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Yuan M, Hu X, Xing W, Wu X, Pu C, Guo W, Zhu X, Yao M, Ao L, Li Z, Xu X. B2M is a Biomarker Associated With Immune Infiltration In High Altitude Pulmonary Edema. Comb Chem High Throughput Screen 2024; 27:168-185. [PMID: 37165489 PMCID: PMC10804239 DOI: 10.2174/1386207326666230510095840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND High altitude pulmonary edema (HAPE) is a serious mountain sickness with certain mortality. Its early diagnosis is very important. However, the mechanism of its onset and progression is still controversial. AIM This study aimed to analyze the HAPE occurrence and development mechanism and search for prospective biomarkers in peripheral blood. METHODS The difference genes (DEGs) of the Control group and the HAPE group were enriched by gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, and then GSEA analysis was performed. After identifying the immune-related hub genes, QPCR was used to verify and analyze the hub gene function and diagnostic value with single-gene GSEA and ROC curves, and the drugs that acted on the hub gene was found in the CTD database. Immune infiltration and its association with the hub genes were analyzed using CIBERSORT. Finally, WGCNA was employed to investigate immune invasion cells' significantly related gene modules, following enrichment analysis of their GO and KEGG. RESULTS The dataset enrichment analysis, immune invasion analysis and WGCNA analysis showed that the occurrence and early progression of HAPE were unrelated to inflammation. The hub genes associated with immunity obtained with MCODE algorithm of Cytoscape were JAK2 and B2M.. RT-qPCR and ROC curves confirmed that the hub gene B2M was a specific biomarker of HAPE and had diagnostic value, and single-gene GSEA analysis confirmed that it participated in MHC I molecule-mediated antigen presentation ability decreased, resulting in reduced immunity. CONCLUSION Occurrence and early progression of high altitude pulmonary edema may not be related to inflammation. B2M may be a new clinical potential biomarker for HAPE for early diagnosis and therapeutic evaluation as well as therapeutic targets, and its decrease may be related to reduced immunity due to reduced ability of MCH I to participate in antigen submission.
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Affiliation(s)
- Mu Yuan
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Xueting Hu
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Wei Xing
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Xiaofeng Wu
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Chengxiu Pu
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Wei Guo
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Xiyan Zhu
- Department of Military Traffic Injury Prevention and Treatment, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Mengwei Yao
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Luoquan Ao
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Zhan Li
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
| | - Xiang Xu
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
- Central Laboratory, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, 400010, Chongqing, China
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谭 璐, 唐 向. [Sleep-Disordered Breathing at High Altitude: Its Characteristics and Research Progress in Treatment]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:246-251. [PMID: 36949680 PMCID: PMC10409183 DOI: 10.12182/20230360506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Indexed: 03/24/2023]
Abstract
Hypobaric hypoxia in regions of high altitude may increase the risk of having sleep-disordered breathing (SDB). SDB at high altitude mainly refers to the SDB incurred in highlanders and lowlanders at a high altitude. At present, research on SDB at high altitude is mainly focused on these two groups of people. On the one hand, highlanders have SDB at a higher prevalence and greater severity than lowlanders do and highlanders have a prolonged duration of apnea when they travel to low-altitude regions. On the other hand, the severity of SDB increased in lowlanders when they travel to high altitude, represented mainly by an increase in central and hypopnea events. In terms of treatment, a substantial number of studies have shown that medication, including acetazolamide and dexamethasone, and nocturnal oxygen supplementation could improve SDB in lowlanders when they travel to high altitude. However, not much research has been done on the treatment of SDB in highlanders and it has only been reported that nocturnal oxygen supplementation was an available treatment option. Herein, we summarized the latest research findings on SDB at high altitude, providing the basis for further studies about the characteristics and treatments for highlanders with SDB.
