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Sleep and breathing in high altitude pulmonary edema susceptible subjects at 4,559 meters


Nussbaumer-Ochsner, Yvonne; Schuepfer, Nicole; Ursprung, Justyna; Siebenmann, Christoph; Maggiorini, Marco; Bloch, Konrad E (2012). Sleep and breathing in high altitude pulmonary edema susceptible subjects at 4,559 meters. Sleep, 35(10):1413-1421.

Abstract

STUDY OBJECTIVES: Susceptible subjects ascending rapidly to high altitude develop pulmonary edema (HAPE). We evaluated whether HAPE leads to sleep and breathing disturbances that are alleviated by dexamethasone.
DESIGN: Double-blind, randomized, placebo-controlled trial with open-label extension.
SETTING: One night in sleep laboratory at 490 m, 2 nights in mountain hut at 4,559 m.
PARTICIPANTS: 21 HAPE susceptibles.
INTERVENTION: Dexamethasone 2 × 8 mg/d, either 24 h prior to ascent and at 4,559 m (dex-early), or started on day 2 at 4,559 m only (dex-late).
MEASUREMENTS: Polysomnography, questionnaires on sleep and acute mountain sickness.
RESULTS: Polysomnographies at 490 m were normal. In dex-late (n = 12) at 4,559 m, night 1 and 3, median oxygen saturation was 71% and 80%, apnea/hypopnea index 91.3/h and 9.6/h. In dex-early (n = 9), corresponding values were 78% and 79%, and 85.3/h and 52.3/h (P < 0.05 vs. 490 m, all instances). In dex-late, ascending from 490 m to 4,559 m (night 1), sleep efficiency decreased from 91% to 65%, slow wave sleep from 20% to 8% (P < 0.05, both instances). In dex-early, corresponding sleep efficiencies were 96% and 95%, slow wave sleep 18% and 9% (P < 0.05). From night 1 to 3, sleep efficiency remained unchanged in both groups while slow wave sleep increased to 20% in dex-late (P < 0.01). Compared to dex-early, initial AMS scores in dex-late were higher but improved during stay at altitude.
CONCLUSIONS: HAPE susceptibles ascending rapidly to high altitude experience pronounced nocturnal hypoxemia, and reduced sleep efficiency and deep sleep. Dexamethasone taken before ascent prevents severe hypoxemia and sleep disturbances, while dexamethasone taken 24 h after arrival at 4,559 m increases oxygenation and deep sleep.

Abstract

STUDY OBJECTIVES: Susceptible subjects ascending rapidly to high altitude develop pulmonary edema (HAPE). We evaluated whether HAPE leads to sleep and breathing disturbances that are alleviated by dexamethasone.
DESIGN: Double-blind, randomized, placebo-controlled trial with open-label extension.
SETTING: One night in sleep laboratory at 490 m, 2 nights in mountain hut at 4,559 m.
PARTICIPANTS: 21 HAPE susceptibles.
INTERVENTION: Dexamethasone 2 × 8 mg/d, either 24 h prior to ascent and at 4,559 m (dex-early), or started on day 2 at 4,559 m only (dex-late).
MEASUREMENTS: Polysomnography, questionnaires on sleep and acute mountain sickness.
RESULTS: Polysomnographies at 490 m were normal. In dex-late (n = 12) at 4,559 m, night 1 and 3, median oxygen saturation was 71% and 80%, apnea/hypopnea index 91.3/h and 9.6/h. In dex-early (n = 9), corresponding values were 78% and 79%, and 85.3/h and 52.3/h (P < 0.05 vs. 490 m, all instances). In dex-late, ascending from 490 m to 4,559 m (night 1), sleep efficiency decreased from 91% to 65%, slow wave sleep from 20% to 8% (P < 0.05, both instances). In dex-early, corresponding sleep efficiencies were 96% and 95%, slow wave sleep 18% and 9% (P < 0.05). From night 1 to 3, sleep efficiency remained unchanged in both groups while slow wave sleep increased to 20% in dex-late (P < 0.01). Compared to dex-early, initial AMS scores in dex-late were higher but improved during stay at altitude.
CONCLUSIONS: HAPE susceptibles ascending rapidly to high altitude experience pronounced nocturnal hypoxemia, and reduced sleep efficiency and deep sleep. Dexamethasone taken before ascent prevents severe hypoxemia and sleep disturbances, while dexamethasone taken 24 h after arrival at 4,559 m increases oxygenation and deep sleep.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2012
Deposited On:17 Jan 2013 12:01
Last Modified:05 Apr 2016 16:17
Publisher:Associated Professional Sleep Societies
ISSN:0161-8105
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.5665/sleep.2126
PubMed ID:23024440

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