Cross-Sectional Comparison of Sleep-Disordered Breathing in Native Peruvian Highlanders and Lowlanders

Pham, Luu V.; Meinzen, Christopher; Arias, Rafael S.; Schwartz, Noah G.; Rattner, Adi; Miele, Catherine H.; Smith, Philip L.; Schneider, Hartmut; Miranda, J. Jaime; Gilman, Robert H.; Polotsky, Vsevolod Y.; Checkley, William; Schwartz, Alan R.

doi:10.1089/ham.2016.0102

Cited by 41 publications

(26 citation statements)

References 43 publications

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“…Both situations can lead to maladaptive cardiovascular outcomes. Sleep disordered breathing is more prevalent in Peruvian highlanders than lowlanders at sea level (Pham et al, 2017a), and nocturnal hypoxemia and sleep apnea events are separately associated with excessive erythrocytosis and glucose intolerance, respectively (Pham et al, 2017b). The severity, frequency, and duration of intermittent desaturation on top of chronic hypoxemia likely influence erythropoiesis and other hypoxia-related pathways that contribute to negative cardiovascular outcomes.…”

Section: Introductionmentioning

confidence: 99%

Relationships Between Chemoreflex Responses, Sleep Quality, and Hematocrit in Andean Men and Women

et al. 2020

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Andean highlanders are challenged by chronic hypoxia and many exhibit elevated hematocrit (Hct) and blunted ventilation compared to other high-altitude populations. While many Andeans develop Chronic Mountain Sickness (CMS) and excessive erythrocytosis, Hct varies markedly within Andean men and women and may be driven by individual differences in ventilatory control and/or sleep events which exacerbate hypoxemia. To test this hypothesis, we quantified relationships between resting ventilation and ventilatory chemoreflexes, sleep desaturation, breathing disturbance, and Hct in Andean men and women. Ventilatory measures were made in 109 individuals (n = 63 men; n = 46 women), and sleep measures in 45 of these participants (n = 22 men; n = 23 women). In both men and women, high Hct was associated with low daytime SpO 2 (p < 0.001 and p < 0.002, respectively) and decreased sleep SpO 2 (mean, nadir, and time <80%; all p < 0.02). In men, high Hct was also associated with increased end-tidal P CO2 (p < 0.009). While ventilatory responses to hypoxia and hypercapnia did not predict Hct, decreased hypoxic ventilatory responses were associated with lower daytime SpO 2 in men (p < 0.01) and women (p < 0.009) and with lower nadir sleep SpO 2 in women (p < 0.02). Decreased ventilatory responses to CO 2 were associated with more time below 80% SpO 2 during sleep in men (p < 0.05). The obstructive apnea index and apnea-hypopnea index also predicted Hct and CMS scores in men after accounting for age, BMI, and SpO 2 during sleep. Finally, heart rate response to hypoxia was lower in men with higher Hct (p < 0.0001). These data support the idea that hypoventilation and decreased ventilatory sensitivity to hypoxia are associated with decreased day time and nighttime SpO 2 levels that may exacerbate the stimulus for erythropoiesis in Andean men and women. However, interventional and longitudinal studies are required to establish the causal relationships between these associations.

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Section: Introductionmentioning

confidence: 99%

Relationships Between Chemoreflex Responses, Sleep Quality, and Hematocrit in Andean Men and Women

et al. 2020

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“…Sleep disturbances at altitude are common: in the systematic review of Bloch and colleagues (Bloch et al., 2015), the authors argued that subjective insomnia occurs at HA (i.e., 4,559 m) rather than at low (1,630 m) and moderate (2,590 m) altitudes, periodic breathing and arousals occur in lowlanders sojourning at altitude, and the effects of acclimatization on sleep are altitude dependent. However, sleep‐disordered breathing occur in a large proportion of highlanders, and a greater prevalence of sleep central apneas in highlanders compared with lowlanders has been reported (Pham et al., 2017), with a pathophysiological link to pulmonary hypertension (Latshang et al., 2017). So far, there is still uncertainty about the role of ethnicity and that of altitude working habit on cardiorespiratory nocturnal response depending on ethnicity and altitude working habit.…”

