Is Poor Sleep Quality at High Altitude Separate from Acute Mountain Sickness? Factor Structure and Internal Consistency of the Lake Louise Score Questionnaire

MacInnis, Martin J.; Lanting, Shawnda; Rupert, Jim L.; Koehle, Michael S.

doi:10.1089/ham.2013.1030

Cited by 38 publications

(24 citation statements)

References 17 publications

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“…The observed 66% of overall sleep impairment was similar to prior high altitude sleep studies, where 32%-60% of subjects reported disturbed sleep ( Jafarian et al, 2008). Sleep disturbances at high altitude are frequent, and sleep quality has been shown to have the weakest correlation with other AMS symptoms (Macinnis et al, 2013). While sleep time was significantly decreased in the EPAP group, it was difficult to determine if this was due to the discomfort of increased work of breathing with expiratory resistance.…”

Section: Discussionsupporting

confidence: 79%

Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID)

Lipman

Kanaan

Phillips

et al. 2015

High Altitude Medicine & Biology

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Lipman, Grant S., Nicholas C. Kanaan, Caleb Phillips, Dave Pomeranz, Patrick Cain, Kristin Fontes, Becky Higbee, Carolyn Meyer, Michael Shaheen, Sean Wentworth, and Diane Walsh. Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID). High Alt Med Biol 16:154-161, 2015.--Acute mountain sickness (AMS) affects 25%-70% of the tens of millions of high altitude travelers annually, with hypoxia and nocturnal desaturations as major contributing factors. This is the first double blind randomized placebo controlled trial to assess expiratory positive airway pressure (EPAP) for AMS prevention and nocturnal hypoxic events. Healthy adult participants trekking in the Khumbu region of the Himalayas were randomized to a single-use EPAP nasal strip, or a visually identical sham device (placebo) prior to first night sleeping between 4371-4530 m (14,340-14,800 ft). The primary outcome was AMS incidence, measured by Lake Louise Questionnaire (LLQ), with secondary outcomes of AMS severity (by LLQ) and physiologic sleep indices measured by continuous sleep monitor. Intent-to-treat analysis included 219 participants with comparable demographic characteristics, of which 115 received EPAP and 104 placebo. There was no decrease in AMS with EPAP intervention (14% EPAP vs. 17% placebo; p=0.65; risk difference (-)3.15%, 95% CI (-)12.85%-6.56%). While overall AMS severity was not different between groups, EPAP reported decreased incidence of headache (64% vs. 76%; p<0.05, OR 0.51, 95% CI 0.27-0.95) and dizziness (81% vs. 98%; p<0.03, OR 0.29, 95% CI 0.09-0.78). During sleep, EPAP resulted in significant improvements in average peripheral oxygenation (Spo(2)) (80% versus 78%; p<0.01, mean difference=2, 95% CI 0.58-3.63) and a reduced percentage of time below 80% Spo(2) (31% vs. 46%; p<0.03, median difference=16, 95% CI 2.22-28.18). This lightweight and inexpensive EPAP device did not prevent acute mountain sickness, but did reduce the subgroup incidence of headache and dizziness while improving average nighttime peripheral oxygenation.

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Section: Discussionsupporting

confidence: 79%

Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID)

Lipman

Kanaan

Phillips

et al. 2015

High Altitude Medicine & Biology

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“…Recently this discussion has intensified. Two independent reports in 2013 provided empirical evidence that sleep disturbance is discordant from other symptoms of AMS (MacInnis et al, 2013;Hall et al, 2014). Hall et al (2014) used network analysis of data from 292 research volunteers exposed to altitudes from 3650 to 5200 m to demonstrate that sleep disturbance correlated poorly with other symptoms of AMS.…”

Section: Rationale For Revising the Lake Louise Ams Scorementioning

confidence: 99%

“…Importantly, sleep disturbance was absent in 40% of cases with severe headache, long considered a hallmark of AMS. MacInnis et al (2013) applied factor analysis to Lake Louise AMS scores of 491 Nepalese pilgrims at 4390 m and revealed that sleep had only a weak relationship with the other four symptoms in the score. Milledge also expressed doubt as to whether sleep disturbance was a symptom of AMS, or rather an effect of hypoxia per se, based on his own experience with AMS studies (Milledge, 2014).…”

Section: Rationale For Revising the Lake Louise Ams Scorementioning

confidence: 99%

“…With 25 years of use in hundreds of publications, the Lake Louise AMS score has provided a robust and practical tool for researchers to diagnose and to score the severity of AMS. Recent opinion (Milledge, 2014) and research (MacInnis et al, 2013;Hall et al, 2014) have suggested that updating the Lake Louise AMS score is in order. This article outlines the brief historical background, reviews diagnostic criteria, describes modifications to the score, and offers suggested experimental procedures that may improve the use of the score in future studies.…”

Section: Introductionmentioning

confidence: 99%

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The 2018 Lake Louise Acute Mountain Sickness Score

Roach

Hackett

Oelz

et al. 2018

High Altitude Medicine & Biology

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398

278

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“…In the recent prospective study (MacInnis et al, 2013a), forty-eight pairs of siblings were identified, but family history was not found to be a risk factor for AMS although signs of familial aggregation were evident. The pilgrims have also helped out with trying to refine the Lake Louise Score Questionnaire and AMS diagnosis (Macinnis et al, 2012;2013b). Finally, oxygen saturation and diastolic blood pressure in 41 pilgrims were negatively and positively correlated with Lake Louise Score, respectively.…”

Section: Overview On Pilgrimagesmentioning

confidence: 99%

High Altitude Pilgrimage Medicine

Basnyat

2014

High Altitude Medicine & Biology

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Religious pilgrims have been going to high altitude pilgrimages long before trekkers and climbers sojourned in high altitude regions, but the medical literature about high altitude pilgrimage is sparse. Gosainkunda Lake (4300 m) near Kathmandu, Nepal, and Shri Amarnath Yatra (3800 m) in Sri Nagar, Kashmir, India, are the two sites in the Himalayas from where the majority of published reports of high altitude pilgrimage have originated. Almost all travels to high altitude pilgrimages are characterized by very rapid ascents by large congregations, leading to high rates of acute mountain sickness (AMS). In addition, epidemiological studies of pilgrims from Gosainkunda Lake show that some of the important risk factors for AMS in pilgrims are female sex and older age group. Studies based on the Shri Amarnath Yatra pilgrims show that coronary artery disease, complications of diabetes, and peptic ulcer disease are some of the common, important reasons for admission to hospital during the trip. In this review, the studies that have reported these and other relevant findings will be discussed and appropriate suggestions made to improve pilgrims' safety at high altitude.

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Is Poor Sleep Quality at High Altitude Separate from Acute Mountain Sickness? Factor Structure and Internal Consistency of the Lake Louise Score Questionnaire

Abstract: The sleep quality item of the LLSQ was weakly related to the other items of the LLSQ. Future research should further investigate whether impaired sleep at altitude should be considered separately from other symptoms of AMS.

Cited by 38 publications

References 17 publications

Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID)

Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID)

The 2018 Lake Louise Acute Mountain Sickness Score

High Altitude Pilgrimage Medicine

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