Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Heart rate variability during sleep at high altitude: effect of periodic breathing

  • 412 Accesses

  • 3 Citations



Heart rate variability (HRV) during sleep in normal subjects at high altitude shows a decrease in parasympathetic tone associated with an increase in the sympathetic one, which tends to be reversed with acclimatization. However, periodic breathing (PB) during sleep may influence this effect detected by HRV spectral analysis.


The aim of our study was to investigate HRV during sleep periodic breathing (PB) at high altitude in normal subjects at two different times of acclimatization, i.e., two different levels of hypoxemia.


Recordings of six healthy climbers (aged between 33 and 40 years), at sea level (SL) and at Everest North Base Camp (5180 m), during the first (BC1) and the tenth (BC2) overnight unattended polygraphy, were analyzed. PB was commonplace in all subjects at high altitude to a variable extent. At SL and at BC1 and BC2, HRV was evaluated overnight and separately during clear regular breathing (RB) and PB.


A mean overnight beat-by-beat series interval (RR) reduction at acute environmental hypoxic exposure that resumed to SL values after 10-day sojourn was observed. This reduction was mostly due to RR during RB, while during PB, RR values were not different from SL. Higher peaks of tidal volume were associated with higher HRV.


The present study shows that in healthy subjects, PB with central apneas increases the amplitude of RR oscillations, and these oscillations are tightly related to respiratory amplitude. Oxygenation does not influence this phenomenon. Therefore, oscillations in ventilation itself should be taken into account when investigating HRV.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7


  1. 1.

    Insalaco G, Romano S, Salvaggio A, Braghiroli A, Lanfranchi P, Patruno V et al (1996) Cardiovascular and ventilatory response to isocapnic hypoxia at sea level and at 5,050 m. J Appl Physiol 80:1724–1730

  2. 2.

    Lahiri S (1972) Dynamic aspects of regulation of ventilation in man during acclimatization to high altitude. Respir Physiol 16:245–258

  3. 3.

    Johnson PL, Edwards N, Burgess KR, Sullivan CE (2010) Sleep architecture changes during a trek from 1400 to 5000 m in the Nepal Himalaya. J Sleep Res 19:148–156

  4. 4.

    Salvaggio A, Insalaco G, Marrone O, Romano S, Braghiroli A, Lanfranchi P et al (1988) Effects of high altitude periodic breathing on sleep and arterial oxyhaemoglobin saturation. Eur Respir J 12:408–413

  5. 5.

    West JB, Peters RM Jr, Aksnes G, Maret KH, Milledge JS, Schoene RB (1986) Nocturnal periodic breathing at altitudes of 6,300 and 8,050 m. J Appl Physiol 61:280–287

  6. 6.

    Bloch KE, Latshang TD, Turk AJ, Hess T, Hefti U, Merz TM et al (2010) Nocturnal periodic breathing during acclimatization at very high altitude at mount Muztagh Ata (7,546 m). Am J Respir Crit Care Med 182:562–568

  7. 7.

    Berssenbrugge A, Dempsey J, Iber C, Skatrud J, Wilson P (1983) Mechanisms of hypoxia-induced periodic breathing during sleep in humans. J Physiol 343:507–524

  8. 8.

    Martin D, Windsor J (2008) From mountain to bedside: understanding the clinical relevance of human acclimatisation to high-altitude hypoxia. Postgrad Med J 84:622–627

  9. 9.

    Hainsworth R, Drinkhill MJ (2007) Cardiovascular adjustments for life at high altitude. Respir Physiol Neurobiol 158:204–211

  10. 10.

    Insalaco G, Romano S, Salvaggio A, Pomidori L, Mandolesi G, Cogo A (2012) Periodic breathing, arterial oxyhaemoglobin saturation and heart rate during sleep at high-altitude. High Alt Med Biol 13:258–262

  11. 11.

    Insalaco G, Romano S, Salvaggio A, Braghiroli A, Lanfranchi P, Patruno V et al (2000) BP and HR during periodic breathing at high altitude. J Appl Physiol 89:947–955

  12. 12.

    Masuyama S, Shinozaki T, Kohchiyama S, Okita S, Kimura H, Honda Y, Kuriyama T (1990) Heart rate depression during sleep apnea depends on hypoxic chemosensitivity. Am Rev Respir Dis 141:39–42

  13. 13.

    Ludwig C (1847) Beiträgezur kenntniss des einflusses der respirationsbewegung auf den blutlauf im aortensystem. Arch Anat Physiol 13:242–302

  14. 14.

    Task Force of the European Society of Cardiology, and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability. standards of measurement, physiological interpretation, and clinical use. Circulation 93:1043–1065

  15. 15.

