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[Co-occurrence of soil fauna communities with changes in altitude on the northern slope of Changbai Mountain].

The co-occurrence of soil fauna communities at different altitudes may reflect at some extent the relationships among communities, their coexistence, and the replacement of species along the altitude gradient. The continuous or disjunctive distribution of different species along altitude gradient not only reflected the environment variation at altitude gradient, but also the biological and ecological spatiality as well as the adaptability of species. The northern slope of Changbai Moutain has not only a high diversity in soil fauna types and species, but also a high variation of diversity pattern along the altitude gradient, which is a perfect transect for the research of biodiversity and gradient patterns. From 550 m to 2,560 m on the northern slope of Changbai Mountain, twenty-two plots were investigated with an interval of 100 m in altitude. By using Jaccard index, the co-occurrence of soil fauna communities at different altitudes was analyzed. For the species of different life forms or for all the species as a whole, the co-occurrence of soil faunae between neighboring communities was the highest, except for that between different soil fauna types. The peak and valley values of the co-occurrence of soil fauna communities along altitude gradient were matched with their gradient patterns, and the co-occurrence of soil faunae at different layers or all of the soil fauna communities were decreased with increasing altitude difference.

Altitude↗

[Criteria suitable for diagnosis of acute respiratory distress syndrome/multiple organ dysfunction syndrome at moderately high altitude area].

OBJECTIVE: To compare the diagnostic parameters of acute respiratory distress syndrome/multiple organ dysfunction syndrome (ARDS/MODS) at high altitude (H-ARDS/MODS) with that on plain, and to establish a more practical diagnostic criterion of H-ARDS/MODS. METHODS: Five hundred and five cases fulfilled the criteria for the diagnosis of ARDS/MODS were divided into three groups according to the altitude of their habitation: control group including inhabitants (<430 m) on plain (CG, n=113), moderate high altitude group 1 inhabitants at the altitude of 1,517 m (H1G, n=314), moderate high altitude group 2 inhabitants at the altitude of 2,261 m to 2,400 m (H2G, n=78). The ARDS/MODS scores of the three groups were made according to the diagnostic criteria of Lushan conference, Marshall(1995) and Lanzhou criteria drafted by the authors respectively to set up three data analyzing models, followed by plotting of receiver operating characteristic curves (ROC curve) and calculation of the Yordon Index and the optimum cutoff points of the parameters,in order to study the accuracy of the three diagnostic criteria in predicting the outcome of the patients suffering from ARDS/MODS. RESULTS: In CG group, the differences were not significant in area of ROC, the maximal Yordon Index, the optimum cutoff points and the sensitivity and the specificity for three criteria; but the differences were significant for the three criteria in H1G group. Further investigation in comparing the ROC values of lung, brain, heart and kidney, the Lanzhou criteria were more advantageous in the high altitude than the other criteria. CONCLUSION: (1)The current diagnostic criteria of ARDS/MODS are not suitable for the diagnosis of these syndromes in moderately high or high altitude areas. It is necessary to revise the diagnostic criteria of H-ARDS/MODS. (2)One thousand five hundred and seventeen meters in altitude might be considered to be an important borderline, above with the diagnostic criteria of ARDS/MODS for patients inhabiting on plain could not be suitably applied to those living above this level.

Altitude↗

[Clinical classification of altitude sickness: analysis of 13,403 cases].

The clinical classification and characteristics of various types of plateau sickness were reported after analysing 13,403 such cases in Tibet region. The conception of plateau sickness and the opinion of its classification in China and abroad were discussed and the names suggested for various types of the disease were also given. However, the rationality of different classifications of the sickness was questioned according to the present understanding of its pathology and clinical manifestations. It is the opinion of the authors to divide this sickness, first of all, into two categories of acute and chronic and then to subdivide each of them into several types according to clinical symptoms and the pathological changes of principally encroached organs. The acute category was subdivided into 4 types as follows: 1. high altitude acute response (HAAR); 2. high altitude pulmonary edema (HAPE); 3. high altitude cerebral edema (HACE); 4. high altitude children cardiopathy (HACC). The chronic category was subdivided into 5 types as follows: 1. high altitude chronic response (HACR); 2. high altitude erythoblastosis (HAEb); 3. high altitude adult cardiopathy (HAAC); 4. high altitude hypertension (HAHyper); 5. high altitude hypotension (HAHypo). This classification is useful in clinical practice and research.

