High‐altitude hypoxia and periodic breathing during sleep: gender‐related differences

Abstract

High-altitude exposure is characterized by the appearance of periodic breathing during sleep. Only limited evidence is available, however, on the presence of gender-related differences in this breathing pattern. In 37 healthy subjects, 23 male and 14 female, we performed nocturnal cardio-respiratory monitoring in the following conditions: (1) sea level; (2) first/second night at an altitude of 3400m; (3) first/second night at an altitude of 5400m and after a 10day sojourn at 5400m. At sea level, a normal breathing pattern was observed in all subjects throughout the night. At 3400m the apnea-hypopnea index was 40.3±33.0 in males (central apneas 77.6%, central hypopneas 22.4%) and 2.4±2.8 in females (central apneas 58.2%, central hypopneas 41.8%; P<0.01). During the first recording at 5400m, the apnea-hypopnea index was 87.5±35.7 in males (central apneas 60.0%, central hypopneas 40.0%) and 41.1±44.0 in females (central apneas 73.2%, central hypopneas 26.8%; P<0.01), again with a higher frequency of central events in males as seen at lower altitude. Similar results were observed after 10days. With increasing altitude, there was also a progressive reduction in respiratory cycle length during central apneas in males (26.9±3.4s at 3400m and 22.6±3.7s at 5400m). Females, who displayed a significant number of central apneas only at the highest reached altitude, were characterized by longer cycle length than males at similar altitude (30.1±5.8s at 5400m). In conclusion, at high altitude, nocturnal periodic breathing affects males more than females. Females started to present a significant number of central sleep apneas only at the highest reached altitude. After 10days at 5400m gender differences in the apnea-hypopnea index similar to those observed after acute exposure were still observed, accompanied by differences in respiratory cycle length.