aimed to explore whether TMZ has any preventive effect on high-altitude fatigue (HAF), cardiac function and cardiorespiratory fitness upon acute high-altitude exposure and how it works on HAF. Thirty-nine healthy young subjects were enrolled in a randomized double-blinded placebo-controlled trial and were randomized to take oral TMZ (n = 20) or placebo (n = 19), 20 mg tid, 14 days prior to departure until the end of study. The 2018 Lake Louise Score questionnaire, echocardiography, assessments of physical working capacity, circulating markers of myocardial energy metabolism and fatigue were performed both before departure and arrival at highland. At follow-up, TMZ significantly reduced the incidence of HAF (p = 0.038), reversed cardiorespiratory fitness impairment, decreased left ventricular end-systolic volume (LVESV, p = 0.032) and enhanced left ventricular ejection fraction (LVEF, p = 0.015) at highland. Relative to the placebo group, the TMZ group had significantly lower LDH (p = 0.025) and lactate levels before (p < 0.001) and after (p = 0.012) physical exercise after acute high-altitude exposure. Additionally, improved left ventricular systolic function might have contributed to ameliorating HAF during TMZ treatment (LVEF, OR = 0.859, 95% CI = 0.741-0.996, p = 0.044). In conclusion, our results demonstrated that TMZ could prevent HAF, cardiorespiratory fitness impairment and improves left ventricular systolic function during acute high-altitude exposure. This trial provides new insights into the effect of TMZ and novel evidence against HAF and cardiorespiratory fitness impairment at highland.

The relationship between anxiety and acute mountain sickness

Introduction

Whilst the link between physical factors and risk of high altitude (HA)-related illness and acute mountain sickness (AMS) have been extensively explored, the influence of psychological factors has been less well examined. In this study we aimed to investigate the relationship between ‘anxiety and AMS risk during a progressive ascent to very HA.

Methods

Eighty health adults were assessed at baseline (848m) and over 9 consecutive altitudes during a progressive trek to 5140m. HA-related symptoms (Lake Louise [LLS] and AMS-C Scores) and state anxiety (State-Trait-Anxiety-Score [STAI Y-1]) were examined at each altitude with trait anxiety (STAI Y-2) at baseline.

Results

The average age was 32.1 ± 8.3 years (67.5% men). STAI Y-1 scores fell from 848m to 3619m, before increasing to above baseline scores (848m) at ≥4072m (p = 0.01). STAI Y-1 scores correlated with LLS (r = 0.31; 0.24–0.3; P<0.0001) and AMS-C Scores (r = 0.29; 0.22–0.35; P<0.0001). There was significant main effect for sex (higher STAI Y-1 scores in women) and altitude with no sex-x-altitude interaction on STAI Y-1 Scores. Independent predictors of significant state anxiety included female sex, lower age, higher heart rate and increasing LLS and AMS-C scores (p<0.0001). A total of 38/80 subjects (47.5%) developed AMS which was mild in 20 (25%) and severe in 18 (22.5%). Baseline STAI Y-2 scores were an independent predictor of future severe AMS (B = 1.13; 1.009–1.28; p = 0.04; r² = 0.23) and STAI Y-1 scores at HA independently predicted AMS and its severity.

Conclusion

Trait anxiety at low altitude was an independent predictor of future severe AMS development at HA. State anxiety at HA was independently associated with AMS and its severity.

Mood changes at very high altitudes in Pakistan

Objective:

To screen out psychiatric ‘cases’ and find the frequency of anxiety and depression symptoms in military volunteers performing duties at very high altitudes in the Karakoram ranges of Pakistan.

Methods:

This was a descriptive study lasting from Jan 2015 to June 2015, on volunteers serving at very high altitude, using General Health Questionnaire-12 (GHQ-12) and Hospital Anxiety and Depression Scale (HADS), Urdu versions. Analysis involved descriptive, inferential techniques and Bonferroni test. Demographic variables were compared to the scores.

Results:

A high percentage of the military volunteers screened positive for psychiatric ‘caseness’ and symptoms of anxiety and depression; mostly in the mild to moderate range, while very few of them reported severe symptoms. Demographic variables such as marital status, number of children, positive family psychiatric history, past medical history, duration at high altitude and educational levels were found to be significant risk factors for developing symptoms of anxiety and depression.