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Affiliation(s)
- 璐 谭
- 四川大学华西医院 睡眠医学中心 (成都 610041)Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 向东 唐
- 四川大学华西医院 睡眠医学中心 (成都 610041)Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Wang L, Xiao R, Chen J, Zhu L, Shi D, Wang J. A slow feature based LSTM network for susceptibility assessment of acute mountain sickness with heterogeneous data. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Furian M, Bitos K, Hartmann SE, Muralt L, Lichtblau M, Bader PR, Rawling JM, Ulrich S, Poulin MJ, Bloch KE. Acute high altitude exposure, acclimatization and re-exposure on nocturnal breathing. Front Physiol 2022; 13:965021. [PMID: 36134332 PMCID: PMC9483161 DOI: 10.3389/fphys.2022.965021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Effects of prolonged and repeated high-altitude exposure on oxygenation and control of breathing remain uncertain. We hypothesized that prolonged and repeated high-altitude exposure will improve altitude-induced deoxygenation and breathing instability. Methods: 21 healthy lowlanders, aged 18-30y, underwent two 7-day sojourns at a high-altitude station in Chile (4–8 hrs/day at 5,050 m, nights at 2,900 m), separated by a 1-week recovery period at 520 m. Respiratory sleep studies recording mean nocturnal pulse oximetry (SpO2), oxygen desaturation index (ODI, >3% dips in SpO2), breathing patterns and subjective sleep quality by visual analog scale (SQ-VAS, 0–100% with increasing quality), were evaluated at 520 m and during nights 1 and 6 at 2,900 m in the 1st and 2nd altitude sojourn. Results: At 520 m, mean ± SD nocturnal SpO2 was 94 ± 1%, ODI 2.2 ± 1.2/h, SQ-VAS 59 ± 20%. Corresponding values at 2,900 m, 1st sojourn, night 1 were: SpO2 86 ± 2%, ODI 23.4 ± 22.8/h, SQ-VAS 39 ± 23%; 1st sojourn, night 6: SpO2 90 ± 1%, ODI 7.3 ± 4.4/h, SQ-VAS 55 ± 20% (p < 0.05, all differences within corresponding variables). Mean differences (Δ, 95%CI) in acute effects (2,900 m, night 1, vs 520 m) between 2nd vs 1st altitude sojourn were: ΔSpO2 0% (-1 to 1), ΔODI -9.2/h (-18.0 to -0.5), ΔSQ-VAS 10% (-6 to 27); differences in acclimatization (changes night 6 vs 1), between 2nd vs 1st sojourn at 2,900 m were: ΔSpO2 -1% (-2 to 0), ΔODI 11.1/h (2.5 to 19.7), ΔSQ-VAS -15% (-31 to 1). Conclusion: Acute high-altitude exposure induced nocturnal hypoxemia, cyclic deoxygenations and impaired sleep quality. Acclimatization mitigated these effects. After recovery at 520 m, repeated exposure diminished high-altitude-induced deoxygenation and breathing instability, suggesting some retention of adaptation induced by the first altitude sojourn while subjective sleep quality remained similarly impaired.
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Affiliation(s)
- Michael Furian
- University Hospital Zurich, Department of Respiratory Medicine, Zurich, Switzerland
| | - Konstantinos Bitos
- University Hospital Zurich, Department of Respiratory Medicine, Zurich, Switzerland
| | - Sara E. Hartmann
- University of Calgary, Cumming School of Medicine, Department of Physiology and Pharmacology and Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Lara Muralt
- University Hospital Zurich, Department of Respiratory Medicine, Zurich, Switzerland
| | - Mona Lichtblau
- University Hospital Zurich, Department of Respiratory Medicine, Zurich, Switzerland
| | - Patrick R. Bader
- University Hospital Zurich, Department of Respiratory Medicine, Zurich, Switzerland
| | - Jean M. Rawling
- University of Calgary, Cumming School of Medicine, Department of Family Medicine, Calgary, AB, Canada
| | - Silvia Ulrich
- University Hospital Zurich, Department of Respiratory Medicine, Zurich, Switzerland
| | - Marc J. Poulin
- University of Calgary, Cumming School of Medicine, Department of Physiology and Pharmacology and Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Konrad E. Bloch
- University Hospital Zurich, Department of Respiratory Medicine, Zurich, Switzerland
- *Correspondence: Konrad E. Bloch,
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Li T, Tan L, Furian M, Zhang Y, Luo L, Lei F, Xue X, He J, Tang X. Sex-Specific Difference in the Effect of Altitude on Sleep and Nocturnal Breathing in Young Healthy Volunteers. J Clin Med 2022; 11:jcm11102869. [PMID: 35628996 PMCID: PMC9143383 DOI: 10.3390/jcm11102869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023] Open
Abstract
