Skip to main content
SpringerLink
Log in

Effects of High Altitude on Sleep and Respiratory System

  • Sleeping and Breathing (A Abreu, Section Editor)
  • Published:
Current Pulmonology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to discuss the pathogenesis, clinical manifestations, and diagnosis treatment of sleep apnea at high altitude as well and acute altitude illnesses.

Recent Findings

Differences in adaptive responses of different native highlander populations are leading to interesting new insights into high-altitude physiology.

Summary

Periodic breathing at altitude is a physiologic response to hypobaric oxygen and patients with obstructive sleep apnea have transition of respiratory events from obstructive to central at altitude. Acetazolamide is first-line therapy for periodic breathing at altitude. Other acute altitude illnesses are best treated with descent to a lower altitude.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. West JB. The physiologic basis of high-altitude diseases. Ann Intern Med. 2004;141(10):789–800.

    Article  PubMed  Google Scholar 

  2. West JB, Lahiri S, Maret KH, Peters RM Jr, Pizzo CJ. Barometric pressures at extreme altitudes on Mt. Everest: physiological significance. J Appl Physiol Respir Environ Exerc Physiol. 1983;54(5):1188–94.

    CAS  PubMed  Google Scholar 

  3. Widdicombe J. Airway receptors. Respir Physiol. 2001;125(1-2):3–15.

    Article  CAS  PubMed  Google Scholar 

  4. Murray, J.F., J.A. Nadel, and R.J. Mason, Murray and Nadel’s textbook of respiratory medicine. 4th ed. 2005, Philadelphia, Pa.: Elsevier Saunders. 2 volumes (xxiv, 2, 486, cxx pages, 32 unnumbered pages of plates).

  5. Guyenet PG, Abbott SB, Stornetta RL. The respiratory chemoreception conundrum: light at the end of the tunnel? Brain Res. 2013;1511:126–37.

    Article  CAS  PubMed  Google Scholar 

  6. West JB. Respiratory physiology: the essentials. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ix; 2008. 186 pages.

    Google Scholar 

  7. Smith JC, et al. Pre-Botzinger complex: a brainstem region that may generate respiratory rhythm in mammals. Science. 1991;254(5032):726–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Orem J. The nature of the wakefulness stimulus for breathing. Prog Clin Biol Res. 1990;345:23–30 discussion 31.

    CAS  PubMed  Google Scholar 

  9. Hackett PH, Roach RC. High-altitude illness. N Engl J Med. 2001;345(2):107–14.

    Article  CAS  PubMed  Google Scholar 

  10. Lahiri S, Barnard P. Role of arterial chemoreflex in breathing during sleep at high altitude. Prog Clin Biol Res. 1983;136:75–85.

    CAS  PubMed  Google Scholar 

  11. Nakayama H, et al. Carotid body denervation eliminates apnea in response to transient hypocapnia. J Appl Physiol (1985). 2003;94(1):155–64.

    Article  Google Scholar 

  12. White DP, et al. Altitude acclimatization: influence on periodic breathing and chemoresponsiveness during sleep. J Appl Physiol (1985). 1987;63(1):401–12.

    Article  CAS  Google Scholar 

  13. Weil JV. Sleep at high altitude. High Alt Med Biol. 2004;5(2):180–9.

    Article  PubMed  Google Scholar 

  14. Burgess KR, Johnson PL, Edwards N. Central and obstructive sleep apnoea during ascent to high altitude. Respirology. 2004;9(2):222–9.

    Article  PubMed  Google Scholar 

  15. Dempsey JA, Skatrud JB. A sleep-induced apneic threshold and its consequences. Am Rev Respir Dis. 1986;133(6):1163–70.

    CAS  PubMed  Google Scholar 

  16. Dempsey JA. Crossing the apnoeic threshold: causes and consequences. Exp Physiol. 2005;90(1):13–24.

    Article  PubMed  Google Scholar 

  17. Dempsey JA. Crossing the apnoeic threshold: causes and consequences. Exp Physiol. 2005;90(1):13–24.

    Article  PubMed  Google Scholar 

  18. Lahiri S, Maret K, Sherpa MG. Dependence of high altitude sleep apnea on ventilatory sensitivty to hypoxia. Respir Physiol. 1983;52(3):281–301.

    Article  CAS  PubMed  Google Scholar 

  19. Hackett PH, Roach RC, Harrison GL, Schoene RB, Mills WJ Jr. Respiratory stimulants and sleep periodic breathing at high altitude. Almitrine versus acetazolamide. Am Rev Respir Dis. 1987;135(4):896–8.

