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; Christian Apel; Daniela Bertsch; Carina Cerfontaine; Michael van der Giet; Simone van der Giet; Miriam Haunolder; Nina Hundt; Julia Jäger; Christian Kühn; Sonja Museol; Lisa Timmermann; Knut Wernitz; Ulf Gieseler; Audry Morrison; Volker Schöffl; Thomas Küpper

doi:10.55225/hppa.522

Autor

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

DOI:

https://doi.org/10.55225/hppa.522

Słowa kluczowe:

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

Abstrakt

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.

Statystyka pobrań

Statystyki pobrań nie są jeszcze dostępne

Bibliografia

Alon D, Shitrit P, Chowers M. Risk behaviors and spectrum of diseases among elderly travelers: A comparison of younger and older adults. J Travel Med. 2010:17(4):250--255. doi: 10.1111/j.1708-8305.2010.00425.x. DOI: https://doi.org/10.1111/j.1708-8305.2010.00425.x Google Scholar

Hackett PH, Roach RC. High-altitude illness. N Engl J Med. 2001;345(2):107-114. doi: 10.1056/NEJM200107123450206. DOI: https://doi.org/10.1056/NEJM200107123450206 Google Scholar

Bärtsch P, Maggiorini M, Mairbäurl H, Vock P, Swenson ER. Pulmonary extravascular fluid accumulation in climbers. Lancet. 2002;360(9332):571. doi: 10.1016/S0140-6736(02)09723-4. DOI: https://doi.org/10.1016/S0140-6736(02)09723-4 Google Scholar

Karinen HM, Peltonen JE, Kähönen M, Tikkanen HO. Prediction of acute mountain sickness by monitoring arterial oxygen saturation during ascent. High Alt Med Biol. 2010;11(4):325-332. doi: 10.1089/ham.2009.1060. DOI: https://doi.org/10.1089/ham.2009.1060 Google Scholar

Newcomb L, Sherpa C, Nickol A, Windsor J. A comparison of the incidence and understanding of altitude illness between porters and trekkers in the Solu Khumbu region of Nepal. Wilderness Environ Med. 2011:22(3):197-201. doi: 10.1016/j.wem.2011.06.001. DOI: https://doi.org/10.1016/j.wem.2011.06.001 Google Scholar

Pagé M, Sauvé C, Serri K, Pagé P, Yin Y, Schampaert E. Echocardiographic assessment of cardiac performance in response to high altitude and developement of subclinical pulmonary edema in healthy climbers. Can J Cardiol. 2013;(29):1277-1284. doi: 10.1016/j.cjca.2013.04.025. DOI: https://doi.org/10.1016/j.cjca.2013.04.025 Google Scholar

Maggiorini M, Brunner-La Rocca H-P, Peth S, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: A randomized trial. Ann Intern Med. 2006;145(7):497-506. doi: 10.7326/0003-4819-145-7-200610030-00007. DOI: https://doi.org/10.7326/0003-4819-145-7-200610030-00007 Google Scholar

Allemann Y, Stuber T, de Marchi SF, et al. Pulmonary artery pressure and cardiac function in children and adolescents after rapid ascent to 3,450 m. Am J Physiol Heart Circ Physiol. 2012;302(12):H2646-2653. doi: 10.1152/ajpheart.00053.2012. DOI: https://doi.org/10.1152/ajpheart.00053.2012 Google Scholar

Allemann Y, Sartori C, Lepori M, et al. Echocardiographic and invasive measurements of pulmonary artery pressure correlate closely at high altitude. Am J Physiol Heart Circ Physiol. 2000;279(4):H2013-2016. doi: 10.1152/ajpheart.2000.279.4.H2013. DOI: https://doi.org/10.1152/ajpheart.2000.279.4.H2013 Google Scholar

Dehnert C, Grünig E, Mereles D, von Lennep N, Bärtsch P. Identification of individuals susceptible to high-altitude pulmonary oedema at low altitude. Eur Respir J. 2005;25(3):545-551. doi: 10.1183/09031936.05.00070404. DOI: https://doi.org/10.1183/09031936.05.00070404 Google Scholar

Bärtsch P, Mairbäurl H, Maggiorini M, Swenson ER. Physiological aspects of high altitude pulmonary edema. J Appl Physiol. 2005;98(3):1101-1110. doi: 10.1152/japplphysiol.01167.2004. DOI: https://doi.org/10.1152/japplphysiol.01167.2004 Google Scholar

Grüning E, Mereles D, Hildebrandt W, et al. Stress Doppler echocardiography for the identification of susceptibility to high altitude pulmonary edema. J Am Coll Cardiol. 2000;35(4):980-987. doi: 10.1016/s0735-1097(99)00633-6. DOI: https://doi.org/10.1016/S0735-1097(99)00633-6 Google Scholar

