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Grimm M, Seglias A, Ziegler L, Mademilov M, Isaeva E, Tynybekov K, Tilebalieva A, Osmonbaeva N, Furian M, Sooronbaev TM, Ulrich S, Bloch KE. Sleep apnea in school-age children living at high altitude. Pulmonology 2023; 29:385-391. [PMID: 36964122 DOI: 10.1016/j.pulmoe.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION Among adults, sleep apnea is more common in highlanders than in lowlanders. We evaluated the sleep apnea prevalence in children living at high altitude compared to age-matched low-altitude controls. METHODS Healthy children, 7-14 y of age, living at 2500-3800m in the Tien Shan mountains, Kyrgyzstan, were prospectively studied in a health post at 3250m. Healthy controls of similar age living at 700-800m were studied in a University Hospital at 760m in Bishkek. Assessments included respiratory sleep studies scored according to pediatric standards, clinical examination, medical history, and the pediatric sleep questionnaire (PSQ, range 0 to 1 with increasing symptoms). RESULTS In children living at high altitude (n = 37, 17 girls, median [quartiles] age 10.8y [9.6;13.0]), sleep studies revealed: mean nocturnal pulse oximetry 90% (89;91), oxygen desaturation index (ODI, >3% dips in pulse oximetry) 4.3/h (2.5;6.7), apnea/hypopnea index (AHI) total 1.7/h (1.0;3.6), central 1.6/h (1.0;3.3), PSQ 0.27 (0.18;0.45). In low-altitude controls (n=41, 17 girls, age 11.6y [9.5;13.0], between-groups comparison of age P=0.69) sleep studies revealed: pulse oximetry 97% (96;97), ODI 0.7/h (0.2;1.2), AHI total 0.4/h (0.1;1.0), central 0.3/h (0.1;0.7), PSQ 0.18 (0.14;0.31); P<0.05, all corresponding between-group comparisons. CONCLUSIONS In school-age children living at high altitude, nocturnal oxygen saturation was lower, and the total and central AHI were higher compared to children living at low altitude. The greater score of sleep symptoms in children residing at high altitude suggests a potential clinical relevance of the nocturnal hypoxemia and subtle sleep-related breathing disturbances.
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Affiliation(s)
- M Grimm
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - A Seglias
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - L Ziegler
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - M Mademilov
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - E Isaeva
- National Center of Maternity and Childhood Care, Bishkek, Kyrgyz Republic; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - K Tynybekov
- National Center of Maternity and Childhood Care, Bishkek, Kyrgyz Republic; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - A Tilebalieva
- National Center of Maternity and Childhood Care, Bishkek, Kyrgyz Republic; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - N Osmonbaeva
- National Center of Maternity and Childhood Care, Bishkek, Kyrgyz Republic; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - M Furian
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - T M Sooronbaev
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - S Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic
| | - K E Bloch
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland; Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyz Republic.
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Saxer S, Bader PR, Schneider SR, Mademilov M, Sheraliev U, Appenzeller P, Müller J, Sooronbaev TM, Bloch KE, Ulrich S, Lichtblau M. Corrigendum: Echocardiography and extravascular lung water during 3 weeks of exposure to high altitude in otherwise healthy asthmatics. Front Physiol 2023; 14:1280696. [PMID: 37711467 PMCID: PMC10499492 DOI: 10.3389/fphys.2023.1280696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/16/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fphys.2023.1214887.].
