Polygraphy of Sleep at Altitudes Between 5300m and 7500m During an Expedition to Mt. Everest (MedEx 2006)

Complex Visceral Coupling During Central Sleep Apnea in Cats

Central sleep apnea is a sudden arrest of breathing during sleep caused by the central commands to the thoracoabdominal muscles. It is a widespread phenomenon in both healthy and diseased people, as well as in some animals. However, there is an ongoing debate whether it can be considered as a pathological deviation of the respiratory function or an adaptive mechanism of an unclear function. We performed chronic recordings from six behaving cats over multiple sleep/wake cycles, which included electroencephalogram, ECG, eye movements, air flow, and thoracic respiratory muscle movements, and in four cats combined that with the registration of myoelectric activity of the stomach and the duodenum. In these experiments, we observed frequent central cessations of breathing (for 5-13 s) during sleep. Each of the sleep apnea episodes was accompanied by a stereotypical complex of somatic and visceral effects. The heart rate increased 3-5 s before the respiration arrest and strongly decreased during the absence of respiration. The myoelectric activity of the stomach and the duodenum also often demonstrated a strong suppression during the apnea episodes. The general composition of the visceral effects was stable during all periods of observation (up to 3 years in one cat). We hypothesize that the stereotypic coupling of activities in various visceral systems during episodes of central sleep apnea most likely reflects a complex adaptive behavior rather than an isolated respiratory pathology and discuss the probable function of this phenomenon.

Neurology and altitude illness

Problems at altitude are most often thought of in trained athletes summiting extremes of elevation. A more common group that needs consideration is the average person with obstructive sleep apnea who must travel to high altitudes for business or pleasure. While the altitudes involved are not likely to be as extreme as for those athletes climbing peaks like Mt. Everest, the increases in elevation may present difficulties for patients, especially if overnight stay is expected. The pathophysiology of altitude-related CNS, respiratory, and sleep disorders is discussed along with treatment options.

Lung disease at high altitude

Large numbers of people travel to high altitudes, entering an environment of hypobaric hypoxia. Exposure to low oxygen tension leads to a series of important physiologic responses that allow individuals to tolerate these hypoxic conditions. However, in some cases hypoxia triggers maladaptive responses that lead to various forms of acute and chronic high altitude illness, such as high-altitude pulmonary edema or chronic mountain sickness. Because the respiratory system plays a critical role in these adaptive and maladaptive responses, patients with underlying lung disease may be at increased risk for complications in this environment and warrant careful evaluation before any planned sojourn to higher altitudes. In this review, we describe respiratory disorders that occur with both acute and chronic exposures to high altitudes. These disorders may occur in any individual who ascends to high altitude, regardless of his/her baseline pulmonary status. We then consider the safety of high-altitude travel in patients with various forms of underlying lung disease. The available data regarding how these patients fare in hypoxic conditions are reviewed, and recommendations are provided for management prior to and during the planned sojourn.