Effects of high-altitude periodic breathing on sleep and arterial oxyhaemoglobin saturation

Salvaggio, Adriana; Insalaco, Giuseppe; Marrone, Oreste; Romano, Salvatore; Braghiroli, Alberto; Lanfranchi, Paola; Patruno, Vincenzo; Donner, Claudio F.; Bonsignore, G

doi:10.1183/09031936.98.12020408

Cited by 81 publications

(56 citation statements)

References 17 publications

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“…Study medication was either oral slow release theophylline (26250 mg?day -1 ), oral acetazolamide (26250 mg?day -1 ) or a matched placebo tablet. Polysomnographic measurements were performed during two consecutive nights, and acute mountain sickness, pulse rate, oxyhaemoglobin saturation and arterial blood gases were assessed three times a day.Without active medication, the apnoea/hypopnoea index (AHI) was highly pathological ( Sleep-disordered breathing (SDB) of the Cheyne-Stokes type is commonly found during sleep at high altitude [1][2][3]. This typical breathing pattern with waxing and waning of the tidal volume is associated with profound desaturations and reduced overall oxygen saturation during sleep, but its association with an increased number of arousals is a matter of ongoing debate [4,5].…”

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confidence: 99%

“…Sleep-disordered breathing (SDB) of the Cheyne-Stokes type is commonly found during sleep at high altitude [1][2][3]. This typical breathing pattern with waxing and waning of the tidal volume is associated with profound desaturations and reduced overall oxygen saturation during sleep, but its association with an increased number of arousals is a matter of ongoing debate [4,5].…”

mentioning

confidence: 99%

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Theophylline and acetazolamide reduce sleep-disordered breathing at high altitude

Fischer¹,

Lang²,

Leitl³

et al. 2003

Eur Respir J

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Theophylline and acetazolamide reduce sleep-disordered breathing at high altitude. R. Fischer, S.M. Lang, M. Leitl, M. Thiere, U. Steiner, R.M. Huber. #ERS Journals Ltd 2004. ABSTRACT: A randomised, double-blind, placebo-controlled study was conducted to evaluate the effects of theophylline and acetazolamide in the treatment of sleepdisordered breathing (SDB) after fast ascent to high altitude (3,454 m).The study was conducted at a high-altitude research laboratory and included 30 healthy male volunteers. Study medication was either oral slow release theophylline (26250 mg?day -1 ), oral acetazolamide (26250 mg?day -1 ) or a matched placebo tablet. Polysomnographic measurements were performed during two consecutive nights, and acute mountain sickness, pulse rate, oxyhaemoglobin saturation and arterial blood gases were assessed three times a day.Without active medication, the apnoea/hypopnoea index (AHI) was highly pathological ( Sleep-disordered breathing (SDB) of the Cheyne-Stokes type is commonly found during sleep at high altitude [1][2][3]. This typical breathing pattern with waxing and waning of the tidal volume is associated with profound desaturations and reduced overall oxygen saturation during sleep, but its association with an increased number of arousals is a matter of ongoing debate [4,5]. The use of acetazolamide at high altitude is known to reduce the time spent with periodic breathing, to improve overall oxygen saturation during sleep and to reduce the number of arousals [6].Acetazolamide inhibits the renal enzyme carbonic anhydrase, which leads to metabolic acidosis, and, as a result, increases ventilation and oxygenation. The beneficial effects of this drug at high altitude are thought to be due to this improved oxygenation. Although serious side-effects of acetazolamide are uncommon, an alternative treatment option would be desirable for patients with known sulphonamide intolerance. In a previous, prospective, randomised study, the authors were able to show that theophylline has a positive impact on symptoms of acute mountain sickness (AMS), compared with placebo [7]. As theophylline was shown to be effective in reducing periodic breathing in premature newborns and in patients with severe heart failure [8, 9], a similar effect in high-altitude periodic breathing could be assumed.Therefore, a randomised, double-blind, placebo-controlled study was conducted to evaluate the effect of theophylline and acetazolamide on periodic breathing and arterial oxyhaemoglobin desaturations during sleep at high altitude. The aims were to compare the efficacy of theophylline and acetazolamide in normalising high-altitude SDB and in decreasing nocturnal oxyhaemoglobin desaturation. Methods Study populationHealthy male volunteers (n=30) gave informed written consent to participate in the study. Of 30 subjects, 22 were engaged in regular mountaineering activities in their spare time, but none of them had experienced altitudes above 3,500 m. The study protocol was approved by the local ethics committee. Exclusion cr...