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Affiliation(s)
- S. Saxer
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
- Eastern University of Applied Sciences, St Gallen, Switzerland
| | - P. R. Bader
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - S. R. Schneider
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - M. Mademilov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - U. Sheraliev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - P. Appenzeller
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - J. Müller
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - T. M. Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - K. E. Bloch
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - S. Ulrich
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - M. Lichtblau
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
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Saxer S, Bader PR, Schneider SR, Mademilov M, Sheraliev U, Appenzeller P, Müller J, Sooronbaev TM, Bloch KE, Ulrich S, Lichtblau M. Echocardiography and extravascular lung water during 3 weeks of exposure to high altitude in otherwise healthy asthmatics. Front Physiol 2023; 14:1214887. [PMID: 37560159 PMCID: PMC10407397 DOI: 10.3389/fphys.2023.1214887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
Background: Asthma rehabilitation at high altitude is common. Little is known about the acute and subacute cardiopulmonary acclimatization to high altitude in middle-aged asthmatics without other comorbidities. Methods: In this prospective study in lowlander subjects with mostly mild asthma who revealed an asthma control questionnaire score >0.75 and participated in a three-week rehabilitation program, we assessed systolic pulmonary artery pressure (sPAP), cardiac function, and extravascular lung water (EVLW) at 760 m (baseline) by Doppler-echocardiography and on the second (acute) and last day (subacute) at a high altitude clinic in Kyrgyzstan (3100 m). Results: The study included 22 patients (eight male) with a mean age of 44.3 ± 12.4 years, body mass index of 25.8 ± 4.7 kg/m2, a forced expiratory volume in 1 s of 92% ± 19% predicted (post-bronchodilator), and partially uncontrolled asthma. sPAP increased from 21.8 mmHg by mean difference by 7.5 [95% confidence interval 3.9 to 10.5] mmHg (p < 0.001) during acute exposure and by 4.8 [1.0 to 8.6] mmHg (p = 0.014) during subacute exposure. The right-ventricular-to-pulmonary-artery coupling expressed by TAPSE/sPAP decreased from 1.1 by -0.2 [-0.3 to -0.1] mm/mmHg (p < 0.001) during acute exposure and by -0.2 [-0.3 to -0.1] mm/mmHg (p = 0.002) during subacute exposure, accordingly. EVLW significantly increased from baseline (1.3 ± 1.8) to acute hypoxia (5.5 ± 3.5, p < 0.001) but showed no difference after 3 weeks (2.0 ± 1.8). Conclusion: In otherwise healthy asthmatics, acute exposure to hypoxia at high altitude increases pulmonary artery pressure (PAP) and EVLW. During subacute exposure, PAP remains increased, but EVLW returns to baseline values, suggesting compensatory mechanisms that contribute to EVLW homeostasis during acclimatization.
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Affiliation(s)
- S. Saxer
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
- Eastern University of Applied Sciences, St Gallen, Switzerland
| | - P. R. Bader
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - S. R. Schneider
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - M. Mademilov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - U. Sheraliev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - P. Appenzeller
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - J. Müller
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - T. M. Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - K. E. Bloch
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - S. Ulrich
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
| | - M. Lichtblau
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Tuja-Ashu, Kyrgyzstan
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Scheiwiller PM, Furian M, Buergin A, Mayer LC, Schneider SR, Mademilov M, Lichtblau M, Muralt L, Sheraliev U, Sooronbaev TM, Ulrich S, Bloch KE. Visuomotor performance at high altitude in COPD patients. Randomized placebo-controlled trial of acetazolamide. Front Physiol 2022; 13:980755. [PMID: 36160864 PMCID: PMC9493049 DOI: 10.3389/fphys.2022.980755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: We evaluated whether exposure to high altitude impairs visuomotor learning in lowlanders with chronic obstructive pulmonary disease (COPD) and whether this can be prevented by acetazolamide treatment.Methods: 45 patients with COPD, living <800 m, FEV1 ≥40 to <80%predicted, were randomized to acetazolamide (375 mg/d) or placebo, administered 24h before and during a 2-day stay in a clinic at 3100 m. Visuomotor performance was evaluated with a validated, computer-assisted test (Motor-Task-Manager) at 760 m above sea level (baseline, before starting the study drug), within 4h after arrival at 3100 m and in the morning after one night at 3100 m. Main outcome was the directional error (DE) of cursor movements controlled by the participant via mouse on a computer screen during a target tracking task. Effects of high altitude and acetazolamide on DE during an adaptation phase, immediate recall and post-sleep recall were evaluated by regression analyses. www.ClinicalTrials.gov NCT03165890.Results: In 22 patients receiving placebo, DE at 3100 m increased during adaptation by mean 2.5°, 95%CI 2.2° to 2.7° (p < 0.001), during immediate recall by 5.3°, 4.6° to 6.1° (p < 0.001), and post-sleep recall by 5.8°, 5.0 to 6.7° (p < 0.001), vs. corresponding values at 760 m. In 23 participants receiving acetazolamide, corresponding DE were reduced by −0.3° (−0.6° to 0.1°, p = 0.120), −2.7° (−3.7° to −1.6°, p < 0.001) and −3.1° (−4.3° to −2.0°, p < 0.001), compared to placebo at 3100 m.Conclusion: Lowlanders with COPD travelling to 3100 m experienced altitude-induced impairments in immediate and post-sleep recall of a visuomotor task. Preventive acetazolamide treatment mitigated these undesirable effects.
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Affiliation(s)
- P. M. Scheiwiller
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - M. Furian
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - A. Buergin
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - L. C. Mayer
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - S. R. Schneider
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - M. Mademilov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, Bishkek, Kyrgyz Republic
| | - M. Lichtblau
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - L. Muralt
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - U. Sheraliev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, Bishkek, Kyrgyz Republic
| | - T. M. Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, Bishkek, Kyrgyz Republic
| | - S. Ulrich
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - K. E. Bloch
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- *Correspondence: K. E. Bloch,
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