Differential impact of acute hypoxia on event related potentials: impaired task-irrelevant, but preserved task-relevant processing and response inhibition

A protocol to simultaneously examine cardiorespiratory, cerebrovascular and neurophysiological responses inside a hypobaric chamber

We describe a protocol to examine neurophysiological (electroencephalography, EEG), cerebrovascular (ultrasound assessments of middle cerebral artery blood velocity, MCAv) and cardiorespiratory (blood pressure, oxygen saturation, end-tidal gases, respiratory rate) responses inside a hypobaric chamber. This procedure aims to standardize the methodology in experiments conducted within a hypobaric chamber such as comparing normobaric and hypobaric hypoxia. This is important because current understanding of relationships between neurophysiological activity, and cerebrovascular and cardiorespiratory responses under varying environmental conditions remains limited. This procedure combines simultaneous neurophysiological, cardiorespiratory and cerebrovascular evaluations, allowing a comprehensive understanding of electro-neurophysiological activity. Our protocol requires an hour and a half of equipment setup, 1-1.5 hours of participant set-up, and 30 minutes of experimental data collection. Since multiple simultaneous physiological recordings, including EEG in this environment, can be fraught with pitfalls, we also provide practical considerations for experimental design and recording setup. Advanced knowledge of hypobaric chamber operation is required, alongside expertise in EEG and transcranial Doppler ultrasonography. Following our procedure one will acquire simultaneous recordings of neurophysiological, cerebrovascular and cardiorespiratory data.

Effect of artificial gravity on neurocognitive performance during head-down tilt bedrest

This study evaluated the acute and chronic effects of intermittent and continuous Artificial Gravity (AG) on cognitive performance during 60 days of Head-down tilt bedrest (HDTBR), a well-established ground-based spaceflight analogue method. Participants were randomly assigned to three groups: intermittent AG, continuous AG, and HDTBR control group without AG exposure. Task performance and electrophysiological measures of attention and working memory were investigated during Simple and Complex tasks in the Visual and the Auditory modality. Compared to baseline, faster reaction time and better accuracy was present during HDTBR regarding the Complex tasks, however, the practice effect was diminished in the three HDTBR groups compared to an ambulatory control group. Brain potentials showed a modality-specific decrease, as P3a was decreased only in the Auditory, while P3b decreased in the Visual modality. No evidence for acute or chronic AG-related cognitive impairments during HDTBR was found.

A review of methods for assessment of cognitive function in high-altitude hypoxic environments

Hypoxic environments like those present at high altitudes may negatively affect brain function. Varying levels of hypoxia, whether acute or chronic, are previously shown to impair cognitive function in humans. Assessment and prevention of such cognitive impairment require detection of cognitive changes and impairment using specific cognitive function assessment tools. This paper summarizes the findings of previous research, outlines the methods for cognitive function assessment used at a high altitude, elaborates the need to develop standardized and systematic cognitive function assessment tools for high-altitude hypoxia environments.

Acute hypoxia alters visuospatial attention orienting: an electrical neuroimaging study

Our study investigated the effects of hypoxia on visuospatial attention processing during preparation for a single/double-choice motor response. ERPs were recorded in two sessions in which participants breathed either ambient-air or oxygen-impoverished air. During each session, participants performed four cue-target attention orienting and/or alerting tasks. Replicating the classic findings of valid visuospatial attentional orienting modulation, ERPs to pre-target cues elicited both an Anterior directing attention negativity (ADAN)/CNV and a posterior Late directing attention positivity (LDAP)/TP, which in ambient air were larger for attention orienting than for alerting. Hypoxia increased the amplitude of both these potentials in the spatial orienting conditions for the upper visual hemifield, while, for the lower hemifield, it increased ADAN/CNV, but decreased LDAP/TP for the same attention conditions. To these ERP changes corresponded compensatory enhanced activation of right anterior cingulate cortex, left superior parietal lobule and frontal gyrus, as well as detrimental effects of hypoxia on behavioral overt performance. Together, these findings reveal for the first time, to our knowledge, that (1) these reversed alterations of the activation patterns during the time between cue and target occur at a larger extent in hypoxia than in air, and (2) acute normobaric hypoxia alters visuospatial attention orienting shifting in space.