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confidence: 99%

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confidence: 99%

Theophylline and acetazolamide reduce sleep-disordered breathing at high altitude

Fischer¹,

Lang²,

Leitl³

et al. 2003

Eur Respir J

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“…When respiratory events are cyclic and contain apneic episodes, this is known as periodic breathing (19). Periodic breathing has been observed during sleep in mountaineers, high-altitude residents, and sedentary sojourners from sea level during sleep at altitudes between 3,200 and 7,167 m (24,29,35). Periodic breathing has also been documented in awake individuals exposed to short-term hypoxia equivalent to 2,440 m (33).…”

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confidence: 99%

Respiratory events and periodic breathing in cyclists sleeping at 2,650-m simulated altitude

Kinsman¹,

Hahn²,

Gore³

et al. 2002

Journal of Applied Physiology

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Moi Chow. Respiratory events and periodic breathing in cyclists sleeping at 2,650-m simulated altitude. J Appl Physiol 92: 2114-2118, 2002; 10.1152/japplphysiol.00737. 2001.-We examined the initial effect of sleeping at a simulated moderate altitude of 2,650 m on the frequency of apneas and hypopneas, as well as on the heart rate and blood oxygen saturation from pulse oximetry (Sp O 2 ) during rapid eye movement (REM) and non-rapid eye movement (NREM) sleep of 17 trained cyclists. Pulse oximetry revealed that sleeping at simulated altitude significantly increased heart rate (3 Ϯ 1 beats/min; means Ϯ SE) and decreased Sp O 2 (Ϫ6 Ϯ 1%) compared with baseline data collected near sea level. In response to simulated altitude, 15 of the 17 subjects increased the combined frequency of apneas plus hypopneas from baseline levels. On exposure to simulated altitude, the increase in apnea was significant from baseline for both sleep states (2.0 Ϯ 1.3 events/h for REM, 9.9 Ϯ 6.2 events/h for NREM), but the difference between the two states was not significantly different. Hypopnea frequency was significantly elevated from baseline to simulated altitude exposure in both sleep states, and under hypoxic conditions it was greater in REM than in NREM sleep (7.9 Ϯ 1.8 vs. 4.2 Ϯ 1.3 events/h, respectively). Periodic breathing episodes during sleep were identified in four subjects, making this the first study to show periodic breathing in healthy adults at a level of hypoxia equivalent to 2,650-m altitude. These results indicate that simulated moderate hypoxia of a level typically chosen by coaches and elite athletes for simulated altitude programs can cause substantial respiratory events during sleep. pulse oximetry; apnea; hypopnea RECENT STUDIES ON THE USE of altitude by athletes suggest that the best effect on subsequent physical performances may be gained by sleeping in a moderately hypoxic condition (equivalent to altitudes of ϳ2,200-3,000 m) while training close to sea level (21,22). The response to this "live high, train low" approach varies widely between individuals, with some athletes showing substantial performance gains and others showing no effect or even a negative outcome (7). Athletes spend a substantial amount of time asleep while exposed to the live high, train low stimulus (3), and the respiratory events during their sleep time increase as altitude increases (28). However, substantial differences appear to exist between individuals in both the magnitude of this effect and the altitude of onset (2,8, 39). Although sleep disturbance has been shown to decrease subsequent physical work capacity and increase the self-perception of fatigue (1), no studies have monitored the sleep physiology of athletes undergoing a live high, train low program.Hyperventilation is among the first physiological adjustments to an acute increase in altitude in an attempt to compensate for the reduced PO 2 (10, 30). Episodes of hyperventilation may be separated by intervals of hypopnea or apnea. When respiratory events are cyclic and conta...

