Are Nocturnal Breathing, Sleep, and Cognitive Performance Impaired at Moderate Altitude (1,630–2,590 m)?

ObjectivesIntact postural control is essential for safe performance of mountain sports, operation of machinery at altitude, and for piloting airplanes. We tested whether exposure to hypobaric hypoxia at moderate altitude impairs the static postural control of healthy subjects.MethodsIn 51 healthy men, median age 24 y (quartiles 20;28), static control was evaluated on a balance platform in Zurich, 490 m, and during a 4-day sojourn in Swiss mountain villages at 1630 m and 2590 m, 2 days each. The order of altitude exposure was randomized. Total center of pressure path length (COPL) and sway amplitude measured in two directions by a balance platform, and pulse oximetry were recorded. Data were compared between altitudes.ResultsMedian (quartiles) COPL during standing on both legs with eyes open at 490 m and in the evenings on the first and second days at 1630 and 2590 m, respectively were: 50 (45;57), 55 (48;62), 56 (49;61), 53 (47;59), 54 (48;60) cm, P<0.001 ANOVA. Corresponding arterial oxygen saturation was 97% (96;97), 95% (94;96), 95%(94;96), 92%(90;93), 93%(91;93), P<0.001. Anterior-posterior sway amplitudes were larger at 1630 and 2590 m compared to 490 m, P<0.001. Multiple logistic regression analysis confirmed that higher altitudes (1630 and 2590m) were independently associated with increased COPL when controlled for the order of altitude exposure and age (P=0.001).ConclusionsExposure to 1630 and 2590m was associated with impaired static postural control even when visual references were available.Trial RegistrationClinicalTrials.gov NCT01130948.

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“…Data on the effects of altitude on sleep and cardiovascular function are described elsewhere [12–14], including the consort flow chart (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

Impaired Postural Control in Healthy Men at Moderate Altitude (1630 M and 2590 M): Data from a Randomized Trial

et al. 2015

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“…In healthy subjects, the increased ventilatory drive induced by exposure to hypobaric hypoxia promotes high altitude periodic breathing, an alternating pattern of hyperventilation, and central apneas/hypopneas associated with cyclic oscillations of oxygen saturation and sleep disturbances (NussbaumerOchsner et al, 2012b;Latshang et al, 2013) In a study performed in 51 healthy subjects sleeping at 490, 1630, and 2590 m, multiple regression analysis controlling for various confounding factors including the AHI and mean nocturnal oxygen saturation at 490 m baseline (among others) predicted a slightly greater AHI in the first night at 2590 m in persons aged 38 years (i.e., 10.9/h) compared to persons aged 24 y (9.3/h) and 20 y (8.9/h), respectively ( Table 3 in Latshang et al, 2013). There was a large variation in the individual susceptibility to altitude-related periodic breathing in that study.…”

Section: Age and High Altitude Periodic Breathingmentioning

confidence: 99%

Patients with Obstructive Sleep Apnea at Altitude

Bloch

Latshang

Ulrich

2015

High Altitude Medicine & Biology

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Bloch, Konrad E., Tsogyal D. Latshang, and Silvia Ulrich. Patients with obstructive sleep apnea at altitude. High Alt Med Biol 16:110-116, 2015.--Obstructive sleep apnea (OSA) is highly prevalent in the general population, in particular in men and women of older age. In OSA patients sleeping near sea level, the apneas/hypopneas associated with intermittent hypoxemia are predominantly due to upper airway collapse. When OSA patients stay at altitudes above 1600 m, corresponding to that of many tourist destinations, hypobaric hypoxia promotes frequent central apneas in addition to obstructive events, resulting in combined intermittent and sustained hypoxia. This induces strong sympathetic activation with elevated heart rate, cardiac arrhythmia, and systemic hypertension. There are concerns that these changes expose susceptible OSA patients, in particular those with advanced age and co-morbidities, to an excessive risk of cardiovascular and other adverse events during a stay at altitude. Based on data from randomized trials, it seems advisable for OSA patients to use continuous positive airway pressure treatment with computer controlled mask pressure adjustment (autoCPAP) in combination with acetazolamide during an altitude sojourn. If CPAP therapy is not feasible, acetazolamide alone is better than no treatment at all, as it improves oxygenation and sleep apnea and prevents excessive blood pressure rises of OSA patients at altitude.

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“…Spindle activity is modifiable24252627 and could represent an attractive therapeutic target if causally implicated in disease risk. In light of recent progress in schizophrenia genetics2829, genetically characterizing variation in spindle activity could help to elucidate pathways between genetic risk and neuropsychiatric disease23.…”

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Characterizing sleep spindles in 11,630 individuals from the National Sleep Research Resource

et al. 2017

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Sleep spindles are characteristic electroencephalogram (EEG) signatures of stage 2 non-rapid eye movement sleep. Implicated in sleep regulation and cognitive functioning, spindles may represent heritable biomarkers of neuropsychiatric disease. Here we characterize spindles in 11,630 individuals aged 4 to 97 years, as a prelude to future genetic studies. Spindle properties are highly reliable but exhibit distinct developmental trajectories. Across the night, we observe complex patterns of age- and frequency-dependent dynamics, including signatures of circadian modulation. We identify previously unappreciated correlates of spindle activity, including confounding by body mass index mediated by cardiac interference in the EEG. After taking account of these confounds, genetic factors significantly contribute to spindle and spectral sleep traits. Finally, we consider topographical differences and critical measurement issues. Taken together, our findings will lead to an increased understanding of the genetic architecture of sleep spindles and their relation to behavioural and health outcomes, including neuropsychiatric disorders.

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Are Nocturnal Breathing, Sleep, and Cognitive Performance Impaired at Moderate Altitude (1,630–2,590 m)?

Abstract: Clinicaltrials.gov: NCT01130948.

Cited by 71 publications

References 37 publications

Impaired Postural Control in Healthy Men at Moderate Altitude (1630 M and 2590 M): Data from a Randomized Trial

Impaired Postural Control in Healthy Men at Moderate Altitude (1630 M and 2590 M): Data from a Randomized Trial

Patients with Obstructive Sleep Apnea at Altitude

Characterizing sleep spindles in 11,630 individuals from the National Sleep Research Resource

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