Adolescent↗

Cardiovascular responses to upright tilt at a simulated altitude of 3,700 m in men.

To examine the effects of high altitude on cardiovascular responses to orthostasis, 11 healthy males were tested at a 10-min passive 70 degrees head-up tilt at sea level and at a simulated high altitude of 3,700 m. During the control period in the supine position, heart rate and forearm blood flow were higher at high altitude (p < 0.05). Mean arterial pressure remained unchanged during head-up tilt at sea level, but it reduced from 82 mm Hg to 72 mm Hg (p < 0.05) during head-up tilt at high altitude. There were no altitude-related changes in the magnitude of the increase in forearm vascular resistance and the reduction in cardiac output and laser-Doppler skin blood flow in response to head-up tilt. The total peripheral resistance increased from 14.4 to 20.5 mm Hg.L-1 x min-1 (p < 0.05) during head-up tilt at sea level, but the change was not significant at high altitude. The lack of altitude-related changes in forearm vascular resistance and laser-Doppler skin blood flow during head-up tilt in the presence of attenuated total peripheral resistance response at high altitude may suggest that the orthostatic hypotension at high altitude is associated with a lower magnitude of vasoconstrictor response in the regions other than the limbs and the skin.

Adult↗

Body mass index and age at menarche in Peruvian children living at high altitude and at sea level.

The present study was designed to determine the relationship between body mass index (BMI) and age at menarche in girls (aged 10-19 years) living in Lima (150 m) and in Cerro de Pasco (4340 m above sea level). The purpose of the study was to determine whether the relationships between BMI and both age at menarche and chronological age differ between girls living at low and at high altitude. The ratio weight/height (the Benn index) was used in the present study as a variant of BMI because the exponent minimizes the relationship with height and maximizes the relationship with weight. From 10 to 16 years of age the Benn index of highlander girls was lower than that for girls at sea level, but at 17-19 years the differences disappeared. A later age at menarche was observed at high altitude than at sea level after controlling for socioeconomic status and for the Benn index. The value of the Benn index at the time of menarche, after controlling for chronological age in the analysis, was significantly higher at high altitude than at sea level. It was also observed that the higher the chronological age, the lower the value of the Benn index at the time of menarche. Using the median ages at menarche in Lima and in Cerro de Pasco, we found that a higher Benn index at the time of menarche is still observed at high altitude compared with girls from sea level. In Lima body weight and height were directly related to age at menarche (p < 0.001 and p < 0.005, respectively), whereas in Cerro de Pasco only weight was related to age at menarche (p < 0.001). The value of body weight at the time of menarche, after controlling for height in the analysis, was significantly higher at high altitude than at sea level. The stepwise multiple regression analysis of data from 93 girls having menarche at the time of or at most one month before the study showed that weight and altitude x height are predictors of age at menarche. These data suggest that age at menarche has an effect on both age and the Benn index acting independently and that later age at menarche in girls from Cerro de Pasco is an independent effect of altitude. Because the Benn index for menarche was different at sea level and at high altitude, we conclude that regression equations to predict age at menarche must include altitude as an independent variable.

Adolescent↗

Acute ventilatory response to simulated altitude, normobaric hypoxia, and hypobaria.

BACKGROUND: Some reports claim that ventilation (VE) is greater in human subjects in normobaric hypoxia than at altitude following an equivalent drop in inspired PO2 (PIO2). It has been suggested that reduced barometric pressure (PB) may decrease chemoreceptor sensitivity and account for these results. In this pilot study we tested the hypothesis that VE and hypoxic chemoresponsiveness would not be different after 30 min of normobaric hypoxia and altitude. METHODS: We exposed three male and three female subjects to four conditions in an environmental chamber, varying the order. The four conditions were: air (PB = 640, FIO2 = 0.204), hypobaria (434, 0.298), hypoxia (640, 0.141) and altitude (434, 0.203). We measured VE, end-tidal O2 and CO2 and arterial O2 saturation (SpO2) after 30 min in each environment, and while breathing 100% O2 for 1 min immediately thereafter. RESULTS: The mean increase in VE relative to air was 14%, 20% and 26% for hypobaria, hypoxia and altitude, respectively, with corresponding reductions in PETCO2 in the three conditions. The reduction in VE with 100% O2 was inversely proportional to the rise in SpO2 in all cases, indicating that chemoresponsiveness was unchanged by PB. When hypobaria preceded altitude, the VE at altitude increased less, relative to air, than when altitude was given first (not significant). CONCLUSIONS: The VE and chemosensitivity are about the same after 30 min of altitude and equivalent hypoxia. However, when the drop in PIO2 is not synchronous with the drop in PB, like at altitude, the VE values may be altered. Air density, hypoxic pulmonary vasoconstriction and circulating microbubbles may interact to account for the observed findings.