Conclusions:

Individuals performing duties at very high altitude, experience symptoms of anxiety and depression, their demographics are important in understanding their emotional problems.

Is acute mountain sickness related to trait anxiety? A normobaric chamber study

INTRODUCTION

Some mountaineers are more prone to the occurrence of acute mountain sickness (AMS) than others. State anxiety during altitude exposure might be associated with AMS development. We hypothesized that trait anxiety might be higher in AMS cases compared to non-AMS cases. The aim of the present study was to study the relationship between AMS development and trait anxiety.

METHODS

In an observational study design, AMS incidence during a 12-hour exposure to normobaric hypoxia (F_iO₂=12.6%, equivalent to 4500m) was determined by the Lake Louise Scoring System. Trait anxiety (State Trait Anxiety Inventory) and confounding variables were assessed in a follow-up questionnaire (37months after hypoxic exposure).

RESULTS

Twenty nine participants returned the follow-up questionnaire. AMS incidence was 38%. Both unadjusted and adjusted logistic regression analyses did not reveal trait anxiety as a significant variable in relation to AMS.

DISCUSSION

Based on the findings of this preliminary study, there is no evidence that AMS development under normobaric conditions is related to trait anxiety. Differences to previous studies might be explained by the type of hypoxia, by different sample characteristics and by considering sleep disturbances in the calculation of the AMS score. However, future studies with larger sample sizes may help to clear the relationship between AMS development and the personality factor anxiety.

Short-term high-altitude pre-exposure improves neurobehavioral ability

This study aims to evaluate the effect of the duration of high-altitude (HA) pre-exposure on human neurobehavioral parameters including mood states and cognitive performance at HA. One hundred and eleven healthy individuals (ranging in age from 18 to 35 years) were recruited to participate in this study. They were divided into two groups: a 4-day short-term HA pre-exposure group (n=57) and a 3-month long-term HA pre-exposure group (n=54). All participants lived in the area at 400 m altitude above sea level before pre-exposure to HA. They were then transported to 3700 m plateau for either a 4-day or a 3-month HA pre-exposure, and finally delivered to 4400 m plateau. On the last day of pre-exposure at 3700 m and on the 10th day at 4400 m, neurobehavioral parameters of the participants in the two groups were evaluated. At the end of pre-exposure and on the 10th day of HA exposure, participants in the short-term group had significantly lower negative mood states, better cognitive performance with higher sensorimotor, attention, and psychomotor abilities, and less acute mountain sickness in comparison with the participants in the long-term pre-exposure group. Our field study with large samples showed that in comparison with 3-month long-term pre-exposure, 4-day short-term HA pre-exposure at 3700 m has a better effect in improving human neurobehavioral parameters including mood states and cognitive performance and reducing acute mountain sickness when exposed to a HA at 4400 m.

Analysis of High-altitude Syndrome and the Underlying Gene Polymorphisms Associated with Acute Mountain Sickness after a Rapid Ascent to High-altitude

To investigated the objective indicators and potential genotypes for acute mountain sickness (AMS). 176 male subjects were evaluated for symptoms scores and physiological parameters at 3700 m. EPAS1 gene polymorphisms were explored and verified effects of potential genotypes on pulmonary function by inhaled budesonide. The incidence of AMS was 53.98% (95/176). The individuals who suffered from headache with anxiety and greater changes in heart rate (HR), the forced vital capacity (FVC), and mean flow velocity of basilar artery (Vm-BA), all of which were likely to develop AMS. The rs4953348 polymorphism of EPAS1 gene had a significant correlation with the SaO2 level and AMS, and a significant difference in the AG and GG genotype distribution between the AMS and non-AMS groups. The spirometric parameters were significantly lower, but HR (P = 0.036) and Vm-BA (P = 0.042) significantly higher in the AMS subjects with the G allele than those with the A allele. In summary, changes in HR (≥82 beats/min), FVC (≤4.2 Lt) and Vm-BA (≥43 cm/s) levels may serve as predictors for diagnosing AMS accompanied by high-altitude syndrome. The A allele of rs4953348 is a protective factor for AMS through HR and Vm-BA compensation, while the G allele may contribute to hypoxic pulmonary hypertension in AMS.