Tannheimer M, Hornung K, Gasche M, et al. Decrease of asymmetric dimethylarginine predicts acute mountain sickness. J Travel Med. 2012;19(6):338-343. doi: 10.1111/j.1708-8305.2012.00652.x. DOI: https://doi.org/10.1111/j.1708-8305.2012.00652.x Google Scholar

Honigman B, Theis MK, Koziol-McLain J, et al. Acute mountain sickness in a general tourist population at moderate altitudes. Ann Intern Med. 1993;118(8):587-592. doi: 10.7326/0003-4819-118-8-199304150-00003. DOI: https://doi.org/10.7326/0003-4819-118-8-199304150-00003 Google Scholar

Gaillard S, Dellasanta P, Loutan L, Kayser B. Awareness, prevalence, medication use, and risk factors of acute mountain sickness in tourists trekking around the Annapurnas in Nepal: A 12-year follow-up. High Alt Med Biol. 2004;5(4):410-419. doi: 10.1089/ham.2004.5.410. DOI: https://doi.org/10.1089/ham.2004.5.410 Google Scholar

McDevitt M et al Risk determinants of acute mountain sickness in trekkers in the Nepali Himalaya: A 24-year follow-up. Wilderness Environ Med. 2014;25(2):152-159. doi: 10.1016/j.wem.2013.12.027. DOI: https://doi.org/10.1016/j.wem.2013.12.027 Google Scholar

Berghold F, Schaffert W. Praxis der Höhenakklimatisation in Handbuch der Trekking- und Expeditionsmedizin. Praxis der Höhenanpassung – Therapie der Höhenkrankheit. Richtlinien der Österreichischen Gesellschaft für Alpin- und Höhenmedizin und der Deutschen Gesellschaft für Berg- und Expeditionsmedizin. München: DAV Summit Club; 2009. Google Scholar

Gieseler U. Die Akklimatisation an die Höhe. In: Küpper T, Ebel K, Gieseler U, eds. Moderne Berg- und Höhenmedizin. Stuttgart: Gentner Verlag; 2010. Google Scholar

Lämmle T. Höhe x Bergsteigen. Die taktischen Grundregeln des Höhenbergsteigens. München: DAV Summit Club; 2010. Google Scholar

Weiß W, Rieke B. Der medizinische Ratgeber für beruflich Reisende. Vol. 2. Düsseldorf: MedPrä Verlag; 2012. Google Scholar

Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984;70(4):657-662. doi: 10.1161/01.cir.70.4.657. DOI: https://doi.org/10.1161/01.CIR.70.4.657 Google Scholar

Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults. J Am Soc Echocardiogr. 2010;23(7):685-713. doi: 10.1016/j.echo.2010.05.010. DOI: https://doi.org/10.1016/j.echo.2010.05.010 Google Scholar

Küpper T, et al. Consensus Statement of the UIAA Medical Commission. Vol. 2. Emergency Field Management of Acute Mountain Sickness High Altitude Pulmonary Oedema and High Altitude Cerebral Oedema. Published 2008. Accessed 2008; Available from: www.theuiaa.org/medical_advice.html. Google Scholar

Hackett PH, Rennie D, Levine HD. The incidence, importance, and prophylaxis of acute mountain sickness. Lancet. 1976;2(7996):1149-1155. doi: 10.1016/s0140-6736(76)91677-9. DOI: https://doi.org/10.1016/S0140-6736(76)91677-9 Google Scholar

Richalet JP, Larmignat P, Poitrine E, Letournel M, Canouï-Poitrine F. Physiological risk factors for severe high altitude illness: A prospective cohort study. Am J Respir Crit Care Med. 2012;185(2):192-198. doi: 10.1164/rccm.201108-1396OC. DOI: https://doi.org/10.1164/rccm.201108-1396OC Google Scholar

Bert P. La pression barométrique. Paris: Masson; 1878. Google Scholar

Loewy A, Loewy J, Zuntz L. Ueber den Einfluss de verdünnten Luft und des Höhenklimas auf den Menschen. Pflügers Arch. 1897;66:477–538. doi: 10.1007/BF01790178. DOI: https://doi.org/10.1007/BF01790178 Google Scholar

Mosso A. Der Mensch auf den Hochalpen. Leipzig: Verlag von Veit; 1899. DOI: https://doi.org/10.1515/9783112344163 Google Scholar

Kronecker H. Die Bergkrankheit. Berlin: Urban & Schwarzenberg; 1903. Google Scholar

