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Sleep and breathing in high altitude pulmonary edema susceptible subjects at 4,559 meters.
Sleep. 2012 Oct 01; 35(10):1413-21.S

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.

Authors+Show Affiliations

Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, and Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23024440

Citation

Nussbaumer-Ochsner, Yvonne, et al. "Sleep and Breathing in High Altitude Pulmonary Edema Susceptible Subjects at 4,559 Meters." Sleep, vol. 35, no. 10, 2012, pp. 1413-21.
Nussbaumer-Ochsner Y, Schuepfer N, Ursprung J, et al. Sleep and breathing in high altitude pulmonary edema susceptible subjects at 4,559 meters. Sleep. 2012;35(10):1413-21.
Nussbaumer-Ochsner, Y., Schuepfer, N., Ursprung, J., Siebenmann, C., Maggiorini, M., & Bloch, K. E. (2012). Sleep and breathing in high altitude pulmonary edema susceptible subjects at 4,559 meters. Sleep, 35(10), 1413-21.
Nussbaumer-Ochsner Y, et al. Sleep and Breathing in High Altitude Pulmonary Edema Susceptible Subjects at 4,559 Meters. Sleep. 2012 Oct 1;35(10):1413-21. PubMed PMID: 23024440.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sleep and breathing in high altitude pulmonary edema susceptible subjects at 4,559 meters. AU - Nussbaumer-Ochsner,Yvonne, AU - Schuepfer,Nicole, AU - Ursprung,Justyna, AU - Siebenmann,Christoph, AU - Maggiorini,Marco, AU - Bloch,Konrad E, Y1 - 2012/10/01/ PY - 2012/10/2/entrez PY - 2012/10/2/pubmed PY - 2013/4/6/medline KW - Control of breathing KW - dexamethasone KW - high altitude illness KW - hypoxia KW - sleep apnea SP - 1413 EP - 21 JF - Sleep JO - Sleep VL - 35 IS - 10 N2 - 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. SN - 1550-9109 UR - https://www.unboundmedicine.com/medline/citation/23024440/Sleep_and_breathing_in_high_altitude_pulmonary_edema_susceptible_subjects_at_4559_meters_ L2 - https://academic.oup.com/sleep/article-lookup/doi/10.5665/sleep.2126 DB - PRIME DP - Unbound Medicine ER -