    Article  CAS  PubMed  Google Scholar 

  20. Sutton JR, Gray GW, Houston CS, Powles ACP. Effects of duration at altitude and acetazolamide on ventilation and oxygenation during sleep. Sleep. 1980;3(3-4):455–64.

    Article  CAS  PubMed  Google Scholar 

  21. Swenson ER, Leatham KL, Roach RC, Schoene RB, Mills WJ Jr, Hackett PH. Renal carbonic anhydrase inhibition reduces high altitude sleep periodic breathing. Respir Physiol. 1991;86(3):333–43.

    Article  CAS  PubMed  Google Scholar 

  22. Edwards BA, Sands SA, Feeney C, Skuza EM, Brodecky V, Wilkinson MH, et al. Continuous positive airway pressure reduces loop gain and resolves periodic central apneas in the lamb. Respir Physiol Neurobiol. 2009;168(3):239–49.

    Article  PubMed  Google Scholar 

  23. Bayliss DA, Millhorn DE. Central neural mechanisms of progesterone action: application to the respiratory system. J Appl Physiol (1985). 1992;73(2):393–404.

    Article  CAS  Google Scholar 

  24. Zhou XS, et al. Effect of testosterone on the apneic threshold in women during NREM sleep. J Appl Physiol (1985). 2003;94(1):101–7.

    Article  CAS  Google Scholar 

  25. Lombardi C, Meriggi P, Agostoni P, Faini A, Bilo G, Revera M, et al. High-altitude hypoxia and periodic breathing during sleep: gender-related differences. J Sleep Res. 2013;22(3):322–30.

    Article  PubMed  Google Scholar 

  26. Caravita S, Faini A, Lombardi C, Valentini M, Gregorini F, Rossi J, et al. Sex and acetazolamide effects on chemoreflex and periodic breathing during sleep at altitude. Chest. 2015;147(1):120–31.

    Article  PubMed  Google Scholar 

  27. Burgess KR, et al. Effect of simulated altitude during sleep on moderate-severity OSA. Respirology. 2006;11(1):62–9.

    Article  PubMed  Google Scholar 

  28. Nussbaumer-Ochsner Y, Schuepfer N, Ulrich S, Bloch KE. Exacerbation of sleep apnoea by frequent central events in patients with the obstructive sleep apnoea syndrome at altitude: a randomised trial. Thorax. 2010;65(5):429–35.

    Article  PubMed  Google Scholar 

  29. Badr MS, Skatrud JB, Dempsey JA. Determinants of poststimulus potentiation in humans during NREM sleep. J Appl Physiol (1985). 1992;73(5):1958–71.

    Article  CAS  Google Scholar 

  30. McSharry DG, Saboisky JP, DeYoung P, Jordan AS, Trinder J, Smales E, et al. Physiological mechanisms of upper airway hypotonia during REM sleep. Sleep. 2014;37(3):561–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Badr MS, et al. Pharyngeal narrowing/occlusion during central sleep apnea. J Appl Physiol (1985). 1995;78(5):1806–15.

    Article  CAS  Google Scholar 

  32. • Liu H-M, et al. The effect of acetazolamide on sleep apnea at high altitude: a systematic review and meta-analysis. Ther Adv Respir Dis. 2017;11(1):20–9 Summarizing the numerous studies that have investigated acetazolamide as a treatment for high altitude illness.

  33. Latshang TD, Nussbaumer-Ochsner Y, Henn RM, Ulrich S, Lo Cascio CM, Ledergerber B, et al. Effect of acetazolamide and AutoCPAP therapy on breathing disturbances among patients with obstructive sleep apnea syndrome who travel to altitude. JAMA. 2012;308(22):2390–8.

    Article  CAS  PubMed  Google Scholar 

  34. Bloch KE, Latshang TD, Ulrich S. Patients with obstructive sleep apnea at altitude. High Alt Med Biol. 2015;16(2):110–6.

    Article  PubMed  Google Scholar 

  35. Bloch KE. Alternatives to CPAP in the treatment of the obstructive sleep apnea syndrome. Swiss Med Wkly. 2006;136(17-18):261–7.

    PubMed  Google Scholar 

  36. Berry RB, Kryger MH, Massie CA. A novel nasal expiratory positive airway pressure (EPAP) device for the treatment of obstructive sleep apnea: a randomized controlled trial. Sleep. 2011;34(4):479–85.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Smith CA, Blain GM, Henderson KS, Dempsey JA. Peripheral chemoreceptors determine the respiratory sensitivity of central chemoreceptors to CO2: role of carotid body CO2. J Physiol. 2015;593(18):4225–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Fatemian M, Robbins PA. Selected contribution: chemoreflex responses to CO2 before and after an 8-h exposure to hypoxia in humans. J Appl Physiol (1985). 2001;90(4):1607–14 discussion 1606.

