Sleep and breathing disturbances in patients with chronic obstructive pulmonary disease traveling to altitude: a randomized trial

Latshang, Tsogyal D.; Tardent, R.; Furian, Michael; Flueck, Deborah; Segitz, Sebastian; Mueller-Mottet, Séverine; Kohler, Malcolm; Ulrich, Silvia; Bloch, Konrad E.

doi:10.1093/sleep/zsy203

Cited by 28 publications

(48 citation statements)

References 38 publications

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“…In a study of 32 lowlanders with COPD (median FEV 1 59% predicted) ascending from 490 to 2590 m, a reduction was observed in the median nocturnal Sp o 2 from 92% to 85% and emergence of predominantly central sleep apnea (increase in median AHI from 15.4 to 55.7 events/h). 5 This degree of nocturnal hypoxemia and central sleep apnea was similar to that in patients in the present study with less severe COPD (placebo group, Table 2 ) exposed to a higher altitude (3100 m). Despite a degree of hypoxemia in the patients with COPD in the present study similar to that of healthy individuals studied at 3150 m, 25 the AHI of patients with COPD was higher (ie, 39.4 events/h in the present study during night 1 at 3100 m with placebo vs 7.4 events/h at 3150 m).…”

Section: Discussionsupporting

confidence: 86%

“…Sample size estimation based on the trial evaluating effects of dexamethasone on AMS indicated a minimal number of 100 participants. 12 The present trial was powered with 80% to detect a mean (SD) minimal difference in Sp o 2 (primary outcome) of 2% (3.5%) 5 and, in AHI, an important secondary outcome, of 10 (17) events/h, with a 2-sided significance level of α = .05.…”

Section: Methodsmentioning

confidence: 99%

“… 2 Patients with preexisting respiratory conditions, such as obstructive sleep apnea syndrome 3 or chronic obstructive pulmonary disease (COPD), 4 seem to be particularly susceptible to altitude-related hypoxemia, sleep, and breathing disturbances. 5 In patients with obstructive sleep apnea syndrome, continuous positive airway pressure therapy combined with acetazolamide was effective in preventing exacerbation of sleep apnea and improving hypoxemia during altitude sojourns. 6 In patients with COPD, mechanical ventilatory constraints combined with the stimulation of ventilation by acetazolamide and hypobaric hypoxia at high altitudes may promote dyspnea, but to our knowledge, this has not been investigated.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Dexamethasone on Nocturnal Oxygenation in Lowlanders With Chronic Obstructive Pulmonary Disease Traveling to 3100 Meters

et al. 2019

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Key Points Question Does preventive dexamethasone treatment mitigate altitude-related nocturnal hypoxemia in lowlanders with chronic obstructive pulmonary disease traveling to a high altitude? Findings In this randomized clinical trial of 118 patients with chronic obstructive pulmonary disease who lived below 800 m, dexamethasone, 4 mg, orally twice daily, starting 24 hours before ascent and while staying in a clinic at 3100 m, significantly mitigated the altitude-induced decrease in mean arterial oxygen saturation during 2 nights at 3100 m by 2% to 3%. In addition, dexamethasone therapy prevented emergence of central sleep apnea and improved subjective sleep quality. Meaning Patients with chronic obstructive pulmonary disease traveling to a high altitude may benefit from preventive dexamethasone treatment in terms of nocturnal oxygenation and sleep quality.

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Section: Discussionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Dexamethasone on Nocturnal Oxygenation in Lowlanders With Chronic Obstructive Pulmonary Disease Traveling to 3100 Meters

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“…With the current study, we have shown that SDB in PH are even more pronounced at altitude. This is in line with healthy volunteers, patients with COPD, and highlanders permanently living above 2,600 m ( 29 , 37 , 38 ).…”

Section: Discussionsupporting

confidence: 87%

“…Forty patients with moderate to severe COPD (median FEV 1 59% predicted) have been assessed in a randomized crossover trial ascending to 2,590 m, and a 24% incidence of altitude-related adverse health effects was reported, confirming the increased susceptibility in COPD patients exposed to moderate hypobaric hypoxia ( 29 ). In the same trial, left and right heart function was assessed by echocardiography, revealing an increase in pulmonary artery pressure and slight reduction in right ventricular function as well as an increase in diastolic dysfunction at altitude ( 15 ).…”

