Abstract
Objectives. To study the relationship between nocturnal periodic breathing episodes and behavioral awakenings at high altitude. Methods. Observational study. It is 6-day ascent of 4 healthy subjects from Besisahar (760 meters) to Manang (3540 meters) in Nepal in March 2012. A recording pulse oximeter was worn by each subject to measure their oxygen saturation and the presence of periodic breathing continuously through the night. An actigraph was simultaneously worn in order to determine nocturnal behavioral awakenings. There were no interventions. Results. 187-hour sleep at high altitude was analyzed, and of this, 145 hours (78%) had at least one PB event. At high altitude, 10.5% (95% CI 6.5–14.6%) of total sleep time was spent in PB while 15 out of 50 awakenings (30%, 95% CI: 18–45%) occurring at high altitudes were associated with PB (P < 0.001). Conclusions. Our data reveals a higher than expected number of behavioral awakenings associated with PB compared to what would be expected by chance. This suggests that PB likely plays a role in behavioral awakenings at high altitude.
Highlights
Sleep disturbances in response to acute altitude ascent are very common and well documented
The study revealed a near absence of deep wave sleep, a substantial decrease in rapid eye movement (REM) sleep, and the presence of periodic breathing (PB) with associated arousals [1]
While some studies and reviews suggest an intimate correlation of periodic breathing and arousals during sleep at high altitudes [3, 5], others have failed to find a significant association between periodic breathing and high-altitude sleep disturbances [6,7,8]
Summary
Sleep disturbances in response to acute altitude ascent are very common and well documented. PB, when occurring in healthy individuals, almost universally predominates at high altitudes [2,3,4]. It is characterized by a sporadic waxing and waning breathing pattern with shifting periods of hyperventilation and central hypopnea and even apnea. While some studies and reviews suggest an intimate correlation of periodic breathing and arousals during sleep at high altitudes [3, 5], others have failed to find a significant association between periodic breathing and high-altitude sleep disturbances [6,7,8]
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