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Sleep and Breathing at High Altitude.
Himanshu Wickramasinghe1, James D. Anholm
1Pulmonary and Intensive Care Section, Department of Internal Medicine, Loma Linda University School of Medicine, Loma Linda, California.
Sleep & Breathing = Schlaf & Atmung
|March 19, 2002
Summary
High altitude sleep is poor due to hypobaric hypoxia and periodic breathing, causing fragmented sleep and worsening acute mountain sickness (AMS). Acetazolamide and temazepam can improve sleep quality at altitude.
Area of Science:
- Environmental Physiology
- Sleep Medicine
- Altitude Physiology
Background:
- Sleep disturbances are common at high altitudes, characterized by poor subjective quality, frequent awakenings, and nocturnal hypoxemia.
- Periodic breathing with central apneas is prevalent in high-altitude sojourners, contributing significantly to sleep disruption.
- Hypobaric hypoxia, especially during sleep, exacerbates sleep fragmentation and is linked to acute mountain sickness (AMS).
Purpose of the Study:
- To investigate the characteristics of sleep at high altitude.
- To identify the primary causes of sleep disruption at altitude.
- To evaluate the efficacy of pharmacological interventions for altitude-related sleep disturbances.
Main Methods:
- Observational studies characterizing sleep architecture and gas exchange at high altitude.
- Analysis of the relationship between periodic breathing, hypobaric hypoxia, and sleep quality.
- Clinical assessment of interventions like acetazolamide and temazepam on sleep and AMS symptoms.
Main Results:
- High altitude sleep features increased light sleep, reduced slow-wave and REM sleep, frequent arousals, and marked nocturnal hypoxemia.
- Periodic breathing and hypobaric hypoxia are identified as principal causes of sleep disruption and fragmentation.
- Hypoxic sleep disruption contributes to AMS symptoms, with hypoxemia being most severe during sleep.
- Acetazolamide demonstrated improvements in sleep quality, AMS symptoms, and hypoxemia.
- Low-dose temazepam showed potential benefits for improving sleep at high altitude.
Conclusions:
- Sleep disruption at high altitude is primarily driven by hypobaric hypoxia and periodic breathing, leading to fragmented sleep and contributing to AMS.
- Pharmacological interventions, including acetazolamide and potentially low-dose temazepam, can effectively mitigate sleep disturbances and associated symptoms at high altitude.