Adult↗

[High altitude retinal hemorrhages in the expeditions to 8,000 meter peaks. A study of 10 cases].

BACKGROUND: Retinal haemorrhages are common at high altitude. Their pathogenesis is unknown. It has been suggested that they are less frequent in sherpas, and that possible predisposing factors might be the abscence of previous high-altitude experience, the extent of the high-altitude hypoxic exposure, polycythemia (because of hyperviscosity), history of cough and Valsalva manoeuvres during the expedition, existence of severe forms of mountain sickness (high-altitude pulmonary oedema and high-altitude cerebral oedema) and use of antiinflammatory drugs. The aim of this study is to know the incidence of retinal haemorrhages in the expeditions to mountains higher than 8.000 m and their relationship to the previously referred possible predisposing factors. SUBJECTS AND METHODS: Funduscopy was performed on 17 healthy subjects taking part in expeditions to Cho-Oyu (8.201 m) and to Shisha Pangma (8.046 m) and on six of their Nepali coworkers. RESULTS: Retinal haemorrhages were found in 10 of the European (59%) and in none of the Nepali mountaineers (p = 0.019). Other 2 Spanish climbers had tortuosity and engorgment of the retinal veins. No statistical association was found between retinal haemorrhages and maximal altitude attained prior to the expedition, maximal altitude reached during the present expedition, number of nights spent at extreme altitude, weight loss as an expression of chronic exposure to hypoxia, haemoglobin, history of cough or Valsalva manoeuvres during the expedition, existence of severe forms of mountain sickness or use of drugs. CONCLUSIONS: These results do not allow us to state that the mentioned factors predispose to high-altitude retinal haemorrhages.

Adult↗

Stereological study of the effect of altitude on the trophoblast cell populations of human term placental villi.

Paraffin-embedded histological material was examined from 10 placentae from uncomplicated pregnancies at high altitude (3000 m). This was compared with material from 10 placentae delivered at low altitude (500 m). The sample groups were matched for maternal age, gestational age and parity. Within terminal and intermediate villi the volume-weighted mean cytotrophoblast cell volume did not significantly change at high altitude (754.1 microm3 at low altitude versus 796 microm3 at high altitude). The fractional volume of the villi occupied by cytotrophoblastic cells and their nuclei number per 10000 microm3 of villous tissue were significantly greater in placenta from high altitude (3.17 and 1.86 per cent, respectively) than those from low altitude (1.05 and 0.79 per cent, respectively) (P<0.0004 and P<0.0058, respectively). No significant differences in either fractional volume of the syncytiotrophoblast or its nuclei number per 10000 microm3 of villous tissue were observed between placentae from high (26.01 and 11.6 per cent, respectively) and low altitude (26.33 and 11.89 per cent, respectively). These results suggest an increase in the number of cytotrophoblastic cells at high altitudes without any changes in their volume. Exposure to hypobaric hypoxia is thought to be the principal aetiological factor.

Cell Count↗

Comparative aspects of high-altitude adaptation in human populations.

