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Shen Y, Yang YQ, Liu C, Yang J, Zhang JH, Jin J, Tan H, Yuan FZY, Ke JB, He CY, Zhang LP, Zhang C, Yu J, Huang L. Association between physiological responses after exercise at low altitude and acute mountain sickness upon ascent is sex-dependent. Mil Med Res 2020; 7:53. [PMID: 33148321 PMCID: PMC7643355 DOI: 10.1186/s40779-020-00283-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 10/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Acute mountain sickness (AMS) is the mildest form of acute altitude illnesses, and consists of non-specific symptoms when unacclimatized persons ascend to elevation of ≥2500 m. Risk factors of AMS include: the altitude, individual susceptibility, ascending rate and degree of pre-acclimatization. In the current study, we examined whether physiological response at low altitude could predict the development of AMS. METHODS A total of 111 healthy adult healthy volunteers participated in this trial; and 99 (67 men and 32 women) completed the entire study protocol. Subjects were asked to complete a 9-min exercise program using a mechanically braked bicycle ergometer at low altitude (500 m). Heart rate, blood pressure (BP) and pulse oxygen saturation (SpO2) were recorded prior to and during the last minute of exercise. The ascent from 500 m to 4100 m was completed in 2 days. AMS was defined as ≥3 points in a 4-item Lake Louise Score, with at least one point from headache wat 6-8 h after the ascent. RESULTS Among the 99 assessable subjects, 47 (23 men and 24 women) developed AMS at 4100 m. In comparison to the subjects without AMS, those who developed AMS had lower proportion of men (48.9% vs. 84.6%, P < 0.001), height (168.4 ± 5.9 vs. 171.3 ± 6.1 cm, P = 0.019), weight (62.0 ± 10.0 vs. 66.7 ± 8.6 kg, P = 0.014) and proportion of smokers (23.4% vs. 51.9%, P = 0.004). Multivariate regression analysis revealed the following independent risks for AMS: female sex (odds ratio (OR) =6.32, P < 0.001), SpO2 change upon exercise at low altitude (OR = 0.63, P = 0.002) and systolic BP change after the ascent (OR = 0.96, P = 0.029). Women had larger reduction in SpO2 after the ascent, higher AMS percentage and absolute AMS score. Larger reduction of SpO2 after exercise was associated with both AMS incidence (P = 0.001) and AMS score (P < 0.001) in men but not in women. CONCLUSIONS Larger SpO2 reduction after exercise at low altitude was an independent risk for AMS upon ascent. Such an association was more robust in men than in women. TRIAL REGISTRATION Chinese Clinical Trial Registration, ChiCTR1900025728 . Registered 6 September 2019.
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Affiliation(s)
- Yang Shen
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Yuan-Qi Yang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Chuan Liu
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Jie Yang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Ji-Hang Zhang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Jun Jin
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Hu Tan
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Fang-Zheng-Yuan Yuan
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Jing-Bin Ke
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Chun-Yan He
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Lai-Ping Zhang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Chen Zhang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Jie Yu
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China. .,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.
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Hüfner K, Sperner-Unterweger B, Brugger H. Going to Altitude with a Preexisting Psychiatric Condition. High Alt Med Biol 2019; 20:207-214. [PMID: 31343257 PMCID: PMC6763955 DOI: 10.1089/ham.2019.0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Katharina Hüfner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Clinic for Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Clinic for Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
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Gonggalanzi, Labasangzhu, Nafstad P, Stigum H, Wu T, Haldorsen ØD, Ommundsen K, Bjertness E. Acute mountain sickness among tourists visiting the high-altitude city of Lhasa at 3658 m above sea level: a cross-sectional study. ACTA ACUST UNITED AC 2016; 74:23. [PMID: 27252854 PMCID: PMC4888367 DOI: 10.1186/s13690-016-0134-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/17/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traveling to Tibet implies a risk for developing acute mountain sickness (AMS), and the size of this problem is likely increasing due to the rising number of tourists. No previous study on AMS has been conducted among the general tourist population in Tibet. Thus, the aim of this study was to estimate the prevalence and determinants of AMS in a large tourist population visiting Lhasa. METHODS A sample of 2385 tourists was recruited from seven randomly selected hotels in Lhasa between June and October 2010. Within three days of their first arrival, the participants filled in a questionnaire based on the Lake Louise Scoring System (LLSS) about AMS-related symptoms and potential contributing factors. AMS was defined as the presence of headache and a cumulative Lake Louise Score ≥4. After estimating the prevalence of AMS, a Log-Binomial Model was applied to analyse the relationship between AMS and selected risk factors. RESULTS The prevalence of AMS was 36.7 % (95 % CI: 34.6-38.7 %) and was not dependent on tourists' country of origin. Among the participants who developed AMS, 47.6 % reported that they experienced symptoms within the first 12 h after arriving in Lhasa, and 79.0 % reported that they had to reduce their activity level. A poor or average health condition (adjusted PR 1.63, 95 % CI 1.38-1.93), an age below 55 years (adjusted PR 1.29, 95 % CI 1.04-1.60), a rapid ascent to Lhasa (adjusted PR 1.17, 95 % CI 1.02-1.34) were independent AMS risk factors, while smoking (adjusted PR 0.75, 95 % CI 0.59-0.96) and pre-exposure to high altitude (adjusted PR 0.71, 95 % CI 0.60-0.84) reduced the risk of AMS. CONCLUSIONS AMS is commonly experienced by tourists visiting Lhasa Tibet, and often affects their activities. The tourists' country of origin did not seem to affect their risk of AMS, and their age was inversely related to AMS. Subjects planning to visit a high-altitude area should be prepared for experiencing AMS-related problems, and consider preventive measures such as pre-exposure or a gradual ascent to high altitudes.