Importance: To date, there is no established evidence of sex-specific differences in altitude-induced sleep-disordered breathing (SDB) during polysomnography-confirmed sleep. Objective: The aim of this study was to investigate whether differences in sex play a pivotal role in incidences of SDB and acute mountain sickness (AMS) when staying overnight at high altitude. Design: This was a prospective cohort study. Setting: Participants underwent overnight polysomnography (PSG) and clinical assessment in a sleep laboratory at 500 m and two consecutive days at 3270 m. Participants: The participants comprised 28 (18 women) healthy, young, low-altitude residents with a median (interquartile range) age of 26.0 (25.0, 28.0) years. Exposures: Altitude exposure. Main outcomes and Measures: The primary outcome was altitude-induced change in the PSG-confirmed apnea−hypopnea index (AHI) at 3270 m compared to 500 m between men and women. Secondary outcomes included sex differences in other parameters related to SDB, sleep structure, AMS, psychomotor vigilance test reaction time and parameters from arterial and venous blood analyses. Results: The median (interquartile range) AHIs at 500 m and 3270 m on night 1 and on night 2 were 6.5/h (3.6, 9.1), 23.7/h (16.2, 42.5) and 15.2/h (11.8, 20.9) in men, respectively, and 2.2/h (1.0, 5.5), 8.0/h (5.3, 17.0) and 7.1/h (4.9, 11.5) in women, respectively (p < 0.05 nights 1 and 2 at 3270 m vs. 500 m in men and women). The median difference (95% CI) of altitude-induced change in AHI (3270 m night 1 compared to 500 m) between men and women was 11.2/h (1.9 to 19.6) (p < 0.05). Over the time course of 2 days at 3270 m, 9 out of 18 (50%) women and 1 out of 10 (10%) men developed AMS (p < 0.05 women versus men). Conclusions and Relevance: This prospective cohort study showed that men were more susceptible to altitude-induced SDB but that they had a lower AMS incidence when staying for 2 days at 3270 m than women. These findings indicate that sex-related prevention and intervention strategies against SDB and AMS are highly warranted. Trial Registration: This trial was registered at the Chinese Clinical Trial Registry; No. ChiCTR1800020155.
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Affiliation(s)
- Taomei Li
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Lu Tan
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Michael Furian
- Sleep Disorders Center, Department of Respiratory Medicine, University Hospital of Zurich, 8091 Zurich, Switzerland;
| | - Yanyan Zhang
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Lian Luo
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Fei Lei
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Xiaofang Xue
- Department of Cardiology, Diqing Tibetan Autonomous Prefectural People’s Hospital, Shangri-La 674400, China; (X.X.); (J.H.)
| | - Jiaming He
- Department of Cardiology, Diqing Tibetan Autonomous Prefectural People’s Hospital, Shangri-La 674400, China; (X.X.); (J.H.)
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
- Correspondence: ; Tel.: +86-28-85422733; Fax: +86-28-85422632
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Tenorio-Lopes L, Kinkead R. Sex-Specific Effects of Stress on Respiratory Control: Plasticity, Adaptation, and Dysfunction. Compr Physiol 2021; 11:2097-2134. [PMID: 34107062 DOI: 10.1002/cphy.c200022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As our understanding of respiratory control evolves, we appreciate how the basic neurobiological principles of plasticity discovered in other systems shape the development and function of the respiratory control system. While breathing is a robust homeostatic function, there is growing evidence that stress disrupts respiratory control in ways that predispose to disease. Neonatal stress (in the form of maternal separation) affects "classical" respiratory control structures such as the peripheral O2 sensors (carotid bodies) and the medulla (e.g., nucleus of the solitary tract). Furthermore, early life stress disrupts the paraventricular nucleus of the hypothalamus (PVH), a structure that has emerged as a primary determinant of the intensity of the ventilatory response to hypoxia. Although underestimated, the PVH's influence on respiratory function is a logical extension of the hypothalamic control of metabolic demand and supply. In this article, we review the functional and anatomical links between the stress neuroendocrine axis and the medullary network regulating breathing. We then present the persistent and sex-specific effects of neonatal stress on respiratory control in adult rats. The similarities between the respiratory phenotype of stressed rats and clinical manifestations of respiratory control disorders such as sleep-disordered breathing and panic attacks are remarkable. These observations are in line with the scientific consensus that the origins of adult disease are often found among developmental and biological disruptions occurring during early life. These observations bring a different perspective on the structural hierarchy of respiratory homeostasis and point to new directions in our understanding of the etiology of respiratory control disorders. © 2021 American Physiological Society. Compr Physiol 11:1-38, 2021.
