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Current Sleep Medicine Reports
Erschienen in:

01.06.2019 | Sleep and Sleep Apnea at the Extremes (D Gozal, Section Editor)

Sleep Disordered Breathing at High Altitude in Adults and Its Interaction with Cardiovascular Homeostasis

verfasst von: Emrush Rexhaj, Rodrigo Soria, Anne-Kathrin Brill, Urs Scherrer

Erschienen in: Current Sleep Medicine Reports | Ausgabe 2/2019

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Abstract

Purpose of Review

Worldwide > 140 million people are living at high altitude and large numbers of lowlanders travel to high altitude for professional reasons or leisure activities. While there is widely held belief that sleep is perturbed at high altitude, little scientific evidence supports this notion. Here, we summarize recent work on sleep at high altitude in newcomers and high-altitude dwellers with particular emphasis on the interactions between sleep-disordered breathing (SDB) and cardiovascular regulation.

Recent Findings

Recent studies show an interaction between SDB and cardiovascular homeostasis in high-altitude dwellers. In high-altitude dwellers, SDB is associated with pulmonary hypertension and right ventricular dysfunction, premature atherosclerosis in the systemic circulation, and altered regulation of the cerebrovascular circulation related with cognitive decline and depression.

Summary

In high-altitude dwellers, recent studies show a potential role of SDB in promoting cardiovascular morbidity and mortality. There is an urgent need for studies examining the effects of the treatment of SDB on cardiovascular homeostasis and its long-term benefits on cardiovascular morbidity/mortality in high-altitude dwellers.
Literatur
1.
Soria R, Egger M, Scherrer U, Bender N, Rimoldi SF. Pulmonary artery pressure and arterial oxygen saturation in people living at high or low altitude: systematic review and meta-analysis. J Appl Physiol (1985). 2016;121(5):1151–9.CrossRef
2.
•• Bloch KE, Buenzli JC, Latshang TD, Ulrich S. Sleep at high altitude: guesses and facts. J Appl Physiol (1985). 2015;119(12):1466–80. This systematic literature research on sleep at altitude assessed by polysomnography shows the main sleep changes while traveling to high altitude. CrossRef
3.
Lovis A, De Riedmatten M, Greiner D, Lecciso G, Andries D, Scherrer U, et al. Effect of added dead space on sleep disordered breathing at high altitude. Sleep Med. 2012;13(6):663–7.CrossRefPubMed
4.
Latshang TD, Lo Cascio CM, Stowhas AC, Grimm M, Stadelmann K, Tesler N, et al. Are nocturnal breathing, sleep, and cognitive performance impaired at moderate altitude (1,630-2,590 m)? Sleep. 2013;36(12):1969–76.CrossRefPubMedPubMedCentral
5.
Nussbaumer-Ochsner Y, Ursprung J, Siebenmann C, Maggiorini M, Bloch KE. Effect of short-term acclimatization to high altitude on sleep and nocturnal breathing. Sleep. 2012;35(3):419–23.CrossRefPubMedPubMedCentral
6.
Bloch KE, Latshang TD, Turk AJ, Hess T, Hefti U, Merz TM, 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):562–8.CrossRefPubMed
7.
Jafarian S, Gorouhi F, Taghva A, Lotfi J. High-altitude sleep disturbance: results of the Groningen Sleep Quality Questionnaire survey. Sleep Med. 2008;9(4):446–9.CrossRefPubMed
8.
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.CrossRefPubMed
9.
Scherrer U, Verges S. Sleep apnoea and pulmonary hypertension in high-altitude dwellers: more than an association? Eur Respir J. 2017;49(2):1602232.CrossRefPubMed
10.