Zuntz N, Loewy A. Höhenklima und Bergwanderungen in ihrer Wirkung auf den Menschen. Berlin: Deutsches Verlagshaus Bong; 1906. Google Scholar

Richalet JP, Rutgers V, Bouchet P, et al. Diurnal variations of acute mountain sickness, colour vision, and plasma cortisol and ACTH at high altitude. Aviat Space Environ Med. 1989;60(2):105-111. Google Scholar

Küpper T. Körperliche und fachliche Anforderungen bei der Rettung aus alpinen Notlagen. Analyse der Belastungen und Beanspruchungen der Ersthelfer und der Angehörigen der Rettungsdienste und ihre Konsequenzen für präventive und rehabilitative Ansätze in Flugmedizin Arbeitsmedizin und alpiner Sportmedizin. [Habilitationsschrift]. Aachen: RWTH Aachen, Medizinischen Fakultät, Institut für Flugmedizin des Universitätsklinikums Aachen; 2006. Google Scholar

Küpper TE, Strohl KP, Hoefer M, Gieseler U, Netzer CM, Netzer NC. Low-dose theophylline reduces symptoms of acute mountain sickness. J Travel Med. 2008;15(5):307-314. doi: 10.1111/j.1708-8305.2008.00228.x. DOI: https://doi.org/10.1111/j.1708-8305.2008.00228.x Google Scholar

Lortet ML. Deux ascensions au Mont-Blanc en 1869: Recherches physiologiques sur le mal des montagnes. Paris: Masson; 1869. Google Scholar

Domej WG, Schwaberger and C. Pietsch Kleines Repetitorium der Höhenphysiologie. Vom Hyper- zum Hyporesponder – die hypoxische Atemantwort (HVR). Alpinmedizinischer Rundbrief. 2009;41:14-16. Google Scholar

Berghold F, Schaffert W. Die akute Höhenkrankheit. In: Berghold F, Schaffert W, eds. Höhenmedizin. Eigenverlag; 2012:129,134. Google Scholar

Basnyat B, Hargrove J, Holck PS, et al. Acetazolamide fails to decrease pulmonary artery pressure at high altitude in partially acclimatized humans. High Alt Med Biol. 2008.9(3):p. 209-216. doi: 10.1089/ham.2007.1073. DOI: https://doi.org/10.1089/ham.2007.1073 Google Scholar

Küpper T, Schöffl V, Netzer N. Cheyne stokes breathing at high altitude: A helpful response or a troublemaker? Sleep Breath. 2008;12(2):123-127. doi: 10.1007/s11325-007-0155-5. DOI: https://doi.org/10.1007/s11325-007-0155-5 Google Scholar

Bloch KE, Latshang TD, Turk AJ, et al. Nocturnal periodic breathing during acclimatization at very high altitude at Mount Muztagh Ata (7,546 m). Am J Respir Crit Care Med. 2010;182(4):562-568. doi: 10.1164/rccm.200911-1694OC. DOI: https://doi.org/10.1164/rccm.200911-1694OC Google Scholar

Fulco CS, Muza SR, Beidleman BA, et al. Effect of repeated normobaric hypoxia exposures during sleep on acute mountain sickness, exercise performance, and sleep during exposure to terrestrial altitude. Am J Physiol Regul Integr Comp Physiol. 2011;300(2):R428-436. doi: 10.1152/ajpregu.00633.2010. DOI: https://doi.org/10.1152/ajpregu.00633.2010 Google Scholar

Moraga FA, Jiménez D, Richalet JP, Vargas M, Osorio J. Periodic breathing and oxygen supplementation in Chilean miners at high altitude (4200 m). Respir Physiol Neurobiol. 2014;203:109-115. doi: 10.1016/j.resp.2014.09.001. DOI: https://doi.org/10.1016/j.resp.2014.09.001 Google Scholar

Anderson PJ, Wiste HJ, Ostby SA, Miller AD, Ceridon ML, Johnson BD. Sleep disordered breathing and acute mountain sickness in workers rapidly transported to the South Pole (2835 m). Respir Physiol Neurobiol. 2015;210:38-43. doi: 10.1016/j.resp.2015.01.012. DOI: https://doi.org/10.1016/j.resp.2015.01.012 Google Scholar

Mosso A, Marro G. Les variations qui ont lieu dans les gaz du sang sur le sommet du Mont Rosa. Arch Ital de Biol. 1903;39(1-2):402-416. Google Scholar

Hultgren H. High Altitude Medicine. Stanford: Hultgren Publications; 1997:187,448-469. Google Scholar

Lakshminarayan S, Pierson DJ. Recurrent high altitude pulmonary edema with blunted chemosensitivity. Am Rev Respir Dis. 1975;111(6):869-872. doi: 10.1164/arrd.1975.111.6.869. Google Scholar

