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Ortiz-Prado E, Encalada S, Mosquera J, Simbaña-Rivera K, Gomez-Barreno L, Duta D, Ochoa I, Izquierdo-Condoy JS, Vasconez E, Burgos G, Calvopiña M, Viscor G. A comparative analysis of lung function and spirometry parameters in genotype-controlled natives living at low and high altitude. BMC Pulm Med 2022; 22:100. [PMID: 35313848 PMCID: PMC8939107 DOI: 10.1186/s12890-022-01889-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background The reference values for lung function are associated to anatomical and lung morphology parameters, but anthropometry it is not the only influencing factor: altitude and genetics are two important agents affecting respiratory physiology. Altitude and its influence on respiratory function has been studied independently of genetics, considering early and long-term acclimatization. Objective The objective of this study is to evaluate lung function through a spirometry study in autochthonous Kichwas permanently living at low and high-altitude. Methodology A cross-sectional study of spirometry differences between genetically matched lowland Kichwas from Limoncocha (230 m) at Amazonian basin and high-altitude Kichwas from Oyacachi (3180 m) in Andean highlands. The sample size estimates permitted to recruited 118 patients (40 men and 78 women) from Limoncocha and 95 (39 men and 56 women) from Oyacachi. Chi-square method was used to analyze association or independence of categorical variables, while Student’s t test was applied to comparison of means within quantitative variables. ANOVA, or in the case that the variables didn’t meet the criteria of normality, Kruskal Wallis test were used to compare more than two groups. Results The FVC and the FEV1 were significantly greater among highlanders than lowlanders (p value < 0.001), with a proportion difference of 15.2% for men and 8.5% for women. The FEV1/FVC was significantly higher among lowlanders than highlanders for men and women. A restrictive pattern was found in 12.9% of the participants. Conclusion Residents of Oyacachi had greater FVC and FEV1 than their peers from Limoncocha, a finding physiologically plausible according to published literature. Lung size and greater ventilatory capacities could be an adaptive mechanism developed by the highlander in response to hypoxia. Our results support the fact that this difference in FVC and FEV1 is a compensatory mechanism towards lower barometric and alveolar partial pressure of oxygen pressure.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador. .,Department of Cell Biology, Physiology and Immunology, Universidad de Barcelona, Barcelona, Spain.
| | - Sebastián Encalada
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Johanna Mosquera
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Katherine Simbaña-Rivera
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Lenin Gomez-Barreno
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Diego Duta
- Limoncocha Community Health Unit, Limoncocha, Ecuador
| | - Israel Ochoa
- Oyacachi Community Health Unit, Oyacachi, Ecuador
| | - Juan S Izquierdo-Condoy
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Eduardo Vasconez
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - German Burgos
- Faculty of Medicine, Universidad de las Américas, Quito, Ecuador
| | - Manuel Calvopiña
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Ginés Viscor
- Department of Cell Biology, Physiology and Immunology, Universidad de Barcelona, Barcelona, Spain
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Muñoz S, Nazzal C, Jimenez D, Frenz P, Flores P, Alcantara-Zapata D, Marchetti N. Health Effects of Chronic Intermittent Hypoxia at a High Altitude among Chilean Miners: Rationale, Design, and Baseline Results of a Longitudinal Study. Ann Work Expo Health 2021; 65:908-918. [PMID: 34435202 DOI: 10.1093/annweh/wxab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study aims to assess the health effects on mining workers of exposure to chronic intermittent hypoxia (CIH) at high- and very high-altitude mining compared with similar work at lower altitudes in Chile, and it also aims to constitute the baseline of a 5-year follow-up study. METHODS We designed a cross-sectional study to assess health conditions in 483 miners working at 2 levels of altitude exposure: 336 working at a very high or high altitude (HA; 247 above 3900-4400 m, and 89 at 3000-3900 m), and 147 below 2400 m. Subjects were randomly selected in two stages. First, a selection of mines from a census of mines in each altitude stratum was made. Secondly, workers with less than 2 years of employment at each of the selected mines were recruited. The main outcomes measured at the baseline were mountain sickness, sleep alterations, hypertension, body mass index, and neurocognitive functions. RESULTS Prevalence of acute mountain sickness (AMS) was 28.4% in the very high-altitude stratum (P = 0.0001 compared with the low stratum), and 71.7% experienced sleep disturbance (P = 0.02). The adjusted odds ratio for AMS was 9.2 (95% confidence interval: 5.2-16.3) when compared with the very high- and low-altitude groups. Motor processing speed and spatial working memory score were lower for the high-altitude group. Hypertension was lower in the highest-altitude subjects, which may be attributed to preoccupational screening even though this was not statistically significant. CONCLUSIONS Despite longer periods of acclimatization to CIH, subjects continue to present AMS and sleep disturbance. Compromise of executive functions was detected, including working memory at HA. Further rigorous research is warranted to understand long-term health impacts of high-altitude mining, and to provide evidence-based policy recommendations.