Nespoulet H, Wuyam B, Tamisier R, Saunier C, Monneret D, Remy J, et al. Altitude illness is related to low hypoxic chemoresponse and low oxygenation during sleep. Eur Respir J. 2012;40(3):673–80.CrossRefPubMed
11.
Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310–8.CrossRefPubMedPubMedCentral
12.
Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation scientific statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol. 2008;52(8):686–717.CrossRefPubMed
13.
Nussbaumer-Ochsner Y, Schuepfer N, Ulrich S, Bloch KE. Exacerbation of sleep apnoea by frequent central events in patients with the obstructive sleep apnoea syndrome at altitude: a randomised trial. Thorax. 2010;65(5):429–35.CrossRefPubMed
14.
Patz D, Spoon M, Corbin R, Patz M, Dover L, Swihart B, et al. The effect of altitude descent on obstructive sleep apnea. Chest. 2006;130(6):1744–50.CrossRefPubMed
15.
Ulrich S, Nussbaumer-Ochsner Y, Vasic I, Hasler E, Latshang TD, Kohler M, et al. Cerebral oxygenation in patients with OSA: effects of hypoxia at altitude and impact of acetazolamide. Chest. 2014;146(2):299–308.CrossRefPubMed
16.
• Latshang TD, Kaufmann B, Nussbaumer-Ochsner Y, Ulrich S, Furian M, Kohler M, et al. Patients with obstructive sleep apnea have cardiac repolarization disturbances when travelling to altitude: randomized, placebo-controlled trial of acetazolamide. Sleep. 2016;39(9):1631–7. This study shows that in OSA patients, the prolongation of mean QTc at high altitude is attenuated by acetazolamide administration. CrossRefPubMedPubMedCentral
17.
Bazurto Zapata MA, Martinez-Guzman W, Vargas-Ramirez L, Herrera K, Gonzalez-Garcia M. Prevalence of central sleep apnea during continuous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m. Sleep Med. 2015;16(3):343–6.CrossRefPubMed
18.
Latshang TD, Nussbaumer-Ochsner Y, Henn RM, Ulrich S, Lo Cascio CM, Ledergerber B, et al. Effect of acetazolamide and autoCPAP therapy on breathing disturbances among patients with obstructive sleep apnea syndrome who travel to altitude: a randomized controlled trial. JAMA. 2012;308(22):2390–8.CrossRefPubMed
19.
Nussbaumer-Ochsner Y, Latshang TD, Ulrich S, Kohler M, Thurnheer R, Bloch KE. Patients with obstructive sleep apnea syndrome benefit from acetazolamide during an altitude sojourn: a randomized, placebo-controlled, double-blind trial. Chest. 2012;141(1):131–8.CrossRefPubMed
20.
21.
Liu HM, Chiang IJ, Kuo KN, Liou CM, Chen C. The effect of acetazolamide on sleep apnea at high altitude: a systematic review and meta-analysis. Ther Adv Respir Dis. 2017;11(1):20–9.CrossRefPubMed
22.
Orr JE, Heinrich EC, Djokic M, Gilbertson D, Deyoung PN, Anza-Ramirez C, et al. Adaptive servoventilation as treatment for central sleep apnea due to high-altitude periodic breathing in nonacclimatized healthy individuals. High Alt Med Biol. 2018;19(2):178–84.CrossRefPubMedPubMedCentral
23.
Augusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (2019 report). Global Initiative Chronic Obstr Lung Dis. 2019.
24.
Chen W, Thomas J, Sadatsafavi M, FitzGerald JM. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(8):631–9.CrossRefPubMed
25.
Christensen CC, Ryg M, Refvem OK, Skjonsberg OH. Development of severe hypoxaemia in chronic obstructive pulmonary disease patients at 2,438 m (8,000 ft) altitude. Eur Respir J. 2000;15(4):635–9.CrossRefPubMed
26.
Steveling EH, Clarenbach CF, Miedinger D, Enz C, Durr S, Maier S, et al. Predictors of the overlap syndrome and its association with comorbidities in patients with chronic obstructive pulmonary disease. Respiration. 2014;88(6):451–7.CrossRefPubMed
27.
