Subscribe to RSS
Download PDF
DOI: 10.1055/s-0043-1767745
Altitude and Breathing during Sleep in Healthy Persons and Sleep Disordered Patients: A Systematic Review
Sources of Funding The authors declare that the article entitled “did not receive external funding and was carried out with the resources of the National Institute of Respiratory Diseases of Mexico.
Abstract
Objetive The aim of this systematic review is to analyze the recent scientific evidence of the clinical effects of altitude on breathing during sleep in healthy persons and sleep disordered patients.
Material and Methods A search was carried out in PubMed and Scopus looking for articles published between January 1, 2010 and December 31, 2021, in English and Spanish, with the following search terms: “sleep disorders breathing and altitude”. Investigations in adults and carried out at an altitude of 2000 meters above mean sea level (MAMSL) or higher were included. The correlation between altitude, apnea hypopnea index (AHI) and mean SpO2 during sleep was calculated.
Results 18 articles of the 112 identified were included. A good correlation was found between altitude and AHI (Rs = 0.66 P = 0.001), at the expense of an increase in the central apnea index. Altitude is inversely proportional to oxygenation during sleep (Rs = −0.93 P = 0.001), and an increase in the desaturation index was observed (3% and 4%). On the treatment of respiratory disorders of sleeping at altitude, oxygen is better than servoventilation to correct oxygenation during sleep in healthy subjects and acetazolamide controlled respiratory events and oxygenation during sleep in patients with obstructive sleep apnea under treatment with CPAP.
Conclusions Altitude increases AHI and decreases oxygenation during sleep; oxygen and acetazolamide could be an effective treatment for sleep-disordered breathing at altitude above 2000 MAMSL.
Keywords
altitude - sleep apnea, obstructive - sleep apnea, central - hypoxia - sleep apnea syndromesPublication History
Received: 12 October 2021
Accepted: 28 June 2022
Article published online:
19 April 2023
© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Moore LG, Niermeyer S, Zamudio S. Human adaptation to high altitude: regional and life-cycle perspectives. Am J Phys Anthropol 1998; 27 (Suppl. 27) 25-64.
- 2 Vázquez-García JC, Pérez-Padilla R. Valores gasométricos estimados para las principales poblaciones y sitios a mayor altitud en México. Rev Inst Nal Enf Resp Mex. 2000; 13: 6-13.
- 3 Dempsey JA, Powell FL, Bisgard GE, Blain GM, Poulin MJ, Smith CA. Role of chemoreception in cardiorespiratory acclimatization to, and deacclimatization from, hypoxia. J Appl Physiol 2014; 116 (07) 858-866.
- 4 Ainslie PN, Lucas SJE, Burgess KR. Breathing and sleep at high altitude. Respir Physiol Neurobiol 2013; 188 (03) 233-256.
- 5 Matheus-Ramírez EP, Bello-Carrera RS, Torres-Fraga MG. et al. Comentarios Clínicos a la 3ra Clasificación Internacional de los Trastornos de Respiratorios del Dormir, Primera Parte: Síndromes de Apnea Obstructiva. Respirar. 2017; 9: 4-9.
- 6 Burgess KR, Ainslie PN. Central Sleep Apnea at High Altitude. Adv Exp Med Biol 2016; 903: 275-283.
- 7 Benjafield AV, Ayas NT, Eastwood PR. et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019; 7 (08) 687-698.
- 8 Lyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology 2020; 25 (07) 690-702.
- 9 Aguayo-Albasini JL, Flores-Pastor B, Soria-Aledo V. Sistema GRADE: clasificación de la calidad de la evidencia y graduación de la fuerza de la recomendación. Cir Esp 2014; 92 (02) 82-88.
- 10 Bloch KE, Latshang TD, Turk AJ. et al. Nocturnal periodic breathing during acclimatization at very high altitude at Mount Muztagh Ata (7,546 m). Am J Respir Crit Care Med 2010; 182 (04) 562-568.
- 11 Nussbaumer-Ochsner Y, Schuepfer N, Ulrich S, Bloch KE. Exacerbation of sleep apnoea by frequent central events in patients with the obstructive sleep apnoea syndrome at altitude: a randomised trial. Thorax 2010; 65 (05) 429-435.
- 12 Pagel JF, Kwiatkowski C, Parnes B. The effects of altitude associated central apnea on the diagnosis and treatment of obstructive sleep apnea: comparative data from three different altitude locations in the mountain west. J Clin Sleep Med 2011; 7 (06) 610-5A.
- 13 Latshang TD, Nussbaumer-Ochsner Y, Henn RM. et al. Effect of acetazolamide and autoCPAP therapy on breathing disturbances among patients with obstructive sleep apnea syndrome who travel to altitude: a randomized controlled trial. JAMA 2012; 308 (22) 2390-2398.
- 14 Nussbaumer-Ochsner Y, Latshang TD, Ulrich S, Kohler M, Thurnheer R, Bloch KE. Patients with obstructive sleep apnea syndrome benefit from acetazolamide during an altitude sojourn: a randomized, placebo-controlled, double-blind trial. Chest 2012; 141 (01) 131-138.
- 15 Latshang TD, Lo Cascio CM, Stöwhas AC. et al. Are nocturnal breathing, sleep, and cognitive performance impaired at moderate altitude (1,630-2,590 m)?. Sleep 2013; 36 (12) 1969-1976.
- 16 Lombardi C, Meriggi P, Agostoni P. et al; HIGHCARE Investigators. High-altitude hypoxia and periodic breathing during sleep: gender-related differences. J Sleep Res 2013; 22 (03) 322-330.