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Affiliation(s)
- Luana Tenorio-Lopes
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, The University of Calgary, Calgary, Alberta, Canada
| | - Richard Kinkead
- Département de Pédiatrie, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
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Swenson ER. Early hours in the development of high-altitude pulmonary edema: time course and mechanisms. J Appl Physiol (1985) 2020; 128:1539-1546. [PMID: 32213112 DOI: 10.1152/japplphysiol.00824.2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Clinically evident high-altitude pulmonary edema (HAPE) is characterized by severe cyanosis, dyspnea, cough, and difficulty with physical exertion. This usually occurs within 1-2 days of ascent often with the additional stresses of any exercise and hypoventilation of sleep. The earliest events in evolving HAPE progress through clinically silent and then minimally recognized problems. The most important of these events involves an exaggerated elevation of pulmonary artery (PA) pressure in response to the ambient hypoxia. Hypoxic pulmonary vasoconstriction (HPV) is a rapid response with several phases. The first phase in both resistance arterioles and venules occurs within 5-10 min. This is followed by a second phase that further raises PA pressure by another 100% over the next 2-8 h. Combined with vasoconstriction and likely an unevenness in the regional strength of HPV, pressures in some microvascular regions with lesser arterial constriction rise to a level that initiates greater filtration of fluid into the interstitium. As pressures continue to rise local lymphatic clearance rates are exceeded and interstitial fluid begins to accumulate. Beyond elevation of transmural pressure gradients there is a dynamic noninjurious relaxation of microvascular and epithelial cell-cell contacts and an increase in transcellular vesicular transport which accelerate leakage. At some point with further pressure elevation, damage occurs with breaks of the barrier and bleeding into the alveolar space, a late-stage situation termed capillary stress failure. Earlier before there is fluid accumulation, alveolar hypoxia and hyperventilation-induced hypocapnia reduce the capacity of the alveolar epithelium to reabsorb sodium and water back into the interstitial space. More modest ascent which slows the rate of rise in PA pressure and allows for adaptive remodeling of the microvasculature, drugs which lower PA pressure, and those that can enhance fluid reabsorption will all forestall the deleterious early rise of microvascular pressures and diminished active alveolar fluid reabsorption that precede and underlie the development of HAPE.
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Affiliation(s)
- Erik R Swenson
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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Furian M, Lichtblau M, Aeschbacher SS, Estebesova B, Emilov B, Sheraliev U, Marazhapov NH, Mademilov M, Osmonov B, Bisang M, Ulrich S, Latshang TD, Ulrich S, Sooronbaev TM, Bloch KE. Effect of Dexamethasone on Nocturnal Oxygenation in Lowlanders With Chronic Obstructive Pulmonary Disease Traveling to 3100 Meters: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e190067. [PMID: 30794302 PMCID: PMC6484579 DOI: 10.1001/jamanetworkopen.2019.0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE During mountain travel, patients with chronic obstructive pulmonary disease (COPD) are at risk of experiencing severe hypoxemia, in particular, during sleep. OBJECTIVE To evaluate whether preventive dexamethasone treatment improves nocturnal oxygenation in lowlanders with COPD at 3100 m. DESIGN, SETTING, AND PARTICIPANTS A randomized, placebo-controlled, double-blind, parallel trial was performed from May 1 to August 31, 2015, in 118 patients with COPD (forced expiratory volume in the first second of expiration [FEV1] >50% predicted, pulse oximetry at 760 m ≥92%) who were living at altitudes below 800 m. The study was conducted at a university hospital (760 m) and high-altitude clinic (3100 m) in Tuja-Ashu, Kyrgyz Republic. Patients underwent baseline evaluation at 760 m, were taken by bus to the clinic at 3100 m, and remained at the clinic for 2 days and nights. Participants were randomized 1:1 to receive either dexamethasone, 4 mg, orally twice daily or placebo starting 24 hours before ascent and while staying at 3100 m. Data analysis was performed from September 1, 2015, to December 31, 2016. INTERVENTIONS Dexamethasone, 4 mg, orally twice daily (dexamethasone total daily dose, 8 mg) or placebo starting 24 hours before ascent and while staying at 3100 m. MAIN OUTCOMES AND MEASURES Difference in altitude-induced change in nocturnal mean oxygen saturation measured by pulse oximetry (Spo2) during night 1 at 3100 m between patients receiving dexamethasone and those receiving placebo was the primary outcome and was analyzed according to the intention-to-treat principle. Other outcomes were apnea/hypopnea index (AHI) (mean number of apneas/hypopneas per hour of time in bed), subjective sleep quality measured by a visual analog scale (range, 0 [extremely bad] to 100 [excellent]), and clinical evaluations. RESULTS Among the 118 patients included, 18 (15.3%) were women; the median (interquartile range [IQR]) age was 58 (52-63) years; and FEV1 was 91% predicted (IQR, 73%-103%). In 58 patients receiving placebo, median nocturnal Spo2 at 760 m was 92% (IQR, 91%-93%) and AHI was 20.5 events/h (IQR, 12.3-48.1); during night 1 at 3100 m, Spo2 was 84% (IQR, 83%-85%) and AHI was 39.4 events/h (IQR, 19.3-66.2) (P < .001 both comparisons vs 760 m). In 60 patients receiving dexamethasone, Spo2 at 760 m was 92% (IQR, 91%-93%) and AHI was 25.9 events/h (IQR, 16.3-37.1); during night 1 at 3100 m, Spo2 was 86% (IQR, 84%-88%) (P < .001 vs 760 m) and AHI was 24.7 events/h (IQR, 13.2-33.7) (P = .99 vs 760 m). Altitude-induced decreases in Spo2 during night 1 were mitigated by dexamethasone vs placebo by a mean of 3% (95% CI, 2%-3%), and increases in AHI were reduced by 18.7 events/h (95% CI, 12.0-25.3). Similar effects were observed during night 2. Subjective sleep quality was improved with dexamethasone during night 2 by 12% (95% CI, 0%-23%). Sixteen (27.6%) patients using dexamethasone had asymptomatic hyperglycemia. CONCLUSIONS AND RELEVANCE In lowlanders in Central Asia with COPD traveling to a high altitude, preventive dexamethasone treatment improved nocturnal oxygen saturation, sleep apnea, and subjective sleep quality. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02450994.