Section: Discussionmentioning

confidence: 99%

Case studies in physiology: Nocturnal cardiorespiratory adaptive differences between an Italian trekker and a Nepali guide

2020

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The cardiopulmonary system is a physiological cornerstone in the adaptive response to hypobaric hypoxia. Portable devices make it feasible nowadays to precisely assess the response to high altitude (HA) expeditions. In this study, we investigated breathing and arterial blood pressure responses during a Himalayan trek from 665 m to 4,780 m altitude in a white European (Italian) sojourner and a native Nepali (Tamang) guide, both healthy males. Resting diurnal and nocturnal data were acquired by means of ambulatory blood pressure monitoring (ABPM) and sleep apnea monitoring. We found an increase in the mean diurnal arterial blood pressure. Nocturnal blood pressure dipping was confirmed at all altitudes. Oxygen saturation decreased at altitude, with its additional nocturnal fall. Sleep apneic episodes, present in the Italian only, increased with altitude. We conclude that the nocturnal, more than diurnal, cardiorespiratory function is affected by HA hypoxia. Further studies should address the role of ethnicity, medications, and sociodemographic factors in the cardiorespiratory responses to hypobaric hypoxia.

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“…Sleep architecture is closely resembling to normal of people at sea level with significant amount of NREM sleep and unimpaired REM sleep [38]. Contrary to the previous reports, a recent study surveyed sleep architecture of Peruvian highlanders living in Puno at 3825 m. The highlanders had a longer time in total sleep time and increased wakeafter-sleep onset and arousal index but decreased sleep efficiency, which suggest greater disturbances in sleep in highlanders compared with lowlanders [39].…”

Section: Variation Of Sleep Architecture At High Altitudementioning

confidence: 95%

Sleep Disorder at High Altitude

Kong¹

2021

Updates in Sleep Neurology and Obstructive Sleep Apnea

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In this chapter, we discuss the occurrence, mechanism, clinical manifestations, outcomes, and managements of a commonly encountered sleep disorder of someone traveling in high altitude for working and sightseeing. Humans ascending to altitudes above 2500 m usually suffer from substantial disturbances in sleep quality as difficulty in sleep onset, frequent awakenings, respiratory disturbance, and a feeling of drowsiness on the next day. Data obtained from polysomnographic studies demonstrated several variations of sleep architecture in those healthy subjects ascending to high altitude during sleep, including periodic breathing and decreased non-rapid eye movement deep sleep stage 3 and 4 (in new nomenclature N3), which were usually accompanied by and the lowered arterial O 2 and restricted ventilation. Hypoxia is most severe during sleep and in correspondence to periodic breathing and sleep disturbance at high altitude. Poor sleep quality impairs cognition and executive abilities at high altitude though it may largely be improved after full time of acclimatization. Evidence-based choices for clinicians to treat sleep disorder at high altitude are relatively scarce at present. Supplemental oxygen and dietary nitrate are effective in alleviating nocturnal hypoxia. There is strong evidence supporting the efficacy and safety of acetazolamide and nonbenzodiazepines in minimizing periodic breathing and improving sleep quality at high altitude.

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Cross-Sectional Comparison of Sleep-Disordered Breathing in Native Peruvian Highlanders and Lowlanders

Cited by 41 publications

References 43 publications

Relationships Between Chemoreflex Responses, Sleep Quality, and Hematocrit in Andean Men and Women

Relationships Between Chemoreflex Responses, Sleep Quality, and Hematocrit in Andean Men and Women

Case studies in physiology: Nocturnal cardiorespiratory adaptive differences between an Italian trekker and a Nepali guide

Sleep Disorder at High Altitude

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