Frates RC Jr, Harrison GM, Edwards GA. High-altitude pulmonary edema in children. Am J Dis Child. 1977;131(6):687-689. doi: 10.1001/archpedi.1977.02120190081018. DOI: https://doi.org/10.1001/archpedi.1977.02120190081018 Google Scholar

Hultgren HN, Marticorena EA. High altitude pulmonary edema: Epidemiologic observations in Peru. Chest. 1978;74(4):372-376. doi: 10.1378/chest.74.4.372. DOI: https://doi.org/10.1016/S0012-3692(15)37380-3 Google Scholar

Marugg D. Lungenprobleme bei akuter bis subakuter Exposition in mittleren Höhen. Schweiz Rundsch Med Prax. 1995:84(40):1101-1107. Google Scholar

Moore LG, Niermeyer S, Zamudio S. Human adaptation to high altitude: Regional and life-cycle perspectives. Am J Phys Anthropol. 1998;(Suppl 27):25-64. doi: 10.1002/(sici)1096-8644(1998)107:27+<25::aid-ajpa3>3.0.co;2-l. DOI: https://doi.org/10.1002/(SICI)1096-8644(1998)107:27+<25::AID-AJPA3>3.0.CO;2-L Google Scholar

Anholm JD, Powles AC, Downey R 3rd, et al. Operation Everest II: Arterial oxygen saturation and sleep at extreme simulated altitude. Am Rev Respir Dis. 1992:145(4 Pt 1):817-826. doi: 10.1164/ajrccm/145.4_Pt_1.817. DOI: https://doi.org/10.1164/ajrccm/145.4_Pt_1.817 Google Scholar

Zielinski J, Koziej M, Mańkowski M, et al. The quality of sleep and periodic breathing in healthy subjects at an altitude of 3,200 m. High Alt Med Biol. 2000;1(4):331-336. doi: 10.1089/15270290050502408. DOI: https://doi.org/10.1089/15270290050502408 Google Scholar

Salvaggio A, Insalaco G, Marrone O, et al. Effects of high-altitude periodic breathing on sleep and arterial oxyhaemoglobin saturation. Eur Respir J. 1998;12(2):408-413. doi: 10.1183/09031936.98.12020408. DOI: https://doi.org/10.1183/09031936.98.12020408 Google Scholar

Eichenberger U, Weiss E, Riemann D, Oelz O, Bärtsch P. Nocturnal periodic breathing and the development of acute high altitude illness. Am J Respir Crit Care Med. 1996;154(6 Pt 1):1748-1754. doi: 10.1164/ajrccm.154.6.8970365. DOI: https://doi.org/10.1164/ajrccm.154.6.8970365 Google Scholar

Richalet J-P, Chenivesse C, Larmignat P, Meille L. High altitude pulmonary edema, down syndrome, and obstructive sleep apneas. High Alt Med Biol. 2008;9(2):179-181. doi: 10.1089/ham.2007.1062. DOI: https://doi.org/10.1089/ham.2007.1062 Google Scholar

Nadadur RD, Umar S, Wong G, et al. Reverse right ventricular structural and extracellular matrix remodeling by estrogen in severe pulmonary hypertension. J Appl Physiol. 2012;113(1):149-158. doi: 10.1152/japplphysiol.01349.2011. DOI: https://doi.org/10.1152/japplphysiol.01349.2011 Google Scholar

Manes A, Palazzini M, Dardi F, D’Adamo A,Rinaldi A, Galiè N. Genere femminile e ipertensione arteriosa polmonare: una relazione complessa [= Female gender and pulmonary arterial hypertension: A complex relationship]. G Ital Cardiol. 2012;13(6):448-460. doi: 10.1714/1073.11764. Google Scholar

Umar SM, Rabinovitch M, Eghbali M. Estrogen paradox in pulmonary hypertension: Current controversies and future perspectives. Am J Respir Crit Care Med. 2012;186(2):125-131. doi: 10.1164/rccm.201201-0058PP. DOI: https://doi.org/10.1164/rccm.201201-0058PP Google Scholar

Kayser B, Dumont L, Lysakowski C, Combescure C, Haller G, Tramèr MR. Reappraisal of acetazolamide for the prevention of acute mountain sickness: A systematic review and meta-analysis. High Alt Med Biol. 2012;13(2):82-92. doi: 10.1089/ham.2011.1084. DOI: https://doi.org/10.1089/ham.2011.1084 Google Scholar

Wang D, Xiang Q, Shen X, Meng J, Dong Q. [Effect of 7 d head down bed rest on cardiopulmonary circulation in human]. Space Med Eng. 1998;11(3):177-180. Google Scholar