The conditions and duration of high-altitude residence differ among high-altitude populations. The Tibetan Plateau is larger, more geographically remote, and appears to have been occupied for a longer period of time than the Andean Altiplano and, certainly, the Rocky Mountain region as judged by archaeological, linguistic, genetic and historical data. In addition, the Tibetan gene pool is less likely to have been constricted by small numbers of initial migrants and/or severe population decline, and to have been less subject to genetic admixture with lowland groups. Comparing Tibetans to other high-altitude residents demonstrates that Tibetans have less intrauterine growth retardation better neonatal oxygenation higher ventilation and hypoxic ventilatory response lower pulmonary arterial pressure and resistance lower hemoglobin concentrations and less susceptibility to CMS These findings are consistent with the conclusion that "adaptation" to high altitude increases with time, considering time in generations of high-altitude exposure. Future research is needed to compare the extent of IUGR and neonatal oxygenation in South American high-altitude residents of Andean vs. European ancestry, controlling for gestational age and other characteristics. Another fruitful line of inquiry is likely to be determining whether persons with CMS or other altitude-associated problems experienced exaggerated hypoxia during prenatal or neonatal life. Finally, the comparison of high-altitude populations with respect to the frequencies of genes involved in oxygen sensing and physiologic response to hypoxia will be useful, once candidate genes have been identified.

Acclimatization↗

Lung disease at high altitude.

The lungs are a delicate interface between the atmosphere and our bodies across which oxygen diffuses from the air we breathe to the blood which carries oxygen to the cells and mitochondria. In healthy lungs at sea level where there is a surfeit of oxygen, this process occurs easily, whereas, in lungs with disease it becomes a task which may not be fully successful and hypoxemia may ensue or worsen. At high altitude where the barometric pressure (Pb) and thus the supply of oxygen is lower, the job of getting oxygen to the blood, even in the healthy lung is more difficult, and in the diseased lung it may be impossible. This presentation will review the lungs' responses to high altitude, with emphasis on the abnormal. Both acute and chronic responses of patients with pre-existing lung disease will be reviewed. Pulmonary diseases encountered at high altitude in previously healthy people, such as high altitude pulmonary edema and chronic mountain sickness will be touched on only as they pertain to other patients. Pre-existing lung disease (with and without hypoxemia at sea level) such as obstructive lung diseases (asthma, COPD, emphysema), and restrictive lung diseases (sarcoid, asbestosis, interstitial pulmonary fibrosis) will be discussed in terms of gas exchange, lung mechanics, and treatment at high altitude. Disorders of ventilatory control; e.g., obesity-hypoventilation syndrome and sleep apnea, may present formidable problems, and guidelines for their treatment will be discussed. Infectious lung diseases; e.g., pneumonia, cystic fibrosis, and pulmonary vascular disorders such as chronic mountain sickness, primary pulmonary hypertension, and congenital absence of the pulmonary artery are important disorders that require special attention because of the accentuated hypoxic pulmonary vascular response encountered at high altitude. The purpose therefore, is to provide the medical practitioner with the insight into prevention, recognition, and treatment of pulmonary problems encountered specifically at high altitude, as well as guidance on how best to advise patients with lung disease who want to fly in airplanes and/or ascend to high altitude for work or pleasure.

Altitude↗

Effect of magnesium, high altitude and acute mountain sickness on blood flow velocity in the middle cerebral artery.

Cerebral blood flow is thought to increase at high altitude and in subjects suffering from acute mountain sickness (AMS); however, data from the literature are contentious. Blood flow velocity in the middle cerebral artery (MCAv) may be used as a proxy measure of cerebral blood flow. Using transcranial Doppler sonography, MCAv was measured during normo- and hyper-ventilation in subjects who participated in a trial that tested the effect of magnesium supplementation on the prevention of AMS. First, MCAv was recorded at 353 m (baseline). Subjects were then randomized to receive oral magnesium citrate and matching placebo. A second measurement was taken after a 24 +/- 2 h ascent from 1130 m to 4559 m (altitude I), and a third after a 20-24 h stay at 4559 m (altitude II). Using multivariate linear regression, an association was sought between MCAv and magnesium supplementation, subjects' age and gender, altitude itself, a temporary stay at altitude, and the presence of AMS (Lake Louise Score >6 with ataxia, nausea and/or headache). Subjects with AMS had additional Doppler recordings immediately before and after rescue medication (oxygen, dexamethasone and acetazolamide). Forty-seven subjects had measurements at baseline, 39 (21 receiving magnesium and 18 placebo) at altitude I and 26 (13 receiving magnesium and 13 placebo) at altitude II. During hyperventilation, MCAv decreased consistently (for each measurement, P<0.001). Magnesium significantly increased MCAv by 8.4 cm.s(-1) (95% confidence interval, 1.8-15), but did not prevent AMS. No other factors were associated with MCAv. Eleven subjects had severe AMS [median score (range), 11 (8-16)] and, after rescue medication, the median score decreased to 3 (range, 0-5; P=0.001), but MCAv remained unchanged (65 +/- 18 cm.s(-1) before compared with 67 +/- 16 cm.s(-1) after rescue medication; P=0.79). MCAv was increased in subjects who received magnesium, but was not affected by exposure to high altitude or by severe AMS.

