Sleep-Disordered Breathing at High Altitude: Its Characteristics and Research Progress in Treatment

TAN L , TANG Xiang-dong

Abstract

Hypobaric hypoxia in regions of high altitude may increase the risk of having sleep-disordered breathing (SDB). SDB at high altitude mainly refers to the SDB incurred in highlanders and lowlanders at a high altitude. At present, research on SDB at high altitude is mainly focused on these two groups of people. On the one hand, highlanders have SDB at a higher prevalence and greater severity than lowlanders do and highlanders have a prolonged duration of apnea when they travel to low-altitude regions. On the other hand, the severity of SDB increased in lowlanders when they travel to high altitude, represented mainly by an increase in central and hypopnea events. In terms of treatment, a substantial number of studies have shown that medication, including acetazolamide and dexamethasone, and nocturnal oxygen supplementation could improve SDB in lowlanders when they travel to high altitude. However, not much research has been done on the treatment of SDB in highlanders and it has only been reported that nocturnal oxygen supplementation was an available treatment option. Herein, we summarized the latest research findings on SDB at high altitude, providing the basis for further studies about the characteristics and treatments for highlanders with SDB.

 

Keywords: High altitude, Obstructive sleep apnea, Central sleep apnea, Treatment

 

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References


VEASEY S C， ROSEN I M. Obstructive sleep apnea in adults. N Engl J Med，2019，380(15): 1442–1449. doi: 10.1056/NEJMcp1816152.

LAVIE P， HERER P， HOFFSTEIN V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ，2000， 320(7233): 479–482. doi: 10.1136/bmj.320.7233.479.

HOU H， ZHAO Y， YU W， et al. Association of obstructive sleep apnea with hypertension: a systematic review and meta-analysis. J Glob Health， 2018，8(1): 010405. doi: 10.7189/jogh.08.010405.

SANCHEZ-De-La-TORRE M， CAMPOS-RODRIGUEZ F， BARBE F. Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med， 2013，1(1): 61–72. doi: 10.1016/S2213-2600(12)70051-6.

TORRES G， SANCHEZ-De-La-TORRE M， BARBE F. Relationship between OSA and hypertension. Chest，2015，148(3): 824–832. doi: 10. 1378/chest.15-0136.

ECKERT D J， JORDAN A S， MERCHIA P， et al. Central sleep apnea: pathophysiology and treatment. Chest，2007，131(2): 595–607. doi: 10. 1378/chest.06.2287.

BURGESS K R， JOHNSON P L， EDWARDS N. Central and obstructive sleep apnoea during ascent to high altitude. Respirology，2004，9(2): 222–229. doi: 10.1111/j.1440-1843.2004.00576.x.

SIMANCAS-RACINES D， AREVALO-RODRIGUEZ I， OSORIO D， et al. Interventions for treating acute high altitude illness. Cochrane Database Syst Rev，2018，6: CD009567. doi: 10.1002/14651858.CD009567. pub2.

BEALL C M， DECKER M J， BRITTENHAM G M， et al. An Ethiopian pattern of human adaptation to high-altitude hypoxia. Proc Natl Acad Sci U S A，2002，99(26): 17215–17218. doi: 10.1073/pnas.252649199.

BEALL C M， LASKOWSKI D， ERZURUM S C. Nitric oxide in adaptation to altitude. Free Radic Biol Med，2012，52(7): 1123–1134. doi: 10.1016/j.freeradbiomed.2011.12.028.

SCHWARTZ N G， RATTNER A， SCHWARTZ A R， et al. Sleep disordered breathing in four resource-limited settings in Peru: prevalence, risk factors, and association with chronic diseases. Sleep，2015，38(9): 1451–1459. doi: 10.5665/sleep.4988.

PHAM L V， MEINZEN C， ARIAS R S， et al. Cross-sectional comparison of sleep-disordered breathing in native Peruvian highlanders and lowlanders. High Alt Med Biol，2017，18(1): 11–19. doi: 10.1089/ham. 2016.0102.

REXHAJ E， RIMOLDI S F， PRATALI L， et al. Sleep-disordered breathing and vascular function in patients with chronic mountain sickness and healthy high-altitude dwellers. Chest，2016，149(4): 991–998. doi: 10.1378/chest.15-1450.

