Central Sleep Apnea at High Altitude

Burgess, Keith R.; Ainslie, Philip N.

doi:10.1007/978-1-4899-7678-9_19

Cited by 28 publications

(16 citation statements)

References 32 publications

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“…In general, it occurs above 2000 m.a.s.l. 6 and presents a characteristic hyperpnoea/apnea phase 2 , 4 , 6 , as we also observed. In our experience, PB is not evident in the basal polygraphy recording (746 m.a.s.l.…”

Section: Discussionsupporting

confidence: 86%

Sleep respiratory disturbances during the ascent to Mount Aconcagua

Ortiz-Naretto

Pereiro²,

Ernst

et al. 2018

Sleep Sci

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IntroductionMountaineers exposed to hypobaric hypoxia (HH) show high-altitude periodic breathing (PB).ObjectiveTo analyze high-altitude PB during the ascent of Mount Aconcagua (Argentina).Materials and MethodsDescriptive study in healthy volunteers using respiratory polygraphy (RP) at different altitudes.ResultsWe studied 8 andinist, mean age: 36 years old (25-51), body mass index (BMI) of 23.6 (20.9-28.7) and 22.77 (20.9-27.7) upon return, p<0.01. RP without PB showed a lower Oxygen Desaturation Index (ODI) and a lower Apnea-Hypopnea-Index (AHI); 5.43 (0 - 20) versus 45.95 (2-122) p<0.001 and 3.9 (0-15.5) versus 44.35 (4-115) p<0.001. AHI increased with altitude at the expense of central apneas and hypopneas: p<0.05.ConclusionHigh-altitude PB is frequent above 2,581m.a.s.l. And it is characterized by short cycles. None of the mountaineers showed PB at baseline; however, high-altitude PB occurred in all subjects above 4,900 m.a.s.l

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Section: Discussionsupporting

confidence: 86%

Sleep respiratory disturbances during the ascent to Mount Aconcagua

Ortiz-Naretto

Pereiro²,

Ernst

et al. 2018

Sleep Sci

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“…Secondly, ventilation, which can have a significant influence on HRV, is affected by HA (Task Force of the European Society of Cardiology and the North American Society of Pacing Electrophysiology, 1996). Alterations in breathing patterns and even periodic breathing (PB) are a well-established phenomenon at HA (Burgess and Ainslie, 2016). PB represents an abnormal ventilatory pattern in which apneas and hypopneas alternate with periods of hyperventilation (Burgess and Ainslie, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Alterations in breathing patterns and even periodic breathing (PB) are a well-established phenomenon at HA (Burgess and Ainslie, 2016). PB represents an abnormal ventilatory pattern in which apneas and hypopneas alternate with periods of hyperventilation (Burgess and Ainslie, 2016). The worsening hypobaric hypoxia at HA leads to compensatory hyperventilation until a point when the arterial PCO 2 (PaCO 2 ) falls below the threshold required to stimulate breathing leading to either hypopnea or even apnea, followed by the restoration of hyperventilation as the hypoxia worsens and the paCO 2 resets (Burgess and Ainslie, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…PB represents an abnormal ventilatory pattern in which apneas and hypopneas alternate with periods of hyperventilation (Burgess and Ainslie, 2016). The worsening hypobaric hypoxia at HA leads to compensatory hyperventilation until a point when the arterial PCO 2 (PaCO 2 ) falls below the threshold required to stimulate breathing leading to either hypopnea or even apnea, followed by the restoration of hyperventilation as the hypoxia worsens and the paCO 2 resets (Burgess and Ainslie, 2016). This phenomenon is subject to marked individual variability, but is generally observed at >2000 m (Burgess and Ainslie, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…The worsening hypobaric hypoxia at HA leads to compensatory hyperventilation until a point when the arterial PCO 2 (PaCO 2 ) falls below the threshold required to stimulate breathing leading to either hypopnea or even apnea, followed by the restoration of hyperventilation as the hypoxia worsens and the paCO 2 resets (Burgess and Ainslie, 2016). This phenomenon is subject to marked individual variability, but is generally observed at >2000 m (Burgess and Ainslie, 2016). Unfortunately, we were not able to measure ventilation throughout the 1 h recording period, but did quantify the ECG derived respiratory rate during part of the HRV recording period.…”

Section: Discussionmentioning

confidence: 99%

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High Altitude Affects Nocturnal Non-linear Heart Rate Variability: PATCH-HA Study

Boos

Bye²,

Sevier

et al. 2018

Front. Physiol.