Administration, Oral↗

Extreme altitude mountaineering and Type 1 diabetes; the Diabetes Federation of Ireland Kilimanjaro Expedition.

AIMS: To examine the effects of extreme altitude mountaineering on glycaemic control in Type 1 diabetes, and to establish whether diabetes predisposes to acute mountain sickness (AMS). METHODS: Fifteen people with Type 1 diabetes and 22 nondiabetic controls were studied during the Diabetes Federation of Ireland Expedition to Kilimanjaro. Daily insulin requirements, blood glucose estimations and hypoglycaemic attacks were recorded in diaries by the people with diabetes. The performance of blood glucose meters at altitude was assessed using standard glucose solutions. Symptoms of acute mountain sickness were recorded daily by people with diabetes and by the nondiabetic controls using the Lake Louise Scoring Charts. The expedition medical team recorded the incidence of complications of altitude and of diabetes. The final height attained for each individual was recorded by the expedition medical team and verified by the expedition guides. RESULTS: The final altitude ascended was lower in the diabetic than the nondiabetic group (5187 +/- 514 vs. 5654 +/- 307 m, P = 0.001). The mean daily insulin dose was reduced from 67.1 +/- 28.3-32.9 +/- 11.8 units (P < 0.001), but only 50% of recorded blood glucose readings were within the target range of 6-14 mmol/L. There were few hypoglycaemic attacks after the first two days of climbing. Both blood glucose meters tested showed readings as low as 60% of standard glucose concentrations at high altitude and low temperatures. The Lake Louise questionnaires showed that symptoms of AMS occurred equally in the diabetic and nondiabetic groups. There were two episodes of mild diabetic ketoacidosis; two of the diabetic group and three of the nondiabetic group developed retinal haemorrhages. CONCLUSIONS: People with Type 1 diabetes can participate in extreme altitude mountaineering. However, there are significant risks associated with this activity, including hypoglycaemia, ketoacidosis and retinal haemorrhage, with the additional difficulties in assessing glycaemic control due to meter inaccuracy at high altitude. People with Type 1 diabetes must be carefully counselled before attempting extreme altitude mountaineering.

Altitude↗

Effects of aspirin during exercise on the incidence of high-altitude headache: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy of aspirin for headache when exercising during acute high-altitude exposure. BACKGROUND: Aspirin effectively prevents headache when mostly resting during acute high-altitude exposure. However, the majority of individuals exposed to high altitude perform mountaineering activities, which might trigger headache. DESIGN: Randomized, double-blind, placebo-controlled trial. METHODS: Thirty-one healthy volunteers (20 men, 11 women; aged 22 to 59 years) were transported to an altitude of about 3000 meters and climbed up to 3800 meters. They then descended to a mountain hut at 3480 meters and spent 2 nights there. Tablets (placebo or 320 mg aspirin) were administered three times at 4-hour intervals, beginning 2 hours before arrival at high altitude. Headache scoring and measurements of heart rate, blood pressure, and arterial oxygen saturation were performed. RESULTS: Ninety-three percent (14 of 15) of the placebo group and 56% (9 of 16) of the aspirin group developed headache when mountaineering activities were performed during acute exposure to high altitude (P<.05). Five hours after arrival at high altitude, mean resting oxygen saturation was 86.1% +/- 2.1% with aspirin and 85.7 % +/- 2.8% with placebo (P =.66). However, subjects in the aspirin group developed headache at saturation values less than or equal to 86%, while those in the placebo group developed headache at saturation values less than 90%. CONCLUSIONS: Although the prophylactic intake of about 1 gram of aspirin reduced the headache incidence when exercising during acute high-altitude exposure, the incidence of headache was higher than previously shown for resting conditions. Aspirin resulted in tolerance to lower arterial oxygen saturation without development of headache; exercise had the opposite effect.