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Affiliation(s)
- Michael Furian
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Bermet Estebesova
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Berik Emilov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Ulan Sheraliev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Nuriddin H. Marazhapov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Maamed Mademilov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Batyr Osmonov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Maya Bisang
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Stefanie Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Tsogyal D. Latshang
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Talant M. Sooronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Konrad E. Bloch
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
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Horiuchi M, Endo J, Handa Y, Nose H. Barometric pressure change and heart rate response during sleeping at ~ 3000 m altitude. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:909-912. [PMID: 29282538 DOI: 10.1007/s00484-017-1487-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/27/2017] [Accepted: 10/01/2017] [Indexed: 05/05/2023]
Abstract
We investigated effects of change in barometric pressure (P B) with climate change on heart rate (HR) during sleep at 3000 m altitude. Nineteen healthy adults (15 males and four females; mean age 32 years) participated in this study. We measured P B (barometry) and HR (electrocardiography) every minute during their overnight stay in a mountain lodge at ~ 3000 m. We also measured resting arterial oxygen saturation (SpO2) and evaluated symptoms of acute mountain sickness (AMS) by using the Lake Louise Questionnaire at 2305 and 3000 m, respectively. P B gradually decreased during the night at the speed of approximately - 0.5 hPa/h. We found that HR during sleep decreased linearly as P B decreased in all subjects, with significance (r = 0.492-0.893; all, P < 0.001). Moreover, cross correlation analysis revealed that HR started to decrease after ~ 15 min following the decrease in P B, on average. SpO2 was 93.8 ± 1.7% at 2305 m before climbing, then decreased significantly to 90.2 ± 2.2% at the lodge before going to bed, and further decreased to 87.5 ± 2.7% after waking (all, P < 0.05). Four of the 19 subjects showed a symptom of AMS after waking (21%). Further, the decrease in HR in response to a given decrease in P B (ΔHR/ΔPB) was negatively related with a decrease in SpO2 from before going to bed to after waking at 3000 m (r = - 0.579, P = 0.009) and with total AMS scores after waking (r = 0.489, P = 0.033).
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Affiliation(s)
- Masahiro Horiuchi
- Division of Human Environmental Science, Mt Fuji Research Institute, Kamiyoshida, Fujiyoshida, 403-0005, Japan.
| | - Junko Endo
- Division of Human Environmental Science, Mt Fuji Research Institute, Kamiyoshida, Fujiyoshida, 403-0005, Japan
| | - Yoko Handa
- Division of Human Environmental Science, Mt Fuji Research Institute, Kamiyoshida, Fujiyoshida, 403-0005, Japan
| | - Hiroshi Nose
- Department of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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10
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In Reply to Drs Sikri and Bhattachar. Wilderness Environ Med 2018; 29:278-279. [PMID: 29653783 DOI: 10.1016/j.wem.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 11/22/2022]
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11
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Horiuchi M, Oda S, Uno T, Endo J, Handa Y, Fukuoka Y. Effects of Short-Term Acclimatization at the Summit of Mt. Fuji (3776 m) on Sleep Efficacy, Cardiovascular Responses, and Ventilatory Responses. High Alt Med Biol 2017; 18:171-178. [PMID: 28375664 DOI: 10.1089/ham.2016.0162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Horiuchi, Masahiro, Shiro Oda, Tadashi Uno, Junko Endo, Yoko Handa, and Yoshiyuki Fukuoka. Effects of short-term acclimatization at the summit of Mt. Fuji (3776 m) on sleep efficacy, cardiovascular responses, and ventilatory responses. High Alt Med Biol. 18:171-178, 2017.-We investigated the effects of a short period of acclimatization, at 3776 m on Mt. Fuji, on sleep parameters and related physiological responses. Physiological responses were assessed in seven healthy lowlander men during both daytime and sleep while at sea level (SL), as well as for three consecutive nights at high altitude (HA; 3776 m, day 1 [D1], D2, D3, and morning only of D4). Blood pressure variables, heart rate (HR), pulmonary ventilation (VE), and breathing frequency (Bf) progressively increased each day, with significant differences between SL and HA (p < 0.05, respectively). In contrast, end-tidal PCO2 (PETCO2) progressively decreased each day with statistical differences between SL and D3 at HA (p < 0.05). During sleep at HA, mean arterial pressure (MAP) was stable, whereas it decreased during sleep at SL. Sleep efficacy, which was assessed by actigraphy, was linearly impaired with statistical differences between SL and D3 (p < 0.05). These impairments in sleep efficacy at HA were associated with higher MAP and HR, as well as lower Bf and PETCO2 during the daytime (pooled data, p < 0.05, respectively). These results suggest that hypoxia-induced cardiovascular and ventilatory responses may be crucial contributors to changes in sleep efficacy at HA.