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Affiliation(s)
- Sergio Muñoz
- Department of Public Health-CIGES, Faculty of Medicine, Universidad de La Frontera, 01145 Av. Francisco Salazar, Casilla 54-D, Temuco, Chile
| | - Carolina Nazzal
- Program of Occupational Health, School of Public Health, Faculty of Medicine, University of Chile, 939 Av. Independencia, Santiago, Chile
| | - Daniel Jimenez
- Program of Occupational Health, School of Public Health, Faculty of Medicine, University of Chile, 939 Av. Independencia, Santiago, Chile
| | - Patricia Frenz
- Program of Occupational Health, School of Public Health, Faculty of Medicine, University of Chile, 939 Av. Independencia, Santiago, Chile
| | - Patricia Flores
- Faculty of Medicine, Psychiatry Department, Catholic University of Chile, 12351 Camino El Alba, Las Condes, Santiago, Chile.,Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Avenida Vitacura 5951, Región Metropolitana de Santiago, Santiago de Chile, Chile
| | - Diana Alcantara-Zapata
- Program of Occupational Health, School of Public Health, Faculty of Medicine, University of Chile, 939 Av. Independencia, Santiago, Chile
| | - Nella Marchetti
- Program of Occupational Health, School of Public Health, Faculty of Medicine, University of Chile, 939 Av. Independencia, Santiago, Chile
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Impact of rapid ascent to high altitude on sleep. Sleep Breath 2014; 19:819-26. [PMID: 25491080 DOI: 10.1007/s11325-014-1093-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/24/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Sleep disturbance at high altitude is common in climbers. In this study, we intended to evaluate the effect of rapid ascent on sleep architecture using polysomnography (PSG) and to compare the differences between subjects with and without acute mountain sickness (AMS). METHODS The study included 40 non-acclimatized healthy subjects completing PSG at four time points, 3 days before the ascent (T0), two successive nights at 3150 m (T1 and T2), and 2 days after the descent (T3). All subjects were transported by bus from 555 to 3150 m within 3 h. AMS was diagnosed using self-reported questionnaire of Lake Louise score. RESULTS Twenty of 40 (50%) subjects developed AMS. At high altitude, awakening percentages increased in AMS group but changed insignificantly in non-AMS group. Arousal index and apnea/hypopnea index (AHI) increased irrespective of AMS. The increases of AHI were more evident in non-AMS group than in AMS group. Compared to subjects without AMS, those with AMS had significantly lower sleep efficiency, lower central apnea index, and longer latencies to sleep and rapid eye movement (REM) sleep at T1 and lower REM sleep percentages at T1 and T2. Subjects with older age and lower minimum arterial oxygen saturation during sleep at sea level were prone to develop AMS. CONCLUSIONS Higher AHI did not cause more frequent awakenings and arousals at high altitude. Central sleep apneas were observed in non-AMS but not in AMS group. Subjects unacclimatized to acute hypobaric hypoxia might have delayed and less REM sleep.
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Karinen HM, Peltonen JE, Kähönen M, Tikkanen HO. Prediction of acute mountain sickness by monitoring arterial oxygen saturation during ascent. High Alt Med Biol 2011; 11:325-32. [PMID: 21190501 DOI: 10.1089/ham.2009.1060] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Acute mountain sickness (AMS) is a common problem while ascending at high altitude. AMS may progress rapidly to fatal results if the acclimatization process fails or symptoms are neglected and the ascent continues. Extensively reduced arterial oxygen saturation at rest (R-Spo₂) has been proposed as an indicator of inadequate acclimatization and impending AMS. We hypothesized that climbers less likely to develop AMS on further ascent would have higher Spo₂ immediately after exercise (Ex-Spo₂) at high altitudes than their counterparts and that these postexercise measurements would provide additional value for resting measurements to plan safe ascent. The study was conducted during eight expeditions with 83 ascents. We measured R-Spo₂ and Ex-Spo₂ after moderate daily exercise [50 m walking, target heart rate (HR) 150 bpm] at altitudes of 2400 to 5300 m during ascent. The Lake Louise Questionnaire was used in the diagnosis of AMS. Ex-Spo₂ was lower at all altitudes among those climbers suffering from AMS during the expeditions than among those climbers who did not get AMS at any altitude during the expeditions. Reduced R-Spo₂ and Ex-Spo₂ measured at altitudes of 3500 and 4300 m seem to predict impending AMS at altitudes of 4300 m (p < 0.05 and p < 0.01) and 5300 m (both p < 0.01). Elevated resting HR did not predict impending AMS at these altitudes. Better aerobic capacity, younger age, and higher body mass index (BMI) were also associated with AMS (all p < 0.01). In conclusion, those climbers who successfully maintain their oxygen saturation at rest, especially during exercise, most likely do not develop AMS. The results suggest that daily evaluation of Spo₂ during ascent both at rest and during exercise can help to identify a population that does well at altitude.
