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

Furian, Michael; Lichtblau, Mona; Aeschbacher, Sayaka S.; Estebesova, Bermet; Emilov, Berik; Sheraliev, Ulan; Marazhapov, Nuriddin H.; Mademilov, Maamed; Osmonov, Batyr; Bisang, Maya; Ulrich, Stefanie; Latshang, Tsogyal D.; Ulrich, Silvia; Sooronbaev, Talant; Bloch, Konrad E.

doi:10.1001/jamanetworkopen.2019.0067

Cited by 16 publications

(19 citation statements)

References 34 publications

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“…16 Subjective sleep quality was rated on a 100-mm visual analog scale ranging from 0 (very bad) to 100 (excellent). 6 Symptoms of acute mountain sickness (AMS) were evaluated by the Environmental Symptoms Downloaded From: https://jamanetwork.com/ on 11/04/2020…”

Section: Assessmentsmentioning

confidence: 99%

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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Section: Assessmentsmentioning

confidence: 99%

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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“…However, the RV/RA pressure gradient was positively correlated with recruitment of RLS at high altitude even when controlled for other factors including the presence of RLS at 760 m, measures of oxygenation, the degree of airflow obstruction, altitude, and dexamethasone (Table 6). We previously described a beneficial effect of preventive dexamethasone treatment on blood oxygenation, sleep apnea, and the RV/RA pressure gradient in COPD patients traveling to altitude (8,9,16). This beneficial effect of dexamethasone could also be demonstrated in COPD patients in the subgroup without C-RLS near sea level (Fig.…”

Section: Discussionmentioning

confidence: 76%

“…The primary outcome of the main trial, the effect of dexamethasone on the incidence of AMS/ARAHE (9), nocturnal arterial oxygen saturation (8), breathing pattern and basic echocardiographic findings have been published (16). The particular focus of the present study was the prevalence and type of RLS evaluated by contrast echocardiography at 760 m and 3,100 m with placebo and dexamethasone.…”

Section: Methodsmentioning

confidence: 99%

“…It has been shown that patients with mild to moderate COPD tolerate exposure to altitude generally well without severe adverse events. However, impairments of exercise capacity, postural control, more severe exertional oxygen desaturation, increased central sleep apnea, and, of interest, increased PAP were demonstrated in COPD during a short stay at altitude (8,9,16,17,26). Glucocorticosteroids such as dexamethasone not only are used to treat airway inflammation and airflow obstruction in exacerbated COPD (27) but are commonly used to treat acute high-altitude illnesses.…”

Section: Introductionmentioning

confidence: 99%

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Right-to-left shunts in lowlanders with COPD traveling to altitude: a randomized controlled trial with dexamethasone

Lichtblau

Furian

Aeschbacher

et al. 2020

Journal of Applied Physiology

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Right-to-left shunts (RLS) are prevalent in patients with chronic obstructive pulmonary disease (COPD) and might exaggerate oxygen desaturation, especially at altitude. The aim of this study was to describe the prevalence of RLS in patients with COPD traveling to altitude and the effect of preventive dexamethasone. Lowlanders with COPD [Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1–2, oxygen saturation assessed by pulse oximetry ([Formula: see text]) >92%] were randomized to dexamethasone (4 mg bid) or placebo starting 24 h before ascent from 760 m and while staying at 3,100 m for 48 h. Saline-contrast echocardiography was performed at 760 m and after the first night at altitude. Of 87 patients (81 men, 6 women; mean ± SD age 57 ± 9 yr, forced expiratory volume in 1 s 89 ± 22% pred, [Formula: see text] 95 ± 2%), 39 were assigned to placebo and 48 to dexamethasone. In the placebo group, 19 patients (49%) had RLS, of which 13 were intracardiac. In the dexamethasone group 23 patients (48%) had RLS, of which 11 were intracardiac ( P = 1.0 vs. dexamethasone). Eleven patients receiving placebo and 13 receiving dexamethasone developed new RLS at altitude ( P = 0.011 for both changes, P = 0.411 between groups). RLS prevalence at 3,100 m was 30 (77%) in the placebo and 36 (75%) in the dexamethasone group ( P = not significant). Development of RLS at altitude could be predicted at lowland by a higher resting pulmonary artery pressure, a lower arterial partial pressure of oxygen, and a greater oxygen desaturation during exercise but not by treatment allocation. Almost half of lowlanders with COPD revealed RLS near sea level, and this proportion significantly increased to about three-fourths when traveling to 3,100 m irrespective of dexamethasone prophylaxis. NEW & NOTEWORTHY The prevalence of intracardiac and intrapulmonary right-to-left shunts (RLS) at altitude in patients with chronic obstructive pulmonary disease (COPD) has not been studied so far. In a large cohort of patients with moderate COPD, our randomized trial showed that the prevalence of RLS increased from 48% at 760 m to 75% at 3,100 m in patients taking placebo. Preventive treatment with dexamethasone did not significantly reduce the altitude-induced recruitment of RLS. Development of RLS at 3,100 m could be predicted at 760 m by a higher resting pulmonary artery pressure and arterial partial pressure of oxygen and a more pronounced oxygen desaturation during exercise. Dexamethasone did not modify the RLS prevalence at 3,100 m.

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“…Patients had a respiratory sleep study (Alice 5, Philips Respironics) according to international standards ( 17 , 18 ) at low and high altitude. Apneas/hypopneas were scored when there was a reduction of nasal pressure swings or the inductive plethysmographic sum signal to <50% of baseline for >10 s, as described previously ( 19 – 21 ) (Transient reductions in breathing amplitude to <50% of baseline for 5–10 s were also scored as apneas/hypopneas if they occurred as part of a periodic breathing pattern with hyperventilation alternating with central apneas/hypopneas for at least three consecutive cycles.). The apnea/hypopnea index (AHI) was computed as the number of events per hour of total sleep time and time in bed; the oxygen desaturation index (ODI, > 3% SpO 2 dips) was computed as the number of events per hour of time in bed as described previously ( 22 ).…”

Section: Methodsmentioning

confidence: 99%

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

Cited by 16 publications

References 34 publications

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

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

Right-to-left shunts in lowlanders with COPD traveling to altitude: a randomized controlled trial with dexamethasone

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

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