Soler X, Gaio E, Powell FL, Ramsdell JW, Loredo JS, Malhotra A, et al. High prevalence of obstructive sleep apnea in patients with moderate to severe chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2015;12(8):1219–25.PubMedPubMedCentral
28.
Sanders MH, Newman AB, Haggerty CL, Redline S, Lebowitz M, Samet J, et al. Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med. 2003;167(1):7–14.CrossRefPubMed
29.
• Latshang TD, Tardent RPM, Furian M, Flueck D, Segitz SD, Mueller-Mottet S, Kohler M, Ulrich S, Bloch KE Sleep and breathing disturbances in patients with chronic obstructive pulmonary disease traveling to altitude: a randomized trial. Sleep. 2019; 42 (1). doi: https://​doi.​org/​10.​1093/​sleep/​zsy203. This study shows central sleep apneas, altered sleep structure, and insomnia in lowlanders with COPD traveling to high altitude.
30.
Latshang TD, Furian M, Aeschbacher SS, Ulrich S, Osmonov B, Mirrakhimov EM, et al. Association between sleep apnoea and pulmonary hypertension in Kyrgyz highlanders. Eur Respir J. 2017;49(2):1601530.CrossRefPubMed
31.
•• Rexhaj E, Rimoldi SF, Pratali L, Brenner R, Andries D, Soria R, et al. Sleep-disordered breathing and vascular function in patients with chronic mountain sickness and healthy high-altitude dwellers. Chest. 2016;149(4):991–8. This study shows that SDB and hypoxemia are more severe in CMS patients and are associated which systemic and pulmonary vascular dysfunction. CrossRefPubMed
32.
Leon-Velarde F, Villafuerte FC, Richalet JP. Chronic mountain sickness and the heart. Prog Cardiovasc Dis. 2010;52(6):540–9.CrossRefPubMed
33.
Pratali L, Rimoldi SF, Rexhaj E, Hutter D, Faita F, Salmon CS, et al. Exercise induces rapid interstitial lung water accumulation in patients with chronic mountain sickness. Chest. 2012;141(4):953–8.CrossRefPubMed
34.
Rimoldi SF, Rexhaj E, Pratali L, Bailey DM, Hutter D, Faita F, et al. Systemic vascular dysfunction in patients with chronic mountain sickness. Chest. 2012;141(1):139–46.CrossRefPubMed
35.
Stuber T, Sartori C, Schwab M, Jayet PY, Rimoldi SF, Garcin S, et al. Exaggerated pulmonary hypertension during mild exercise in chronic mountain sickness. Chest. 2010;137(2):388–92.CrossRefPubMed
36.
Badran M, Ayas N, Laher I. Cardiovascular complications of sleep apnea: role of oxidative stress. Oxidative Med Cell Longev. 2014;2014:985258.CrossRef
37.
Gilmartin GS, Lynch M, Tamisier R, Weiss JW. Chronic intermittent hypoxia in humans during 28 nights results in blood pressure elevation and increased muscle sympathetic nerve activity. Am J Physiol Heart Circ Physiol. 2010;299(3):H925–31.CrossRefPubMedPubMedCentral
38.
Tamisier R, Pepin JL, Remy J, Baguet JP, Taylor JA, Weiss JW, et al. 14 nights of intermittent hypoxia elevate daytime blood pressure and sympathetic activity in healthy humans. Eur Respir J. 2011;37(1):119–28.CrossRefPubMed
39.
Yamauchi M, Kimura H. Oxidative stress in obstructive sleep apnea: putative pathways to the cardiovascular complications. Antioxid Redox Signal. 2008;10(4):755–68.CrossRefPubMed
40.
Pialoux V, Hanly PJ, Foster GE, Brugniaux JV, Beaudin AE, Hartmann SE, et al. Effects of exposure to intermittent hypoxia on oxidative stress and acute hypoxic ventilatory response in humans. Am J Respir Crit Care Med. 2009;180(10):1002–9.CrossRefPubMed
41.
Bailey DM, Rimoldi SF, Rexhaj E, Pratali L, Salinas Salmon C, Villena M, et al. Oxidative-nitrosative stress and systemic vascular function in highlanders with and without exaggerated hypoxemia. Chest. 2013;143(2):444–51.CrossRefPubMed
42.