Acute Disease↗

Oxygen saturation course and altitude symptomatology during an expedition to broad peak (8047 m).

Thirteen healthy European mountaineers (11 male, 2 female) participated in the 62-day German-Pakistani Research Expedition to Broad Peak (8047 m) in the Karakorum, Pakistan. During ascent, base camp stay and approach to the summit, oxygen saturation was measured by pulse oximetry at rest, during exercise and during sleep; in addition, questionnaires on high altitude symptomatic had to be answered. We found a dramatic decrease in oxygen saturation especially at extreme altitudes (7100 m: Median 63%, Min 59%, Max 65%) and a long time required for real acclimatization. The lowest figures at 4850 m were found during maximal exercise, 77.5% (69 - 85%) and during sleep, 81% (73 - 88%), the highest ones at rest, 86.5% (77 - 89%). There was a significant correlation (Spearman rank correlation coefficient with ties) between measured oxygen saturation during the ascent to/stay at base camp and high altitude illness (p = 0.005 - 0.05), as well as with high altitude performance (p = 0.025 - 0.01). The limiting values of "no high altitude symptomatic", "high altitude discomfort", AMS and the malignant forms could be estimated for acclimatized (>90%/>80%/>70%/<70%) and unacclimatized (>80%/>70%/>65%/<65%) condition. Pulse oximetry is an objective non-invasive method of measurement that is easy to handle. It is a suitable device besides clinical examination and questionnaire-test in the diagnosis of high altitude illness even in the hands of non-professionals. The measurement at sleep can possibly explain present high altitude symptomatic despite of (nearly) normal oxygen saturation values at rest.

Adult↗

Integrative Genomic, Transcriptomic and Epigenomic Analysis Reveals cis-regulatory Contributions to High-altitude Adaptation in Tibetan Pigs.

The Qinghai-Tibet Plateau, characterized by its extreme environmental conditions, presents significant challenges to life, making it an ideal region for studying adaptation and evolution. Tibetan pigs, known for their high genetic diversity and exceptional adaptability to high altitudes, serve as excellent models for investigating high-altitude adaptation. While previous studies have extensively identified genetic determinants associated with high-altitude adaptation, the molecular mechanisms, particularly cis-regulatory patterns, remain poorly understood. Here, we conducted a selective sweep analysis using 484 genomes from Chinese and Western pig breeds across various altitudes, revealing 38.56 Mb of genomic regions under selection in Tibetan pigs. Enrichment analysis identified the lung as the primary functional tissue involved in high-altitude adaptation, supported by tissue-specific transcriptional and regulatory patterns observed between Tibetan and Meishan pigs (low altitude). By integrating genomic, RNA-seq, ATAC-seq, and H3K27ac HiChIP data, we constructed comprehensive enhancer-promoter regulatory maps of candidate genes and pinpointed promising genetic determinants associated with high-altitude adaptation, including SNPs in EPAS1, KLF13, SPRED1, and CFD. These loci were predicted to influence chromatin accessibility and the interactions of regulatory elements, with altered binding strength of relevant transcription factors. Further in vitro experiments confirmed that these loci function as allele-specific enhancers, modulating the expression of target genes. Our findings elucidate the regulatory basis of high-altitude adaptation in Tibetan pigs and provide valuable insights for exploring hypoxia-related diseases in livestock and humans.

Animals↗

Acute mountain sickness is associated with sleep desaturation at high altitude.