TAN L， LI T， LUO L， et al. The characteristics of sleep apnea in Tibetans and Han long-term high altitude residents. Nat Sci Sleep，2022， 14: 1533–1544. doi: 10.2147/NSS.S371388.

HILL C M， CARROLL A， DIMITRIOU D， et al. Polysomnography in Bolivian children native to high altitude compared to children native to low altitude. Sleep，2016，39(12): 2149–2155. doi: 10.5665/sleep.6316.

DUENAS-MEZA E， BAZURTO-ZAPATA M A， GOZAL D， et al. Overnight polysomnographic characteristics and oxygen saturation of healthy infants, 1 to 18 months of age, born and residing at high atitude (2, 640 Meters). Chest，2015，148(1): 120–127. doi: 10.1378/chest.14-3207.

ALFORD N J， FLETCHER E C， NICKESON D. Acute oxygen in patients with sleep apnea and COPD. Chest，1986，89(1): 30–38. doi: 10.1378/chest.89.1.30.

ALI N J， DAVIES R J， FLEETHAM J A， et al. The acute effects of continuous positive airway pressure and oxygen administration on blood pressure during obstructive sleep apnea. Chest，1992，101(6): 1526–1532. doi: 10.1378/chest.101.6.1526.

PHILLIPS B A， SCHMITT F A， BERRY D T， et al. Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest，1990，98(2): 325–330. doi: 10.1378/chest.98.2.325.

MILLS P J， KENNEDY B P， LOREDO J S， et al. Effects of nasal continuous positive airway pressure and oxygen supplementation on norepinephrine kinetics and cardiovascular responses in obstructive sleep apnea. J Appl Physiol (1985)，2006，100(1): 343–348. doi: 10.1152/japplphysiol.00494.2005.

TAN L， LI T， ZHANG Y， et al. Effect of one night of nocturnal oxygen supplementation on highland patients with OSA: a randomized, crossover trial. Chest，2021，160(2): 690–700. doi: 10.1016/j.chest.2021.02.046.

TAN L， LI T， LEI F， et al. Longer apnea duration at low altitude in Tibetan and Han highlanders compared with Han lowlanders: a retrospective study. J Sleep Res，2019，29(2): e12934. doi: 10.1111/jsr. 12934.

PATZ D， SPOON M， CORBIN R， et al. The effect of altitude descent on obstructive sleep apnea. Chest，2006，130(6): 1744–1750. doi: 10.1378/chest.130.6.1744.

BENJAMIN H H， JOHN T B， DAVID G I， et al. The impact of altitude on sleep-disordered breathing in children dwelling at high altitude. Sleep， 2017，40(9): zsx120. doi: 10.1093/sleep/zsx120.

PATZ D S， SWIHART B， WHITTE D P. CPAP pressure requirements for obstructive sleep apnea patients at varying altitudes. Sleep，2010， 33(5): 715–718. doi: 10.1093/sleep/33.5.715.

BLOCH K E， LATSHANG T D， TURK A J， 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.

LATSHANG T D， Lo CASCIO C M， STOWHAS A C， et al. Are nocturnal breathing, sleep, and cognitive performance impaired at moderate altitude (1,630-2,590 m)? Sleep，2013，36(12): 1969–1976. doi: 10.5665/sleep.3242.

NUSSBAUMER-OCHSNER Y， SCHUEPFER N， ULRICH S， et al. 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): 429–435. doi: 10.1136/thx.2009.125849.

LATSHANG T D， TARDENT R P M， FURIAN M， et al. Sleep and breathing disturbances in patients with chronic obstructive pulmonary disease traveling to altitude: a randomized trial. Sleep，2019，42(1): zsy203. doi: 10.1093/sleep/zsy203.

GAVLAK J C， STOCKS J， LAVERTY A， et al. The Young Everest Study: preliminary report of changes in sleep and cerebral blood flow velocity during slow ascent to altitude in unacclimatised children. Arch Dis Child， 2013，98(5): 356–362. doi: 10.1136/archdischild-2012-302512.


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