Neurodynamics of awareness detection in Tibetan immigrants: evidence from EEG analysis

The psychological effects of long-term exposure to high-altitude environments have attracted great attention. These effects are usually attributed to the diminished cognitive resources due to high-altitude exposure. This study employed electroencephalography (EEG) to investigate the effects of exposure duration on awareness detection tasks. Neither reaction time nor accuracy showed the direct effects of the exposure duration, so did the model indexes obtained from drift diffusion model analysis. However, event-related potentials (ERP) analysis revealed that exposure duration was associated with changes in the visual awareness negativity (VAN) and the late positivity (LP) components, which in turn affected reaction time. Specifically, longer exposure durations were associated with lower VAN and higher LP, resulting in shorter reaction times and greater drift rate. In contrast to previous studies, the reverse relationship between VAN and LP may reflect a compensatory response to the reduced cognitive resources caused by high-altitude exposure. Additionally, increased LP and shorter reaction times with exposure duration may reflect a resistance to the high-altitude environment. We also conducted time-frequency analysis and found that theta power did not vary with exposure duration, suggesting that the reduction in cognitive resources remains stable in these individuals over time. Overall, our study provides new insights into the dynamic effects of high-altitude environments on awareness detection in the presence of reduced cognitive resources.

Cognition and Neuropsychological Changes at Altitude-A Systematic Review of Literature

High-altitude (HA) exposure affects cognitive functions, but studies have found inconsistent results. The aim of this systematic review was to evaluate the effects of HA exposure on cognitive functions in healthy subjects. A structural overview of the applied neuropsychological tests was provided with a classification of superordinate cognitive domains. A literature search was performed using PubMed up to October 2021 according to PRISMA guidelines. Eligibility criteria included a healthy human cohort exposed to altitude in the field (at minimum 2440 m [8000 ft]) or in a hypoxic environment in a laboratory, and an assessment of cognitive domains. The literature search identified 52 studies (29 of these were field studies; altitude range: 2440 m-8848 m [8000-29,029 ft]). Researchers applied 112 different neuropsychological tests. Attentional capacity, concentration, and executive functions were the most frequently studied. In the laboratory, the ratio of altitude-induced impairments (64.7%) was twice as high compared to results showing no change or improved results (35.3%), but altitudes studied were similar in the chamber compared to field studies. In the field, the opposite results were found (66.4 % no change or improvements, 33.6% impairments). Since better acclimatization can be assumed in the field studies, the findings support the hypothesis that sufficient acclimatization has beneficial effects on cognitive functions at HA. However, it also becomes apparent that research in this area would benefit most if a consensus could be reached on a standardized framework of freely available neurocognitive tests.

Effects of Long-Term Exposure to 2260 m Altitude on Working Memory and Resting-State Activity in the Prefrontal Cortex: A Large-Sample Cross-Sectional Study

It has been well established that very-high-altitude (>4000 m) environments can affect human cognitive function and brain activity. However, the effects of long-term exposure to moderate altitudes (2000−3000 m) on cognitive function and brain activity are not well understood. In the present cross-sectional study, we utilized an N-back working memory task and resting-state functional near-infrared spectroscopy to examine the effects of two years of exposure to 2260 m altitude on working memory and resting-state brain activity in 208 college students, compared with a control group at the sea level. The results showed that there was no significant change in spatial working memory performance after two years of exposure to 2260 m altitude. In contrast, the analysis of resting-state brain activity revealed changes in functional connectivity patterns in the prefrontal cortex (PFC), with the global efficiency increased and the local efficiency decreased after two years of exposure to 2260 m altitude. These results suggest that long-term exposure to moderate altitudes has no observable effect on spatial working memory performance, while significant changes in functional connectivity and brain network properties could possibly occur to compensate for the effects of mild hypoxic environments. To our knowledge, this study is the first to examine the resting state activity in the PFC associated with working memory in people exposed to moderate altitudes.