OBJECTIVE: This study was intended to demonstrate a biologically important association between acute mountain sickness (AMS) and sleep disordered breathing. METHODOLOGY: A total of 14 subjects (eight males, six females aged 36 +/- 10 years) were studied at six different altitudes from sea level to 5050 m over 12 days on a trekking route in the Nepal Himalaya. AMS was quantified by Lake Louise (LL) score. At each altitude, sleep was studied by 13 channel polysomnography (PSG). Resting arterial blood gases (ABG) and exercise SaO2 were measured. Ventilatory responses (VR) were measured at sea level. Individual data were analysed for association at several altitudes and mean data were analysed for association over all altitudes. RESULTS: ABG showed partial acclimatization. For the mean data, there were strong positive correlations between LL score and altitude, and periodic breathing, as expected. Strong negative correlations existed between LL score and PaO2, PaCO2, sleep SaO2 and exercise SaO2, but there was no correlation with sea level VR. There were equally tight correlations between LLs/PaO2 and LL score/sleep SaO2. The individual data showed no significant correlations with LL score at any altitude, probably reflecting the non-steady state nature of the experiment. In addition, mean SaO2 during sleep was similar to minimum exercise SaO2 at each altitude and minimum sleep SaO2 was lower, suggesting that the hypoxic insult during sleep was equivalent to or greater than walking at high altitude. CONCLUSIONS: It is concluded that desaturation during sleep has a biologically important association with AMS, and it is speculated that under similar conditions (trekking) it is an important cause of AMS.

Adult↗

Sea level and acute responses to hypoxia: do they predict physiological responses and acute mountain sickness at altitude?

OBJECTIVES: To compare a range of physiological responses to acute sea level hypoxia at simulated altitudes with the same physiological responses and acute mountain sickness (AMS) scores measured at altitude (similar to the simulated altitudes) during a 17 day trek in the Himalayas. METHODS: Twenty men and women aged 18-54 years took part in the study. End tidal CO(2) tension (PETCO(2)) and saturated oxygen (SaO(2)) were measured using a capnograph. Observations made at sea level and some simulated altitudes were compared with those in the Himalayas. Pairwise correlations were used to examine the correlation between variables and regression, with 95% prediction intervals providing information on how well one variable could be predicted from another for a given subject. RESULTS: There was only a significant correlation for a few comparisons. The 95% prediction intervals for individual SaO(2) values at a range of simulated altitudes were fairly wide going from +/- 4% to +/- 5%. All of the correlations between laboratory and Himalayan PETCO(2) values were not statistically significant. There was a significant correlation for the relation between SaO(2)and PETCO(2) at sea level for the laboratory data (r=-0.51; p=0.05). For the Himalayan data, there were significant correlations at Namche Bazaar (3450 m; day 3) (r=-0.56; p=0.01) and Dingboche (4300 m; day 6) (r=-0.48; p=0.03). The correlation between SaO(2) and PETCO(2) and AMS was generally poor. CONCLUSIONS: The results indicate that limited information can be gained on a subject's response to altitude by assessing physiological variables at sea level and a range of simulated altitudes before the subject carries out a trek at altitude.

Adolescent↗

Effects of high altitude exposure on cerebral hemodynamics in normal subjects.

BACKGROUND AND PURPOSE: Acute mountain sickness (AMS) may be an early stage of high altitude cerebral edema. If so, AMS could result from an alteration of dynamic autoregulation of cerebral blood flow resulting in overperfusion of capillaries and vasogenic cerebral edema. METHODS: We measured middle cerebral artery blood flow velocity (Vmca) by transcranial Doppler and arterial blood pressure by finger plethysmography at 490 m and 20 hours after arrival at 4559 m in 35 volunteers who had been randomized to tadalafil, dexamethasone, or placebo in a study on the pharmacological prevention of high altitude pulmonary edema. A dynamic cerebral autoregulation index (ARI) was calculated from continuous recordings of Vmca and blood pressure during transiently induced hypotension. RESULTS: Altitude was associated with an increase in a cerebral-sensible AMS (AMS-C) score (P<0.001) and with a decrease in arterial oxygen saturation (Sao2), whereas average Vmca or ARI did not change. However, at altitude, the subjects with the lowest ARI combined with the lowest Sao2 presented with the highest AMS-C score (P<0.03). In addition, a stepwise multiple linear regression analysis on arterial Pco2, Sao2, and baseline or altitude ARI identified altitude ARI as the only significant predictor of the AMS-C score (P=0.01). The AMS-C score was lower in dexamethasone-treated subjects compared with high altitude pulmonary edema-susceptible untreated subjects. Neither tadalafil nor dexamethasone had any significant effect on Vmca or ARI. CONCLUSIONS: High altitude hypoxia is associated with impairment in the regulation of the cerebral circulation that might play a role in AMS pathogenesis.

Adult↗