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Affiliation(s)
- Masahiro Horiuchi
- 1 Division of Human Environmental Science, Mt. Fuji Research Institute , Yamanashi, Japan
| | - Shiro Oda
- 2 Department of Health and Welfare, School of Life Long Sport, Hokusho University , Hokkaido, Japan
| | - Tadashi Uno
- 1 Division of Human Environmental Science, Mt. Fuji Research Institute , Yamanashi, Japan
| | - Junko Endo
- 1 Division of Human Environmental Science, Mt. Fuji Research Institute , Yamanashi, Japan
| | - Yoko Handa
- 1 Division of Human Environmental Science, Mt. Fuji Research Institute , Yamanashi, Japan
| | - Yoshiyuki Fukuoka
- 3 Faculty of Health and Sports Science, Doshisha University , Kyoto, Japan
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12
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Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, Buyse B, De Backer W, Eckert DJ, Grote L, Hagmeyer L, Hedner J, Jennum P, La Rovere MT, Miltz C, McNicholas WT, Montserrat J, Naughton M, Pepin JL, Pevernagie D, Sanner B, Testelmans D, Tonia T, Vrijsen B, Wijkstra P, Levy P. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J 2016; 49:13993003.00959-2016. [DOI: 10.1183/13993003.00959-2016] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/25/2016] [Indexed: 02/07/2023]
Abstract
The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a “marker” of disease severity or a “mediator” of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.
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13
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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0093-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Swenson ER. Pharmacology of acute mountain sickness: old drugs and newer thinking. J Appl Physiol (1985) 2015; 120:204-15. [PMID: 26294748 DOI: 10.1152/japplphysiol.00443.2015] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/12/2015] [Indexed: 01/09/2023] Open
Abstract
Pharmacotherapy in acute mountain sickness (AMS) for the past half century has largely rested on the use of carbonic anhydrase (CA) inhibitors, such as acetazolamide, and corticosteroids, such as dexamethasone. The benefits of CA inhibitors are thought to arise from their known ventilatory stimulation and resultant greater arterial oxygenation from inhibition of renal CA and generation of a mild metabolic acidosis. The benefits of corticosteroids include their broad-based anti-inflammatory and anti-edemagenic effects. What has emerged from more recent work is the strong likelihood that drugs in both classes act on other pathways and signaling beyond their classical actions to prevent and treat AMS. For the CA inhibitors, these include reduction in aquaporin-mediated transmembrane water transport, anti-oxidant actions, vasodilation, and anti-inflammatory effects. In the case of corticosteroids, these include protection against increases in vascular endothelial and blood-brain barrier permeability, suppression of inflammatory cytokines and reactive oxygen species production, and sympatholysis. The loci of action of both classes of drug include the brain, but may also involve the lung as revealed by benefits that arise with selective administration to the lungs by inhalation. Greater understanding of their pluripotent actions and sites of action in AMS may help guide development of better drugs with more selective action and fewer side effects.