A higher baseline somatization score at sea level as an independent predictor of acute mountain sickness

OBJECTIVE

The current study aimed to identify the predictive values of psychological factors that are evaluated by the Symptoms Checklist-90 (SCL-90) for acute mountain sickness (AMS).

METHODS

The subjects (n=285, non-acclimatized young Chinese men), who were recruited in July 2013, completed a case report questionnaire. In addition, their vital signs (heart rate [HR], blood pressure and pulse oxygen saturation) were measured, and their psychological factors were examined using the SCL-90 at sea level. AMS was diagnosed using the Lake Louise self-assessment scoring system in the morning of the second day after their arrival at 3450m.

RESULTS

Of the nine factors of the SCL-90, the AMS patients (AMS score≥3) were characterized by significantly higher scores for baseline somatization [14.0 (5.0) vs. 13.0 (3.0), p<0.001], obsession-compulsion, depression, anxiety and hostility compared with the non-AMS group (all p values<0.05). Spearman's correlation analyses revealed associations between AMS scores and somatization (r=0.316, p<0.001), depression, anxiety, obsession-compulsion, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation and psychoticism scores (all p values<0.001). Although all nine factors were associated with AMS in a univariate regression (all p<0.05), a further adjusted logistic regression analysis indicated that only baseline somatization score (odds ratio=1.129, p=0.001) was an independent predictor of AMS. Furthermore, some non-AMS often-occurred symptoms (paresthesia, shortness of breath, reduced activity and tinnitus) were also found to be associated with the baseline SCL-90 scores.

CONCLUSION

AMS is correlated with the baseline somatization score at sea level, which was measured using the SCL-90. A higher baseline somatization score is also an independent predictor of AMS.

Physiological and psychological factors associated with onset of high-altitude headache in Chinese men upon acute high-altitude exposure at 3700 m

Aim

We aimed to identify clinical characteristics and risk factors associated with onset of high-altitude headache (HAH) after acute exposure at 3700 m.

Method

In two hours, 163 individuals ascended by plane to 3700 m. Demographic information, physiological and psychological measurements, cognitive function, physical work capacity tests and profile of mood states within one week prior to the departure and within 24 hours after arrival were examined.

Results

HAH patients featured significantly higher vertebral artery diastolic velocity (Vd), heart rate (HR) and pulmonary artery diameter. HAH was also associated with a more negative mood state, including scores for tension anxiety, depression, hostility, fatigue and confusion, as well as lower vigor (all p values <0.05). Furthermore, negative emotions were positively related to HAH severity. HAH slightly decreased cognitive functioning. HR, Vd, lack of vigor, confusion and self-reported anxiety (all p values <0.05) were independent risk factors for HAH. We have identified three independent baseline predictors for HAH including internal diameter of the left ventricle (LVD), Athens Insomnia Scale (AIS) and confusion score.

Conclusions

Higher HR, Vd, confusion and self-reported anxiety and insufficient vigor were independent risk factors for HAH. Furthermore, higher baseline LVD, AIS and confusion score are independent predictors of HAH.

Anxiety and depression in Nepal: prevalence, comorbidity and associations

BACKGROUND

Anxiety and depression are two important contributors to the global burden of disease. In many developing countries, including Nepal, their prevalences are yet to be assessed.

METHODS

A nationwide cross-sectional study was conducted among a representative sample of Nepalese adults aged 18-65 years (N = 2100), selected by multistage random cluster sampling and interviewed at home during unannounced visits. The validated questionnaires included the Hospital Anxiety and Depression Scale (HADS), to detect cases of anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD), the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N), and the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Logistic regression analyses were used to explore associations of caseness with four groups of variables: demographic, domicile, substance use, and behavioural and health.