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Affiliation(s)
- Gonggalanzi
- Institute of Health and Society, University of Oslo, P.O. Box 1130 Blindern, Oslo, 0318 Norway ; Tibet University Medical College, No. 1 South Luobulinka Road, Lhasa, 850002 Tibet China
| | - Labasangzhu
- Tibet University Medical College, No. 1 South Luobulinka Road, Lhasa, 850002 Tibet China
| | - Per Nafstad
- Institute of Health and Society, University of Oslo, P.O. Box 1130 Blindern, Oslo, 0318 Norway ; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Hein Stigum
- Institute of Health and Society, University of Oslo, P.O. Box 1130 Blindern, Oslo, 0318 Norway ; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Tianyi Wu
- National Key Laboratory of High-Altitude Medicine, Qinghai, China
| | - Øyvind Drejer Haldorsen
- Institute of Health and Society, University of Oslo, P.O. Box 1130 Blindern, Oslo, 0318 Norway
| | - Kristoffer Ommundsen
- Institute of Health and Society, University of Oslo, P.O. Box 1130 Blindern, Oslo, 0318 Norway
| | - Espen Bjertness
- Institute of Health and Society, University of Oslo, P.O. Box 1130 Blindern, Oslo, 0318 Norway
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Xu C, Lu HX, Wang YX, Chen Y, Yang SH, Luo YJ. Association between smoking and the risk of acute mountain sickness: a meta-analysis of observational studies. Mil Med Res 2016; 3:37. [PMID: 27980800 PMCID: PMC5146861 DOI: 10.1186/s40779-016-0108-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 11/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People rapidly ascending to high altitudes (>2500 m) may suffer from acute mountain sickness (AMS). The association between smoking and AMS risk remains unclear. Therefore, we performed a meta-analysis to evaluate the association between smoking and AMS risk. METHODS The association between smoking and AMS risk was determined according to predefined criteria established by our team. Meta-analysis was conducted according to the PRISMA guidelines. We included all relevant studies listed in the PubMed and Embase databases as of September 2015 in this meta-analysis and performed systemic searches using the terms "smoking", "acute mountain sickness" and "risk factor". The included studies were required to provide clear explanations regarding their definitions of smoking, the final altitudes reached by their participants and the diagnostic criteria used to diagnose AMS. Odds ratios (ORs) were used to evaluate the association between smoking and AMS risk across the studies, and the Q statistic was used to test OR heterogeneity, which was considered significant when P < 0.05. We also computed 95% confidence intervals (CIs). Data extracted from the articles were analyzed with Review Manager 5.3 (Cochrane Collaboration, Oxford, UK). RESULTS We used seven case-control studies including 694 smoking patients and 1986 non-smoking controls to analyze the association between smoking and AMS risk. We observed a significant association between AMS and smoking (OR = 0.71, 95% CI 0.52-0.96, P = 0.03). CONCLUSIONS We determined that smoking may protect against AMS development. However, we do not advise smoking to prevent AMS. More studies are necessary to confirm the role of smoking in AMS risk.
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Affiliation(s)
- Chen Xu
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Battalion 5 of Cadet Brigade, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
| | - Hong-Xiang Lu
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
| | - Yu-Xiao Wang
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
| | - Yu Chen
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
| | - Sheng-Hong Yang
- Mountain Sickness Research Institute, 18th Hospital of PLA, Yecheng, Xinjiang 844900 China
| | - Yong-Jun Luo
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
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Ma WH, Sheng L, Gong HP, Guo LL, Lu QH. The application of vWF/ADAMTS13 in essential hypertension. Int J Clin Exp Med 2014; 7:5636-42. [PMID: 25664083 PMCID: PMC4307530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/24/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Plasma von Willebrand factor (vWF), a key player in hemostasis and thrombosis, is released from endothelial cells during inflammation. Hypertension, a progressing in chronic inflammation and cardiovascular syndrome with various causes, results in functional and structural changes of heart and arterial vessels. However little information is available on LA changes during hypertension. Left atrial (LA) enlargement is associated with significant cardiovascular morbidity and mortality. The aim of this study was to explore the relationship between LA enlargement and thromboembolic risk in essential hypertensive patients with Af without any signs of clinical thrombotic disease or previous stroke. METHODS The relationship between Plasma vWF, ADAMTS13 and left atrial diameter (LAD), left atrial volume (LAV), left atrial volume index (LAVi) were evaluated in essential hypertensive group included 105 patients (55 patients with nonvalvular atrial fibrillation (AF) and 50 patients with normal sinus rhythm (NSR)). RESULTS The study demonstrated that vWF, vWF/ADAMT13, LAD, LAV and LAVi were increased significantly (P < 0.01) but ADAMTS13: Ag was decreased significantly (P < 0.01) in the hypertensive with AF group compared with NSR group. CONCLUSION vWF/ADAMTS13 were positively correlated with LAD, LAV and LAVi (P < 0.01). Increased vWF and vWF/ADAMTS13 is associated with LAD, LAV and LAVi in essential hypertension. The study suggests it played a positive role of vWF and vWF/ADAMTS13 in the progressing major adverse cardiovascular events (MACE) in essential hypertensive patients with LA enlargement.
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Affiliation(s)
- Wei-Hong Ma
- Department of Cardiology, The Second Hospital of Shandong University Jinan 250033, China
| | - Lin Sheng
- Department of Cardiology, The Second Hospital of Shandong University Jinan 250033, China
| | - Hui-Ping Gong
- Department of Cardiology, The Second Hospital of Shandong University Jinan 250033, China
| | - Lin-Lin Guo
- Department of Cardiology, The Second Hospital of Shandong University Jinan 250033, China
| | - Qing-Hua Lu
- Department of Cardiology, The Second Hospital of Shandong University Jinan 250033, China
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