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Affiliation(s)
- Erik R Swenson
- Veterans Affairs Puget Sound Health Care System, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle
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15
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Bloch KE, Buenzli JC, Latshang TD, Ulrich S. Sleep at high altitude: guesses and facts. J Appl Physiol (1985) 2015; 119:1466-80. [PMID: 26229000 DOI: 10.1152/japplphysiol.00448.2015] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/13/2015] [Indexed: 11/22/2022] Open
Abstract
Lowlanders commonly report a poor sleep quality during the first few nights after arriving at high altitude. Polysomnographic studies reveal that reductions in slow wave sleep are the most consistent altitude-induced changes in sleep structure identified by visual scoring. Quantitative spectral analyses of the sleep electroencephalogram have confirmed an altitude-related reduction in the low-frequency power (0.8-4.6 Hz). Although some studies suggest an increase in arousals from sleep at high altitude, this is not a consistent finding. Whether sleep instability at high altitude is triggered by periodic breathing or vice versa is still uncertain. Overnight changes in slow wave-derived encephalographic measures of neuronal synchronization in healthy subjects were less pronounced at moderately high (2,590 m) compared with low altitude (490 m), and this was associated with a decline in sleep-related memory consolidation. Correspondingly, exacerbation of breathing and sleep disturbances experienced by lowlanders with obstructive sleep apnea during a stay at 2,590 m was associated with poor performance in driving simulator tests. These findings suggest that altitude-related alterations in sleep may adversely affect daytime performance. Despite recent advances in our understanding of sleep at altitude, further research is required to better establish the role of gender and age in alterations of sleep at different altitudes, to determine the influence of acclimatization and of altitude-related illness, and to uncover the characteristics of sleep in highlanders that may serve as a study paradigm of sleep in patients exposed to chronic hypoxia due to cardiorespiratory disease.
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Affiliation(s)
- Konrad E Bloch
- Sleep Disorders Center, Pulmonary Division, University Hospital of Zurich, Zurich; Switzerland; Zurich Center for Human Integrative Physiology, University of Zurich, Zurich, Switzerland; and Zurich Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - Jana C Buenzli
- Sleep Disorders Center, Pulmonary Division, University Hospital of Zurich, Zurich; Switzerland
| | - Tsogyal D Latshang
- Sleep Disorders Center, Pulmonary Division, University Hospital of Zurich, Zurich; Switzerland; Zurich Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Sleep Disorders Center, Pulmonary Division, University Hospital of Zurich, Zurich; Switzerland; Zurich Center for Human Integrative Physiology, University of Zurich, Zurich, Switzerland; and
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Abstract
Exposure to high altitude imposes significant strain on cardiopulmonary system and the brain. As a consequence, sojourners to high altitude frequently experience sleep disturbances, often reporting restless and sleepless nights. At altitudes above 3,000 meters (9,800 ft) almost all healthy subjects develop periodic breathing especially during NREM sleep. Sleep architecture gradually improves with increased NREM and REM sleep despite persistence of periodic breathing. The primary reason for periodic breathing at high altitude is a hypoxic-induced increase in chemoreceptor sensitivity to changes in PaCO2 – both above and below eupnea, leading to periods of apnea and hyperpnea. Acetazolamide improves sleep by reducing the periodic breathing through development of metabolic acidosis and induced hyperventilation decreasing the plant gain and widening the PCO2 reserve. This widening of the PCO2 reserve impedes development of central apneas during sleep. Benzodiazepines and GABA receptor antagonist such as zolpidem improve sleep without affecting breathing pattern or cognitive functions.
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Affiliation(s)
- Vahid Mohsenin
- Department of Pulmonary, Critical Care and Sleep Medicine Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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Abstract
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.
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Affiliation(s)
- Terry Rolan
- Department of Neurology, University of Missouri, Columbia
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Guan W, Ga Q, Li R, Bai ZZ, Wuren T, Wang J, Yang YZ, Li YH, Ge RL. Sleep disturbances in long-term immigrants with chronic mountain sickness: A comparison with healthy immigrants at high altitude. Respir Physiol Neurobiol 2015; 206:4-10. [DOI: 10.1016/j.resp.2014.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
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Zheng CR, Chen GZ, Yu J, Qin J, Song P, Bian SZ, Xu BD, Tang XG, Huang YT, Liang X, Yang J, Huang L. Inhaled budesonide and oral dexamethasone prevent acute mountain sickness. Am J Med 2014; 127:1001-1009.e2. [PMID: 24784698 DOI: 10.1016/j.amjmed.2014.04.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/07/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND This double-blind, randomized controlled trial aimed to investigate inhaled budesonide and oral dexamethasone compared with placebo for their prophylactic efficacy against acute mountain sickness after acute high-altitude exposure. METHODS There were 138 healthy young male lowland residents recruited and randomly assigned to receive inhaled budesonide (200 μg, twice a day [bid]), oral dexamethasone (4 mg, bid), or placebo (46 in each group). They traveled to 3900 m altitude from 400 m by car. Medication started 1 day before high-altitude exposure and continued until the third day of exposure. Primary outcome measure was the incidence of acute mountain sickness after exposure. RESULTS One hundred twenty-four subjects completed the study (42, 39, and 43 in the budesonide, dexamethasone, and placebo groups, respectively). Demographic characteristics were comparable among the 3 groups. After high-altitude exposure, significantly fewer participants in the budesonide (23.81%) and dexamethasone (30.77%) groups developed acute mountain sickness compared with participants receiving placebo (60.46%) (P = .0006 and P = .0071, respectively). Both the budesonide and dexamethasone groups had lower heart rate and higher pulse oxygen saturation (SpO2) than the placebo group at altitude. Only the budesonide group demonstrated less deterioration in forced vital capacity and sleep quality than the placebo group. Four subjects in the dexamethasone group reported adverse reactions. CONCLUSIONS Both inhaled budesonide (200 μg, bid) and oral dexamethasone (4 mg, bid) were effective for the prevention of acute mountain sickness, especially its severe form, compared with placebo. Budesonide caused fewer adverse reactions than dexamethasone.