RESULTS

Age- and gender-adjusted point prevalences of HADS-A, HADS-D and HADS-cAD were 16.1, 4.2 and 5.9% respectively. In a multivariate model, HADS-A was positively associated with urban residence (AOR = 1.82; p < 0.001) and neuroticism (AOR = 1.32; p < 0.001), and negatively with alcohol consumption (AOR = 0.71; p = 0.041). HADS-D was positively associated with marijuana use (AOR = 3.61; p = 0.017) and negatively with quality of life (QoL) (AOR = 0.86; p < 0.001). HADS-cAD was positively associated with widowhood (AOR = 2.71; p = 0.002), urban residence (AOR = 2.37; p = 0.001), living at altitude ≥2000 m (AOR = 2.32; p = 0.002) and neuroticism (AOR = 1.26; p < 0.001), and negatively with alcohol use (AOR = 0.56; p = 0.026) and QoL (AOR = 0.79; p < 0.001).

CONCLUSION

Depression and anxiety are important mental health conditions in Nepal, and major contributors to public ill health, being very highly prevalent, comorbid and associated with psychosocial burden. They are also linked to the unique topography, habitation and social structure of the country. High prevalence coupled with the disabling nature of these disorders establishes their health-care priority and their importance in national health policy.

Principal Component Analysis and Risk Factors for Acute Mountain Sickness upon Acute Exposure at 3700 m

OBJECTIVE

We aimed to describe the heterogeneity in the clinical presentation of acute mountain sickness (AMS) and to identify its primary risk factors.

METHODS

The participants (n = 163) received case report form questionnaires, and their heart rate (HR), oxygen saturation (SpO2), echocardiographic and transcranial Doppler variables, ability to perform mental and physical work, mood and psychological factors were assessed within 18 to 22 hours after arriving at 3700 m from sea level (500 m) by plane. First, we examined the differences in all variables between the AMS-positive and the AMS-negative groups. Second, an adjusted regression analysis was performed after correlation and principal component analyses.

RESULTS

The AMS patients had a higher diastolic vertebral artery velocity (Vd; p = 0.018), a higher HR (p = 0.006) and a lower SpO2. The AMS subjects also experienced poorer sleep quality, as quantified using the Athens Insomnia Scale (AIS). Moreover, the AMS population exhibited more negative mood states, including anxiety, depression, hostility, fatigue and confusion. Five principal components focused on diverse aspects were also found to be significant. Additionally, more advanced age (p = 0.007), a higher HR (p = 0.034), a higher Vd (p = 0.014), a higher AIS score (p = 0.030), a decreased pursuit aiming capacity (p = 0.035) and decreased vigor (p = 0.015) were risk factors for AMS.

CONCLUSIONS

Mood states play critical roles in the development of AMS. Furthermore, an elevated HR and Vd, advanced age, elevated AIS sores, insufficient vigor and decreased mental work capacity are independent risk factors for AMS.

Systemic lupus erythematosus patients in the low-latitude plateau of China: altitudinal influences

The current study was to investigate the features of hospitalized patients with systemic lupus erythematosus (SLE) at different altitudes. The correlation between SLE activity and altitudinal variations was also explored. Medical records of 1029 patients were retrospectively reviewed. Activity of SLE in each organ system was recorded using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). There was no significant correlation between SLE activity and altitudes (r = 0.003, p = 0.159). Age at onset for SLE patients at high altitudes was significantly younger than that at low and moderate altitudes (p = 0.022 and p = 0.004, respectively). Age at SLE admission at low altitudes was significant older than those at moderate and high altitudes (p = 0.011 and p < 0.001, respectively). Patients at high altitudes had shorter duration from disease onset to admission than those at moderate altitudes (p = 0.009). Incidence of Sm antibodies-positive for resident patients at high altitudes was 36.4%, which were higher than that at moderate altitudes (p = 0.003). We found increasing trends of CNS activity in active patients; immunological and renal activities in inactive patients were correlated with elevated altitudes (p = 0.024, p = 0.004, p = 0.005), while arthritis scores in active patients showed the tendency of decreasing with the rise of elevation (p = 0.002). Hemoglobin level, red blood cell and platelet counts at high altitudes were significantly lower than those at low altitudes (p < 0.05, respectively). There was no significant difference in hemoglobin level between moderate- and low-altitude groups (p > 0.05). No significant difference in platelet counts between moderate- and high-altitude groups was observed (p > 0.05). Our findings suggest that some clinical features, laboratory tests and activity of main organs in SLE are influenced by altitudes. Furthermore, organ activities of active and inactive SLE patients have different patterns of altitudinal variations. These distinctive variations likely reveal that peculiar environmental factors at high altitudes can affect the development of SLE.

