Journal
HIGH ALTITUDE MEDICINE & BIOLOGY
Volume 18, Issue 1, Pages 11-19Publisher
MARY ANN LIEBERT, INC
DOI: 10.1089/ham.2016.0102
Keywords
altitude; Andean; apnea; epidemiology; hypoxia
Funding
- US National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services [HHSN268200900033C]
- NIH National Research Service Award [5T32HL1109523]
- Fogarty International Centre [R21TW009982]
- Grand Challenges Canada [0335-04]
- International Development Research Center Canada [106887-001]
- Inter-American Institute for Global Change Research [IAI CRN3036]
- Medical Research Council UK [M007405]
- National Heart, Lung and Blood Institute [U01HL114180]
- National Institutes of Mental Health [U19MH098780]
- National Heart, Lung and Blood Institute grants [R01s HL133100, HL128970, HL080105]
- National Institute of Environmental Health Sciences [P50ES018176]
- NHLBI [HL128970, HL133100]
- Medical Research Council [MR/K007467/1] Funding Source: researchfish
- MRC [MR/K007467/1] Funding Source: UKRI
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Background: Altitude can accentuate sleep disordered breathing (SDB), which has been linked to cardiovascular and metabolic diseases. SDB in highlanders has not been characterized in large controlled studies. The purpose of this study was to compare SDB prevalence and severity in highlanders and lowlanders. Methods: 170 age-, body-mass-index-(BMI), and sex-matched pairs (age 58.2 +/- 12.4 years, BMI 27.2 +/- 3.5 kg/m(2), and 86 men and 84 women) of the CRONICAS Cohort Study were recruited at a sea-level (Lima) and a highaltitude (Puno, 3825 m) setting in Peru. Participants underwent simultaneous nocturnal polygraphy and actigraphy to characterize breathing patterns, movement arousals, and sleep/wake state. We compared SDB prevalence, type, and severity between highlanders and lowlanders as measured by apnea-hypopnea index (AHI) and pulse oximetry (SPO2) during sleep. Results: Sleep apnea prevalence was greater in highlanders than in lowlanders (77% vs. 54%, p < 0.001). Compared with lowlanders, highlanders had twofold elevations in AHI due to increases in central rather than obstructive apneas. In highlanders compared with lowlanders, SPO2 was lower during wakefulness and decreased further during sleep (p < 0.001). Hypoxemia during wakefulness predicted sleep apnea in highlanders, and it appears to mediate the effects of altitude on sleep apnea prevalence. Surprisingly, hypoxemia was also quite prevalent in lowlanders, and it was also associated with increased odds of sleep apnea. Conclusions: High altitude and hypoxemia at both high and low altitude were associated with increased SDB prevalence and severity. Our findings suggest that a large proportion of highlanders remain at risk for SDB sequelae.
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