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Affiliation(s)
- Cheng-Rong Zheng
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Guo-Zhu Chen
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China
| | - Jie Yu
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China
| | - Jun Qin
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China
| | - Pan Song
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Shi-Zhu Bian
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China
| | - Bai-Da Xu
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xu-Gang Tang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yong-Tao Huang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiao Liang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jie Yang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China; PLA Institute of Cardiovascular Disease, Chongqing, China.
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Latshang TD, Lo Cascio CM, Stöwhas AC, Grimm M, Stadelmann K, Tesler N, Achermann P, Huber R, Kohler M, Bloch KE. Are nocturnal breathing, sleep, and cognitive performance impaired at moderate altitude (1,630-2,590 m)? Sleep 2013; 36:1969-76. [PMID: 24293773 PMCID: PMC3825448 DOI: 10.5665/sleep.3242] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Newcomers at high altitude (> 3,000 m) experience periodic breathing, sleep disturbances, and impaired cognitive performance. Whether similar adverse effects occur at lower elevations is uncertain, although numerous lowlanders travel to moderate altitude for professional or recreational activities. We evaluated the hypothesis that nocturnal breathing, sleep, and cognitive performance of lowlanders are impaired at moderate altitude. DESIGN Randomized crossover trial. SETTING University hospital at 490 m, Swiss mountain villages at 1,630 m and 2,590 m. PARTICIPANTS Fifty-one healthy men, median (quartiles) age 24 y (20-28 y), living below 800 m. INTERVENTIONS Studies at Zurich (490 m) and during 4 consecutive days at 1,630 m and 2,590 m, respectively, 2 days each. The order of altitude exposure was randomized. Polysomnography, psychomotor vigilance tests (PVT), the number back test, several other tests of cognitive performance, and questionnaires were evaluated. MEASUREMENTS AND RESULTS The median (quartiles) apnea-hypopnea index at 490 m was 4.6/h (2.3; 7.9), values at 1,630 and 2,590 m, day 1 and 2, respectively, were 7.0/h (4.1; 12.6), 5.4/h (3.5; 10.5), 13.1/h (6.7; 32.1), and 8.0/h (4.4; 23.1); corresponding values of mean nocturnal oxygen saturation were 96% (95; 96), 94% (93; 95), 94% (93; 95), 90% (89; 91), 91% (90; 92), P < 0.05 versus 490 m, all instances. Slow wave sleep on the first night at 2,590 m was 21% (18; 25) versus 24% (20; 27) at 490 m (P < 0.05). Psychomotor vigilance and various other measures of cognitive performance did not change significantly. CONCLUSIONS Healthy men acutely exposed during 4 days to hypoxemia at 1,630 m and 2,590 m reveal a considerable amount of periodic breathing and sleep disturbances. However, no significant effects on psychomotor reaction speed or cognitive performance were observed. CLINICAL TRIALS REGISTRATION Clinicaltrials.gov: NCT01130948.
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Affiliation(s)
| | | | | | - Mirjam Grimm
- Sleep Disorders Center and Pulmonary Division, University Hospital Zurich
| | | | - Noemi Tesler
- Child Development Center, Children's University Hospital Zurich
| | - Peter Achermann
- Institute of Pharmacology and Toxicology, University of Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Reto Huber
- Child Development Center, Children's University Hospital Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Malcolm Kohler
- Sleep Disorders Center and Pulmonary Division, University Hospital Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Konrad E. Bloch
- Sleep Disorders Center and Pulmonary Division, University Hospital Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
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Ainslie PN, Lucas SJ, Burgess KR. Breathing and sleep at high altitude. Respir Physiol Neurobiol 2013; 188:233-56. [DOI: 10.1016/j.resp.2013.05.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 05/04/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
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Sightings edited by John W. Severinghaus. High Alt Med Biol 2013. [DOI: 10.1089/ham.2013.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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