Section: Discussionmentioning

confidence: 83%

Altitude Travel in Patients With Pulmonary Hypertension: Randomized Pilot-Trial Evaluating Nocturnal Oxygen Therapy

et al. 2020

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Introduction: Stable patients with pulmonary arterial or chronic thromboembolic pulmonary hypertension (PH) wish to undergo altitude sojourns or air travel but fear disease worsening. This pilot study investigates health effects of altitude sojourns and potential benefits of nocturnal oxygen therapy (NOT) in PH patients. Methods: Nine stable PH patients, age 65 (47; 71) years, 5 women, in NYHA class II, on optimized medication, were investigated at 490 m and during two sojourns of 2 days/nights at 2,048 m, once using NOT, once placebo (ambient air), 3 L/min per nasal cannula, according to a randomized crossover design with 2 weeks washout at <800 m. Assessments included safety, nocturnal pulse oximetry (SpO 2 ), 6-min walk distance (6 MWD), and echocardiography. Results: At 2,048 m, two of nine patients required medical intervention, one for exercise-induced syncope, one for excessive nocturnal hypoxemia (SpO 2 < 75% for >30 min). Both recovered immediately with oxygen therapy. Two patients suffered from acute mountain sickness. In 6 patients with complete data, nocturnal mean SpO 2 and cyclic SpO 2 dips reflecting sleep apnea significantly differed from 490 to 2,048 m with placebo, and 2,048 m with NOT (medians, quartiles): SpO 2 93 (91; 95)%, 89 (85; 90)%, 97 (95; 97)%; SpO 2 dips 10.4/h (3.1; 26.9), 34.0/h (5.3; 81.3), 0.3/h (0.1; 2.3). 6 MWD at 490, 2,048 m without and with NOT was 620 m (563; 720), 583 m (467; 696), and 561 m (501; 688). Echocardiographic indices of heart function and PH were unchanged at 2,048 m with/without NOT vs. 490 m. Conclusions: 7/9 PH patients stayed safely at 2,048 m but revealed hypoxemia, sleep apnea, and reduced 6 MWD. Hemodynamic changes were trivial. NOT improved oxygenation and sleep apnea. The current pilot trial is important for designing further studies on altitude tolerance of PH patients.

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Effect of Nocturnal Oxygen Therapy on Nocturnal Hypoxemia and Sleep Apnea Among Patients With Chronic Obstructive Pulmonary Disease Traveling to 2048 Meters

et al. 2020

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IMPORTANCE There are no established measures to prevent nocturnal breathing disturbances and other altitude-related adverse health effects (ARAHEs) among lowlanders with chronic obstructive pulmonary disease (COPD) traveling to high altitude. OBJECTIVE To evaluate whether nocturnal oxygen therapy (NOT) prevents nocturnal hypoxemia and breathing disturbances during the first night of a stay at 2048 m and reduces the incidence of ARAHEs. DESIGN, SETTING, AND PARTICIPANTS This randomized, placebo-controlled crossover trial was performed from January to October 2014 with 32 patients with COPD living below 800 m with forced expiratory volume in the first second of expiration (FEV 1) between 30% and 80% predicted, pulse oximetry of at least 92%, not requiring oxygen therapy, and without history of sleep apnea. Evaluations were performed at the University Hospital Zurich (490 m, baseline) and during 2 stays of 2 days and nights each in a Swiss Alpine hotel at 2048 m while NOT or placebo treatment was administered in a randomized order. Between altitude sojourns, patients spent at least 2 weeks

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Sleep and breathing disturbances in patients with chronic obstructive pulmonary disease traveling to altitude: a randomized trial

Cited by 28 publications

References 38 publications

Effect of Dexamethasone on Nocturnal Oxygenation in Lowlanders With Chronic Obstructive Pulmonary Disease Traveling to 3100 Meters

Effect of Dexamethasone on Nocturnal Oxygenation in Lowlanders With Chronic Obstructive Pulmonary Disease Traveling to 3100 Meters

Altitude Travel in Patients With Pulmonary Hypertension: Randomized Pilot-Trial Evaluating Nocturnal Oxygen Therapy

Effect of Nocturnal Oxygen Therapy on Nocturnal Hypoxemia and Sleep Apnea Among Patients With Chronic Obstructive Pulmonary Disease Traveling to 2048 Meters

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