The integrative role of the sigh in psychology, physiology, pathology, and neurobiology

"Sighs, tears, grief, distress" expresses Johann Sebastian Bach in a musical example for the relationship between sighs and deep emotions. This review explores the neurobiological basis of the sigh and its relationship with psychology, physiology, and pathology. Sighs monitor changes in brain states, induce arousal, and reset breathing variability. These behavioral roles homeostatically regulate breathing stability under physiological and pathological conditions. Sighs evoked in hypoxia evoke arousal and thereby become critical for survival. Hypoarousal and failure to sigh have been associated with sudden infant death syndrome. Increased breathing irregularity may provoke excessive sighing and hyperarousal, a behavioral sequence that may play a role in panic disorders. Essential for generating sighs and breathing is the pre-Bötzinger complex. Modulatory and synaptic interactions within this local network and between networks located in the brainstem, cerebellum, cortex, hypothalamus, amygdala, and the periaqueductal gray may govern the relationships between physiology, psychology, and pathology. Unraveling these circuits will lead to a better understanding of how we balance emotions and how emotions become pathological.

Correlation between blood pressure changes and AMS, sleeping quality and exercise upon high-altitude exposure in young Chinese men

BACKGROUND

Excessive elevation of arterial blood pressure (BP) at high altitude can be detrimental to our health due to acute mountain sickness (AMS) or some AMS symptoms. This prospective and observational study aimed to elucidate blood pressure changes induced by exposure to high-altitude hypoxia and the relationships of these changes with AMS prevalence, AMS severity, sleep quality and exercise condition in healthy young men.

METHODS

A prospective observational study was performed in 931 male young adults exposed to high altitude at 3,700 m (Lhasa) from low altitude (LA, 500 m). Blood pressure measurement and AMS symptom questionnaires were performed at LA and on day 1, 3, 5, and 7 of exposure to high altitude. Lake Louise criteria were used to diagnose AMS. Likewise, the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS) were filled out at LA and on day 1, 3, and 7 of exposure to high altitude.

RESULTS

After acute exposure to 3,700 m, diastolic blood pressure (DBP) and mean arterial blood pressure (MABP) rose gradually and continually (P < 0.05). Analysis showed a relationship with AMS for only MABP (P < 0.05) but not for SBP and DBP (P > 0.05). Poor sleeping quality was generally associated with higher SBP or DBP at high altitude, although inconsistent results were obtained at different time (P < 0.05). SBP and Pulse BP increased noticeably after high-altitude exercise (P < 0.05).

CONCLUSIONS

Our data demonstrate notable blood pressure changes under exposure to different high-altitude conditions: 1) BP increased over time. 2) Higher BP generally accompanied poor sleeping quality and higher incidence of AMS. 3) SBP and Pulse BP were higher after high-altitude exercise. Therefore, we should put more effort into monitoring BP after exposure to high altitude in order to guard against excessive increases in BP.

High altitude medicine in China in the 21st century: opportunities and challenges

China has the largest plateau, Qinghai-Tibet Plateau, where inhabited the most high altitude populations. Moreover, millions of people from plain areas come to the plateau for travel and work purposes and the number of the newcomers has been increasing every year. The hypoxic environment of plateau raised a series of related health issues in the new immigrants, so have created a special medical discipline - High Altitude Medicine. Over the past decades, researches on high altitude medicine have never being ceased in China, and lots of research findings have been reported. Application and practice of these achievements have greatly decreased the mobility and mortality of high-altitude diseases, however, there remained lots of questions to be elucidated. In view of this, the authors were granted a special project from the National Health and Family Planning Commission of China, and conducted a multi-center, prospective, on-scene high altitude medicine study for the acute mountain sickness. Some innovative findings were achieved, and the parameters for diagnosis and application conditions were proposed. Furthermore, the different diagnoses and treatment effects were compared, and a more standardized, reasonable scheme was drawn up. Regarding the unbalanced medical resources in the vast high altitude area, an application system for the public and the army has been established. In the 21st century, innovations in China and novel research approaches have provided great opportunities for the development of high altitude medicine. It is believed that the researchers in China are able to catch the opportunities and address the challenges.