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Background: High altitude (HA) exposure can lead to changes in resting heart rate variability (HRV), which may be linked to acute mountain sickness (AMS) development. Compared with traditional HRV measures, non-linear HRV appears to offer incremental and prognostic data, yet its utility and relationship to AMS have been barely examined at HA. This study sought to examine this relationship at terrestrial HA.Methods: Sixteen healthy British military servicemen were studied at baseline (800 m, first night) and over eight consecutive nights, at a sleeping altitude of up to 3600 m. A disposable cardiac patch monitor was used, to record the nocturnal cardiac inter-beat interval data, over 1 h (0200–0300 h), for offline HRV assessment. Non-linear HRV measures included Sample entropy (SampEn), the short (α1, 4–12 beats) and long-term (α2, 13–64 beats) detrend fluctuation analysis slope and the correlation dimension (D2). The maximal rating of perceived exertion (RPE), during daily exercise, was assessed using the Borg 6–20 RPE scale.Results: All subjects completed the HA exposure. The average age of included subjects was 31.4 ± 8.1 years. HA led to a significant fall in SpO2 and increase in heart rate, LLS and RPE. There were no significant changes in the ECG-derived respiratory rate or in any of the time domain measures of HRV during sleep. The only notable changes in frequency domain measures of HRV were an increase in LF and fall in HFnu power at the highest altitude. Conversely, SampEn, SD1/SD2 and D2 all fell, whereas α1 and α2 increased (p < 0.05). RPE inversely correlated with SD1/SD2 (r = -0.31; p = 0.002), SampEn (r = -0.22; p = 0.03), HFnu (r = -0.27; p = 0.007) and positively correlated with LF (r = 0.24; p = 0.02), LF/HF (r = 0.24; p = 0.02), α1 (r = 0.32; p = 0.002) and α2 (r = 0.21; p = 0.04). AMS occurred in 7/16 subjects (43.8%) and was very mild in 85.7% of cases. HRV failed to predict AMS.Conclusion: Non-linear HRV is more sensitive to the effects of HA than time and frequency domain indices. HA leads to a compensatory decrease in nocturnal HRV and complexity, which is influenced by the RPE measured at the end of the previous day. HRV failed to predict AMS development.

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High flow nasal cannula treatment for obstructive sleep apnea in infants and young children

Ignatiuk

Schaer

McGinley

2020

Pediatric Pulmonology

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Background Continuous positive airway pressure (CPAP) is the nonsurgical treatment of choice for children with obstructive sleep apnea (OSA). However, CPAP limitations include difficulty with adherence and midface hypoplasia risk. We, therefore, sought to assess the effect of warm humidified air delivered via open nasal cannula (HFNC) on OSA in children in the sleep laboratory and at home. Methods A retrospective review was performed among children recommended treatment of OSA with HFNC. Reasons for HFNC recommendation included poor surgical candidacy, residual OSA following surgery, and CPAP intolerance. Children underwent both diagnostic and HFNC titration sleep studies and were prescribed HFNC for home use. Standard sleep architecture, arousals, and apnea‐hypopnea indices (AHI) were assessed with the evaluation of reported adherence and complications over 12 months of treatment. Results Twenty‐two children (average 12.8 months, 95% confidence interval [95% CI: 7.0, 18.6]) with OSA (obstructive AHI [OAHI] range: 4.8‐89.2 events/h) underwent HFNC titration with significant reduction in OAHI (28.9 events/h [17.6, 40.2] vs 2.6 [1.1, 4.0]; P < .001) (mean [95% CI]). Nineteen patients received home HFNC treatment. By 12 months, four patients were lost to follow‐up and OSA resolved in three patients (16%). Of 12 remaining patients, 7 (58%) continued therapy while 5 (42%) discontinued due to intolerance. The most common treatment complication was cannula dislodgement. Additional complications included skin irritation, dry mucus membranes, restlessness, oxygen desaturation, and increased central apneas. Conclusion HFNC offers a treatment alternative to CPAP in infants and young children with OSA and was well tolerated at home in our study.

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Central Sleep Apnea at High Altitude

Cited by 28 publications

References 32 publications

Sleep respiratory disturbances during the ascent to Mount Aconcagua

Sleep respiratory disturbances during the ascent to Mount Aconcagua

High Altitude Affects Nocturnal Non-linear Heart Rate Variability: PATCH-HA Study

High flow nasal cannula treatment for obstructive sleep apnea in infants and young children

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