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Affiliation(s)
- Heikki M Karinen
- Unit for Occupational Health, Department of Health Sciences, University of Tampere, Medisiinarinkatu 3, Tampere, Finland.
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Effect of rapid ascent to high altitude on autonomic cardiovascular modulation. Am J Med Sci 2008; 336:248-53. [PMID: 18794620 DOI: 10.1097/maj.0b013e3181629a32] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effect of acute hypobaric hypoxia on autonomic nervous activities remains unclear. We evaluated the effect of rapid ascent to high altitude on autonomic cardiovascular modulation and compared the differences between the subjects with and without acute mountain sickness (AMS). METHOD Twenty-seven unacclimatized healthy subjects were included for this study. The sleep and study altitude (3180 m) was reached by car from low level (555 m) within 3 hours. The stationary spectral heart rate variability was measured 3 days before ascent (T0), 2 nights at high altitude (T1 and T2), and 2 days after descent (T3). AMS occurrence was evaluated by the Lake Louise score system. RESULTS At high altitude, RR intervals (RRI), standard deviation of RRI (SDRR), total power (TP), low-frequency power (LF), high-frequency power (HF), and normalized HF decreased significantly but normalized LF and LF/HF ratio increased significantly in subjects irrespective of AMS. AMS developed in 13 of 27 (48.1%) subjects. Compared with the data at T1, SDRR, TP, LF, and HF increased at T2 in AMS group but decreased in non-AMS group, and the differences in these variables (data at T2 minus data at T1) between the 2 groups showed statistical significance. CONCLUSIONS After rapid ascent to high altitude, autonomic nervous activities were suppressed and sympathetic activity was relatively predominant. At high altitude, the discordant changes in SDRR, TP, LF, and HF may reflect varying capacity of acute hypobaric hypoxic adaptation between the subjects with and without AMS.
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Botella de Maglia J, Fuster Escrivà A. Ascensión a gran altitud de un paciente con trasplante pulmonar. Comparación con montañeros sanos. Med Clin (Barc) 2007; 129:339-42. [PMID: 17910850 DOI: 10.1016/s0025-7753(07)72845-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE To ascertain if a bilaterally lung transplanted patient can climb a mountain higher than 4,000 metres and to compare the evolution of his physiological parameters during the ascent with those of healthy mountaineers. SUBJECTS AND METHOD Heart rate, blood pressure, arterial oxygen saturation (SaO2), forced vital capacity, forced expiratory volume in one second, Tiffenau test, 25-75 mesoexpiratory flow, peak flow, severity of dyspnoea (analogic score) and symptoms and signs of acute mountain sickness (lake Louise and Serrano-Alcócer scores) were measured in a bilaterally lung transplanted patient and in 4 healthy mountaineers at sea level and at different altitudes during the ascent of Breithorn (4,164 m) from Zermatt in 3 days. RESULTS All subjects attained the summit. The transplanted patient suffered from an acute mountain sickness at 2,700 m but recovered spontaneously. No other substantial differences were found during the climb between the patient's physiological parameters and those of the healthy controls. On the summit (third day) the patient's SaO2 (90%) was higher than the figure which should be theoretically expected for this altitude among non-acclimatised subjects (81%). CONCLUSIONS Our study confirms that it is possible for a bilaterally lung transplanted patient to climb by his own effort a mountain higher than 4,000 m with no physiological changes other than those experienced by healthy mountaineers. Considering the spontaneous recovery from the acute mountain sickness and the high SaO2 on the summit of Breithorn, we conclude that lung transplantation does not necessarily prevent altitude acclimatisation.
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Alonso J, Marin JM. [The ARCHIVOS archive, 2005: and overview of research published in Archivos De Bronconneumología]. Arch Bronconeumol 2006; 42:475-83. [PMID: 17120348 DOI: 10.1016/s1579-2129(06)60570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- José Alonso
- Servicio de Neumología, Hospital Miguel Servet, Zaragoza, España
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