Document Detail

Sleep and breathing in high altitude pulmonary edema susceptible subjects at 4,559 meters.
MedLine Citation:
PMID:  23024440     Owner:  NLM     Status:  MEDLINE    
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.
Yvonne Nussbaumer-Ochsner; Nicole Schuepfer; Justyna Ursprung; Christoph Siebenmann; Marco Maggiorini; Konrad E Bloch
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-10-01
Journal Detail:
Title:  Sleep     Volume:  35     ISSN:  1550-9109     ISO Abbreviation:  Sleep     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-01     Completed Date:  2013-04-05     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  7809084     Medline TA:  Sleep     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1413-21     Citation Subset:  IM    
Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, and Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
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MeSH Terms
Altitude Sickness / drug therapy*,  physiopathology
Anti-Inflammatory Agents / pharmacology,  therapeutic use*
Dexamethasone / pharmacology,  therapeutic use*
Disease Susceptibility
Double-Blind Method
Middle Aged
Pulmonary Edema / physiopathology*
Respiration* / drug effects
Sleep / drug effects,  physiology*
Reg. No./Substance:
0/Anti-Inflammatory Agents; 50-02-2/Dexamethasone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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