    Bernardi L, Passino C, Spadacini G, Calciati A, Robergs R, Greene R et al (1998) Cardiovascular autonomic modulation and activity of carotid baroreceptors at altitude. Clin Sci (London) 95:565–573

  16. 16.

    Hughson RL, Yamamoto Y, McCullough RE, Sutton JR, Reeves JT (1994) Sympathetic and parasympathetic indicators of heart rate control at altitude studied by spectral analysis. J Appl Physiol 77:2537–2542

  17. 17.

    Lipsitz LA, Hashimoto F, Lubowsky LP, Mietus J, Moody GB, Appenzeller O, Goldberger AL (1995) Heart rate and respiratory rhythm dynamics on ascent to high altitude. Br Heart J 74:390–396

  18. 18.

    Sevre K, Bendz B, Hankø E, Nakstad AR, Hauge A, Kåsin JI et al (2001) Reduced autonomic activity during stepwise exposure to high altitude. Acta Physiol Scand 173:409–417

  19. 19.

    Perini R, Milesi S, Biancardi L, Veicsteinas A (1996) Effects of high altitude acclimatization on heart rate variability in resting humans. Eur J Appl Physiol 73:521–528

  20. 20.

    Levine BD (2001) Mountain medicine and the autonomic nervous system. In: Appenzeller O (ed) Handbook of clinical neurology. The autonomic nervous system. Dysfunction, vol 75. Elsevier Science, New York, pp 1–21, part 2

  21. 21.

    Mazzeo RS, Wolfel EE, Butterfield GE, Reeves JT (1994) Sympathetic response during 21 days at high altitude (4,300 m) as determined by urinary and arterial catecholamines. Metabolism 43:1226–1132

  22. 22.

    Richalet JP, Kacimi R, Antezana AM (1992) The control of cardiac chronotropic function in hypobaric hypoxia. Int J Sports Med 13:S22–S24

  23. 23.

    Di Rienzo M, Castiglioni P, Rizzo F, Faini A, Mazzoleni P, Lombardi C, HIGHCARE investigators et al (2010) Linear and fractal heart rate dynamics during sleep at high altitude. investigation with textile technology. Methods Inf Med 49:521–525

  24. 24.

    Cornolo J, Mollard P, Brugniaux JV, Robach P, Richalet JP (2004) Autonomic control of the cardiovascular system during acclimatization to high altitude: effects of sildenafil. J Appl Physiol 97:935–940

  25. 25.

    Brown TE, Beightol LA, Koh J, Eckberg DL (1993) Important influence of respiration on human R-R interval power spectra is largely ignored. J Appl Physiol 75:2310–2317

  26. 26.

    Flevari A, Vagiakis E, Zakynthinos S (2014) Heart rate variability is augmented in patients with positional obstructive sleep apnea, but only supine LF/HF index correlates with its severity. Sleep Breath Jul 11

  27. 27.

    Szollosi I, Krum H, Kaye D, Naughton MT (2007) Sleep apnea in heart failure increases heart rate variability and sympathetic dominance. Sleep 30:1509–1514

  28. 28.

    Leung RS, Floras JS, Lorenzi-Filho G, Rankin F, Picton P, Bradley TD (2003) Influence of Cheyne-stokes respiration on cardiovascular oscillations in heart failure. Am J Respir Crit Care Med 167:1534–1539

  29. 29.

    Lorenzi-Filho G, Dajani HR, Leung RS, Floras JS, Bradley TD (1999) Entrainment of blood pressure and heart rate oscillations by periodic breathing. Am J Respir Crit Care Med 159:1147–1154

  30. 30.

    Coleridge HM, Coleridge JCG, Jordan D (1991) Integration of ventilatory and cardiovascular control systems. In: The Lung, edited by Crystal RG and West JB. New York: Raven, chapter 5.4.10, pp. 1405–1418

Download references


The authors would like to thank A. Da Pollenza (Ev-K2-CNR Project, Head of “K2-2004 50 years later” Italian Expedition to Everest and K2) on behalf of all members of the Expedition, and Ente Italiano per la Montagna for funding this study and for providing technical and logistical support. Supported also by the Italian National Research Council, order number ME.P01.014.009, is acknowledged.

Author information

Correspondence to Giuseppe Insalaco.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Insalaco, G., Salvaggio, A., Pomidori, L. et al. Heart rate variability during sleep at high altitude: effect of periodic breathing. Sleep Breath 20, 197–204 (2016). https://doi.org/10.1007/s11325-015-1205-z

Download citation


  • Sleep
  • Periodic breathing
  • High altitude
  • Arterial oxygen saturation
  • Heart rate variability