Hypoxic Hypoxia and Brain Function in Military Aviation: Basic Physiology and Applied Perspectives

Acute hypobaric hypoxia (HH) is a major physiological threat during high-altitude flight and operations. In military aviation, although hypoxia-related fatalities are rare, incidences are common and are likely underreported. Hypoxia is a reduction in oxygen availability, which can impair brain function and performance of operational and safety-critical tasks. HH occurs at high altitude, due to the reduction in atmospheric oxygen pressure. This physiological state is also partially simulated in normobaric environments for training and research, by reducing the fraction of inspired oxygen to achieve comparable tissue oxygen saturation [normobaric hypoxia (NH)]. Hypoxia can occur in susceptible individuals below 10,000 ft (3,048 m) in unpressurised aircrafts and at higher altitudes in pressurised environments when life support systems malfunction or due to improper equipment use. Between 10,000 ft and 15,000 ft (4,572 m), brain function is mildly impaired and hypoxic symptoms are common, although both are often difficult to accurately quantify, which may partly be due to the effects of hypocapnia. Above 15,000 ft, brain function exponentially deteriorates with increasing altitude until loss of consciousness. The period of effective and safe performance of operational tasks following exposure to hypoxia is termed the time-of-useful-consciousness (TUC). Recovery of brain function following hypoxia may also lag beyond arterial reoxygenation and could be exacerbated by repeated hypoxic exposures or hyperoxic recovery. This review provides an overview of the basic physiology and implications of hypoxia for military aviation and discusses the utility of hypoxia recognition training.

Deficits in Visual Processing During Hypoxia as Evidenced by Visual Mismatch Negativity

INTRODUCTION: Hypoxia is an ever-present threat in tactical aviation and gained recent attention due to its putative role in physiological episodes. Previous work has demonstrated that hypoxia negatively impacts a variety of sensory, cognitive, and motor systems. In particular, the visual system is one of the earliest systems affected by hypoxia. While the majority of previous studies have relied on self-report and behavioral testing, the use of event-related potentials as a novel tool to monitor responses to low oxygen in humans has recently been investigated. Specifically, ERP components that are evoked passively in response to unattended changes in background sensory stimulation have been explored.METHOD: Subjects (N 28) completed a continuous visuomotor tracking task while EEG was recorded. During the tracking task, a series of standard color checkerboard patterns were presented in the periphery while occasionally a deviant color checkerboard was presented. The visual mismatch negativity (MMN) component was assessed in response to the deviant compared to the standard stimuli. Subjects completed two sessions in counterbalanced order that only differed by the oxygen concentration breathed (10.6% vs. 20.4%).RESULTS: Results demonstrated a significant reduction in the amplitude of the visual MMN under hypoxic compared to normoxic conditions, showing a 50% reduction in amplitude during hypoxia. Our results suggest that during low-oxygen exposure the ability to detect environmental changes and process sensory information is impaired.DISCUSSION: The visual MMN may represent an early and reliable predictor of sensory and cognitive deficits during hypoxia exposure, which may be of great use to the aviation community.Blacker KJ, Seech TR, Funke ME, Kinney MJ. Deficits in visual processing during hypoxia as evidenced by visual mismatch negativity. Aerosp Med Hum Perform. 2021; 92(5):326332.

Impaired Sensory Processing During Low-Oxygen Exposure: A Noninvasive Approach to Detecting Changes in Cognitive States

The ability to detect novelty in our environment is a critical sensory function. A reliable set of event-related potentials (ERP), known as the auditory deviance response (ADR), are elicited in the absence of directed attention and indexes functionally relevant networks. The ADR consists of three peaks: mismatch negativity (MMN), P3a, and reorienting negativity (RON) that are sequentially evoked in response to unattended changes in repetitive background stimulation. While previous studies have established the ADR's sensitivity to a range of pharmacologic and nonpharmacologic interventions and are leading candidate biomarkers of perturbations of the central nervous system (CNS), here we sought to determine if ADR peaks are sensitive to decreases in breathable oxygen. Participants performed a visuomotor tracking task while EEG was recorded during two 27-min sessions. The two sessions differed in the amount of environmental oxygen available: 10.6% O₂ (hypoxia) versus 20.4% O₂ (normoxia). ERPs were measured while a series of identical, or "standard," tones combined with occasional "oddball," tones, were presented. MMN, P3a, and RON were assessed in response to the oddball compared to the standard stimuli. Behavioral impairment during hypoxia was demonstrated by a deficit in tracking performance compared to the normoxia condition. Whereas no changes were detected in the MMN or RON, the amplitude of the P3a component was significantly reduced during hypoxia compared to normoxia, within the first 9 min of exposure. To our knowledge, this is the first study to demonstrate the effect of low oxygen exposure on passively elicited neural measures of early sensory processing. This study demonstrates that passively elicited EEG measures, reflecting preattentive auditory processing, are disrupted by acute hypoxia. Results have implications for the development of biomarkers for the noninvasive assessment of CNS perturbations.