The impact of sleeping in an elevated upper body position during acclimatization to high altitude on acute mountain sickness and pulmonary artery systolic pressure


  • Maren Graß RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Christian Apel RWTH Aachen University, Department of Biohybrid and Medical Textiles, Institute of Applied Medical Engineering, Helmholtz Institute of Biomedical Engineering, Germany
  • Daniela Bertsch Ilmtalklinik, Department of Internal Medicine and Cardiology, Pfaffenhofen, Germany
  • Carina Cerfontaine RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Michael van der Giet RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Simone van der Giet RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Miriam Haunolder RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Nina Hundt RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Julia Jäger RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Christian Kühn RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Sonja Museol RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Lisa Timmermann RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany
  • Knut Wernitz RWTH Aachen Technical University, Department of Dental Preservation, Parodontology and Preventive Dentistry, Germany
  • Ulf Gieseler Union Internationale des Associations d’Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
  • Audry Morrison Union Internationale des Associations d’Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland; Royal Free London NHS Foundation Trust, London, UK
  • Volker Schöffl Klinikum Bamberg, Department of Orthopedic and Trauma Surgery, Sportsorthopedics and Sportsmedicine, Bamberg, Germany; Friedrich Alexander University Erlangen-Nuremberg, Department of Trauma Surgery, Erlangen, Germany; School of Applied and Clinical Sciences, Leeds Becket University, Leeds, UK; University of Colorado School of Medicine, Department of Emergency Medicine, Section of Wilderness Medicine, Denver, USA
  • Thomas Küpper RWTH Aachen Technical University, Department of Occupational, Social and Environmental Medicine, Germany; Royal College of Physicians and Surgeons of Glasgow, Faculty for Travel Medicine, Glasgow, UK



acute mountain sickness, pulmonary artery systolic pressure, sleeping positions, acclimatization


Background: The effect of sleeping positions during acclimatization to high altitude on Acute Mountain Sickness (AMS) and High Altitude Pulmonary Edema (HAPE) is unknown. We tested whether sleeping with the upper body raised by 5° reduces prevalence and severity of symptoms of AMS as well as of elevated pulmonary artery systolic pressure (PASP) values as a risk factor of HAPE.

Methods: Randomly assigning trekking tourist volunteers n = 44 (25 m, 19 f; mean age 42.9 yr) sleeping at 4280 m or 5170 m to the experimental group (upper body elevated by 5°), or to the control group. After exclusion of other reasons for AMS-like symptoms those assumed to be related to AMS were rated by Lake Louise Score questionnaire in the evening and the following morning of the study. Transthoracic echocardiography was performed on both occasions to estimate PASP.

Results: In the study group, symptoms of AMS were significantly reduced in younger subjects (p = 0.021), prevalence of AMS was reduced in women (p = 0.156), and PASP values were significantly reduced in older subjects and men (p = 0.032; p = 0.031 respectively).

Conclusion: Results suggest that sleeping with the upper body in elevated position during a high altitude ascent may benefit those suffering from AMS or at risk of HAPE due to elevated PASP values.


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How to Cite

Graß, M., Apel, C., Bertsch, D., Cerfontaine, C., van der Giet, M., van der Giet, S., Haunolder, M., Hundt, N., Jäger, J., Kühn, C., Museol, S., Timmermann, L., Wernitz, K., Gieseler, U., Morrison, A., Schöffl, V., & Küpper, T. (2024). The impact of sleeping in an elevated upper body position during acclimatization to high altitude on acute mountain sickness and pulmonary artery systolic pressure. Health Promotion & Physical Activity, 25(4), 1–8.



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