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“…Sleep at altitude is often characterized by periodic breathing which is correlated with more arousals, although sleep is has been shown to be more disrupted at altitude regardless of the amount of periodic breathing. 110 These factors typically lead to sleep disruptions at altitude that reduce the quality of sleep for individuals during altitude residence that do not appear to diminish over the first few nights at altitude. 95,110 However, many individuals experience sleep disruptions in unfamiliar environments regardless of altitude.…”

Section: Altitude Exposure and Sleep Qualitymentioning

confidence: 99%

“…110 These factors typically lead to sleep disruptions at altitude that reduce the quality of sleep for individuals during altitude residence that do not appear to diminish over the first few nights at altitude. 95,110 However, many individuals experience sleep disruptions in unfamiliar environments regardless of altitude. The current study showed that the disruptions in sleep were not greater at altitude than they were from simply sleeping in a new environment, as there was no difference in sleep quality between the altitude conditions and control (normoxia).…”

Section: Altitude Exposure and Sleep Qualitymentioning

confidence: 99%

Short-term arrival strategies for endurance exercise performance at moderate altitude

Foss

Constantini

Mickleborough

et al. 2017

Journal of Applied Physiology

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For sea level-based endurance athletes who compete at moderate and high altitudes, many are not logistically able to arrive at altitude weeks before the event to fully acclimatize. For those who can only arrive at altitude the night before competition, we asked if there is a physiological and performance advantage in reducing altitude exposure time to 2 h before competition. On three separate visits, 10 cyclists completed overnight laboratory exposures of: 1) a 14-h exposure to normobaric hypoxia (16.2% O2, simulating 2,500 m; 14H), 2) a 12-h exposure to normoxia, then a 2-h hypoxic exposure (2H), and 3) a 14-h exposure to normoxia (CON). Immediately following each exposure, subjects completed a 20-km cycle ergometry time trial in normoxia (CON) or 16.2% O2 (14H and 2H). Measures of plasma volume changes, sleep quality, ventilatory acclimatization, perceived exertion, oxygen uptake, and 20-km time were collected. No significant differences were observed in performance measures or perceived exertion between hypoxic trials. Plasma volume loss was significantly greater during 14H than 2H and CON. No differences in ventilatory acclimatization or sleep quality were observed between trials. Although some divergent 20-km performance responses were observed between 14H and 2H, they were not explained by the physiological measures completed. The data suggest that endurance athletes who are logistically restricted from arriving at altitude more than the evening before competition would not gain an advantage by delaying their arrival until a few hours before the competition, although unique individual responses may ultimately influence optimal arrival strategy. NEW & NOTEWORTHY For athletes who cannot arrive at altitude multiple days before an endurance competition to properly acclimatize, this study asked if shortening hypoxic exposure time to 2 h before a competition was more advantageous than arrival at altitude the evening before competition. Our data suggest that athletes who cannot arrive at altitude with adequate time for complete acclimatization can choose the short-term arrival strategy that best fits with the logistics of their travel.

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Effects of high-altitude periodic breathing on sleep and arterial oxyhaemoglobin saturation

Cited by 81 publications

References 17 publications

Theophylline and acetazolamide reduce sleep-disordered breathing at high altitude

Theophylline and acetazolamide reduce sleep-disordered breathing at high altitude

Respiratory events and periodic breathing in cyclists sleeping at 2,650-m simulated altitude

Short-term arrival strategies for endurance exercise performance at moderate altitude

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