•• Brenner R, Pratali L, Rimoldi SF, Murillo Jauregui CX, Soria R, Rexhaj E, et al. Exaggerated pulmonary hypertension and right ventricular dysfunction in high-altitude dwellers with patent foramen ovale. Chest. 2015;147(4):1072–9. This study shows that a PFO facilitates pulmonary hypertension and right ventricular dysfunction in high-altitude dwellers.CrossRefPubMed
43.
Rigatelli G, Sharma S. Patent foramen ovale-obstructive sleep apnea relationships: pro and cons. Cardiovasc Revasc Med. 2012;13(5):286–8.CrossRefPubMed
44.
Shaikh ZF, Jaye J, Ward N, Malhotra A, de Villa M, Polkey MI, et al. Patent foramen ovale in severe obstructive sleep apnea: clinical features and effects of closure. Chest. 2013;143(1):56–63.CrossRefPubMedPubMedCentral
45.
• Rimoldi SF, Ott S, Rexhaj E, de Marchi SF, Allemann Y, Gugger M, et al. Patent foramen ovale closure in obstructive sleep apnea improves blood pressure and cardiovascular function. Hypertension. 2015;66(5):1050–7. This study shows that in OSA patients, PFO closure improved SDB and nocturnal oxygenation and, in turn, decreased arterial blood pressure and improved left ventricular diastolic function. CrossRefPubMed
46.
•• Bailey DM, Brugniaux JV, Filipponi T, Marley CJ, Stacey B, Soria R, et al. Exaggerated systemic oxidative-inflammatory-nitrosative stress in chronic mountain sickness is associated with cognitive decline and depression. J Physiol. 2019;597(2):611–29. This study shows that in CMS patients, increased oxidative–inflammatory–nitrosative stress is associated with altered cerebral perfusion, accelerated cognitive decline, and depression. CrossRefPubMed
47.
48.
Dempsey JA, Smith CA, Przybylowski T, Chenuel B, Xie A, Nakayama H, et al. The ventilatory responsiveness to CO(2) below eupnoea as a determinant of ventilatory stability in sleep. J Physiol. 2004;560 (Pt 1:1–11.CrossRefPubMedPubMedCentral
49.
Berssenbrugge A, Dempsey J, Iber C, Skatrud J, Wilson P. Mechanisms of hypoxia-induced periodic breathing during sleep in humans. J Physiol. 1983;343:507–24.CrossRefPubMedPubMedCentral
50.
Richalet JP, Rivera M, Bouchet P, Chirinos E, Onnen I, Petitjean O, et al. Acetazolamide: a treatment for chronic mountain sickness. Am J Respir Crit Care Med. 2005;172(11):1427–33.CrossRefPubMed
51.
Beall CM. Andean, Tibetan, and Ethiopian patterns of adaptation to high-altitude hypoxia. Integr Comp Biol. 2006;46(1):18–24.CrossRefPubMed
52.
Beall CM, Strohl KP, Blangero J, Williams-Blangero S, Almasy LA, Decker MJ, et al. Ventilation and hypoxic ventilatory response of Tibetan and Aymara high altitude natives. Am J Phys Anthropol. 1997;104(4):427–47.CrossRefPubMed
53.
54.
Jansen GF, Basnyat B. Brain blood flow in Andean and Himalayan high-altitude populations: evidence of different traits for the same environmental constraint. J Cereb Blood Flow Metab. 2011;31(2):706–14.CrossRefPubMed
55.
Virues-Ortega J, Hogan AM, Baya-Botti A, Kirkham FJ, Baldeweg T, Mahillo-Fernandez I, et al. Survival and mortality in older adults living at high altitude in Bolivia: a preliminary report. J Am Geriatr Soc. 2009;57(10):1955–6.CrossRefPubMed
Metadaten
Titel
Sleep Disordered Breathing at High Altitude in Adults and Its Interaction with Cardiovascular Homeostasis
verfasst von
Emrush Rexhaj
Rodrigo Soria
Anne-Kathrin Brill
Urs Scherrer
Publikationsdatum
01.06.2019
Verlag
Springer International Publishing
Erschienen in
Current Sleep Medicine Reports / Ausgabe 2/2019
Elektronische ISSN: 2198-6401
DOI
https://doi.org/10.1007/s40675-019-00138-x

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