- 17 Ulrich S, Nussbaumer-Ochsner Y, Vasic I. et al. Cerebral oxygenation in patients with OSA: effects of hypoxia at altitude and impact of acetazolamide. Chest 2014; 146 (02) 299-308.
- 18 Shogilev DJ, Tanner JB, Chang Y, Harris NS. Periodic Breathing and Behavioral Awakenings at High Altitude. Sleep Disord 2015; 2015: 279263
- 19 Heinzer R, Saugy JJ, Rupp T. et al. Comparison of Sleep Disorders between Real and Simulated 3,450-m Altitude. Sleep 2016; 39 (08) 1517-1523.
- 20 Steier J, Cade N, Walker B, Moxham J, Jolley C. Observational Study of Neural Respiratory Drive During Sleep at High Altitude. High Alt Med Biol 2017; 18 (03) 242-248.
- 21 Pramsohler S, Wimmer S, Kopp M. et al. Normobaric hypoxia overnight impairs cognitive reaction time. BMC Neurosci 2017; 18 (01) 43.
- 22 Orr JE, Heinrich EC, Djokic M. et al. Adaptive Servoventilation as Treatment for Central Sleep Apnea Due to High-Altitude Periodic Breathing in Nonacclimatized Healthy Individuals. High Alt Med Biol 2018; 19 (02) 178-184.
- 23 Pramsohler S, Schilz R, Patzak A, Rausch L, Netzer NC. Periodic breathing in healthy young adults in normobaric hypoxia equivalent to 3500 m, 4500 m, and 5500 m altitude. Sleep Breath 2019; 23 (02) 703-709.
- 24 Tan L, Latshang TD, Aeschbacher SS. et al. Effect of Nocturnal Oxygen Therapy on Nocturnal Hypoxemia and Sleep Apnea Among Patients With Chronic Obstructive Pulmonary Disease Traveling to 2048 Meters: A Randomized Clinical Trial. JAMA Netw Open 2020; 3 (06) e207940
- 25 Frost S, E Orr J, Oeung B. et al. Improvements in sleep-disordered breathing during acclimatization to 3800 m and the impact on cognitive function. Physiol Rep 2021; 9 (09) e14827.
- 26 Ju JD, Zhang C, Sgambati FP. et al. Acute Altitude Acclimatization in Young Healthy Volunteers: Nocturnal Oxygenation Increases Over Time, Whereas Periodic Breathing Persists. High Alt Med Biol 2021; 22 (01) 14-23.
- 27 Bird JD, Kalker A, Rimke AN. et al. Severity of central sleep apnea does not affect sleeping oxygen saturation during ascent to high altitude. J Appl Physiol 2021; 131 (05) 1432-1443.
- 28 American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed.. Darien Il.: American Academy of Sleep Medicine; 2014. .
- 29 Robbins PA. Role of the peripheral chemoreflex in the early stages of ventilatory acclimatization to altitude. Respir Physiol Neurobiol 2007; 158 (2-3): 237-242.
- 30 Salazar-Peña CM, Torres-Fraga M, Schalch-Ponce de León JM. et al. Sobre el control central de la respiración: A propósito de una mujer con apnea obstructiva del sueño, enfermedad de Lyme y consumo crónico de opioides. Neumol Cir Torax 2016; 75: 25-31.
- 31 Dempsey JA, Xie A, Patz DS, Wang D. Physiology in medicine: obstructive sleep apnea pathogenesis and treatment–considerations beyond airway anatomy. J Appl Physiol 2014; 116 (01) 3-12.
- 32 Xie A, Teodorescu M, Pegelow DF. et al. Effects of stabilizing or increasing respiratory motor outputs on obstructive sleep apnea. J Appl Physiol 2013; 115 (01) 22-33.
- 33 Chiodi H. Respiratory adaptations to chronic high altitude hypoxia. J Appl Physiol 1957; 10 (01) 81-87.
- 34 Rahn H, Otis AB. Man's respiratory response during and after acclimatization to high altitude. Am J Physiol 1949; 157 (03) 445-462.
- 35 West JB. Rate of ventilatory acclimatization to extreme altitude. Respir Physiol 1988; 74 (03) 323-333.
- 36 Lahiri S, Barnard P. Role of arterial chemoreflex in breathing during sleep at high altitude. Prog Clin Biol Res 1983; 136: 75-85.
- 37 Swenson ER, Leatham KL, Roach RC, Schoene RB, Mills Jr WJ, Hackett PH. Renal carbonic anhydrase inhibition reduces high altitude sleep periodic breathing. Respir Physiol 1991; 86 (03) 333-343.
- 38 Teppema LJ, Rochette F, Demedts M. Effects of acetazolamide on medullary extracellular pH and PCO2 and on ventilation in peripherally chemodenervated cats. Pflugers Arch 1990; 415 (05) 519-525.
- 39 Ghazanshahi SD, Khoo MC. Optimal ventilatory patterns in periodic breathing. Ann Biomed Eng 1993; 21 (05) 517-530.
- 40 Hernández-Zenteno RJ, Pérez-Padilla R, Vázquez JC. Normal breathing during sleep at an altitude of 2240 meters. Arch Med Res 2002; 33 (05) 489-494.
- 41 Vázquez JC, Pérez-Padilla R. Effect of oxygen on sleep and breathing in patients with interstitial lung disease at moderate altitude. Respiration 2001; 68 (06) 584-589.
- 42 Vázquez-García JC, Pérez-Padilla R. Respiración durante el sueño en pacientes con enfermedad pulmonar obstructiva crónica a una altitud de 2,240 metros. Rev Invest Clin 2004; 56 (03) 334-340.