Research article
Dynamics of periodic breathing and arousal during sleep at extreme altitude

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Abstract

To determine whether nocturnal periodic breathing (PB) at altitude is due primarily to unstable control of ventilation or the inability to maintain stable sleep states, we performed visual and computer analyses of the electroencephalographic and respiratory records of healthy volunteers at simulated altitudes of 4572, 6100 and 7620 m. Transient arousals were associated with < 52% of the apneas identified; thus, the PB cycle was not always associated with transient arousal. Following the termination of oxygen breathing, the reinitiation of PB was not dependent on the occurrence of arousal as the primary event. The transition from apnea to breathing preceded the appearance of arousal by ∼ 1 to 4 sec. Ventilatory drive in the breaths immediately following arousal was significantly larger than corresponding control breaths, matched for Sao2. Our findings suggest that altitude-induced PB is unlikely to result from primary fluctuations in state. Arousals promote the development of PB with apnea and help to sustain these episodes, but are not necessary for their initiation.

References (23)

  • S. Lahiri et al.

    Dependence of high altitude sleep apnea on ventilatory sensitivity to hypoxia

    Respir. Physiol.

    (1983)
  • T.W. Millar et al.

    The entrainment of low frequency breathing periodicity

    Chest

    (1990)
  • M. Reite et al.

    Sleep physiology at high altitude

    EEG Clin. Neurophysiol.

    (1975)
  • S. Andreas et al.

    Periodic respiration in patients with heart failure

    Clin. Investig.

    (1993)
  • J.D. Anholm et al.

    Periodic breathing and sleep disruption at high altitude: Operation Everest II

  • J.D. Anholm et al.

    Operation Everest II: Arterial oxygen saturation and sleep at extreme simulated altitude

    Am. Rev. Respir. Dis.

    (1992)
  • A. Berssenbruge et al.

    Mechanisms of hypoxia-induced periodic breathing during sleep in humans

    J. Physiol. (London)

    (1983)
  • V.A. Forte et al.

    Operation Everest II: Comparison of four instruments for measuring blood oxygen saturation

    J. Appl. Physiol.

    (1989)
  • C.S. Houston et al.

    Operation Everest II: man at extreme altitude

    J. Appl. Physiol.

    (1987)
  • M.C.K. Khoo et al.

    Factors inducing periodic breathing in humans: a general model

    J. Appl. Physiol.

    (1982)
  • M.C.K. Khoo et al.

    Sleep-induced periodic breathing and apnea: a theoretical study

    J. Appl. Physiol.

    (1991)
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