    Article  CAS  Google Scholar 

  39. West JB, Wagner PD. Predicted gas exchange on the summit of Mt. Everest Respir Physiol. 1980;42(1):1–16.

    Article  CAS  PubMed  Google Scholar 

  40. Knaupp W, et al. Erythropoietin response to acute normobaric hypoxia in humans. J Appl Physiol (1985). 1992;73(3):837–40.

    Article  CAS  Google Scholar 

  41. West JB. High-altitude medicine. Am J Respir Crit Care Med. 2012;186(12):1229–37.

    Article  PubMed  Google Scholar 

  42. • Roach RC, et al. The 2018 Lake Louise Acute Mountain Sickness Score. High Alt Med Biol. 2018;19(1):4–6 Objective evaluation of acute mountain sickness.

  43. Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force. Chest. 2006;129(1):174–81.

    Article  PubMed  Google Scholar 

  44. Luks AM, Auerbach PS, Freer L, Grissom CK, Keyes LE, McIntosh SE, et al. Wilderness medical society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update. Wilderness Environ Med. 2019;30(4S):S3–S18.

    Article  PubMed  Google Scholar 

  45. Tseng CH, Lin FC, Chao HS, Tsai HC, Shiao GM, Chang SC. Impact of rapid ascent to high altitude on sleep. Sleep Breath. 2015;19(3):819–26.

    Article  PubMed  Google Scholar 

  46. Eichenberger U, Weiss E, Riemann D, Oelz O, Bärtsch P. Nocturnal periodic breathing and the development of acute high altitude illness. Am J Respir Crit Care Med. 1996;154(6 Pt 1):1748–54.

    Article  CAS  PubMed  Google Scholar 

  47. Luks AM. Do lung disease patients need supplemental oxygen at high altitude? High Alt Med Biol. 2009;10(4):321–7.

    Article  PubMed  Google Scholar 

  48. Stokes S, Kalson N, Earl M, Frost H, Whitehead AG, Tyrrell-Marsh I, et al. Bronchial asthma on Mount Kilimanjaro is not a disadvantage. Thorax. 2008;63(10):936–7.

    Article  CAS  PubMed  Google Scholar 

  49. Reeves JT, et al. Operation Everest II: preservation of cardiac function at extreme altitude. J Appl Physiol (1985). 1987;63(2):531–9.

    Article  CAS  Google Scholar 

  50. Luks AM. Can patients with pulmonary hypertension travel to high altitude? High Alt Med Biol. 2009;10(3):215–9.

    Article  PubMed  Google Scholar 

  51. Flint J, Harding RM, Boyce AJ, Clegg JB. The population genetics of the haemoglobinopathies. Baillieres Clin Haematol. 1998;11(1):1–51.

    Article  CAS  PubMed  Google Scholar 

  52. Bigham AW, Wilson MJ, Julian CG, Kiyamu M, Vargas E, Leon-Velarde F, et al. Andean and Tibetan patterns of adaptation to high altitude. Am J Hum Biol. 2013;25(2):190–7.

    Article  PubMed  Google Scholar 

  53. Beall CM, Decker MJ, Brittenham GM, Kushner I, Gebremedhin A, Strohl KP. An Ethiopian pattern of human adaptation to high-altitude hypoxia. Proc Natl Acad Sci U S A. 2002;99(26):17215–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. • Moore LG. Measuring high-altitude adaptation. J Appl Physiol. 2017;123(5):1371–85 Investigations of various native highlander populations reveals insights into physiological mechanisms of high altitude adaptation.

  55. Wagner PD, et al. Pulmonary gas exchange and acid-base state at 5,260 m in high-altitude Bolivians and acclimatized lowlanders. J Appl Physiol (1985). 2002;92(4):1393–400.

    Article  Google Scholar 

  56. Brutsaert TD, Soria R, Caceres E, Spielvogel H, Haas JD. Effect of developmental and ancestral high altitude exposure on chest morphology and pulmonary function in Andean and European/North American natives. Am J Hum Biol. 1999;11(3):383–95.

    Article  PubMed  Google Scholar 

  57. Zhuang J, Droma T, Sutton JR, Groves BM, McCullough RE, McCullough RG, et al. Smaller alveolar-arterial O2 gradients in Tibetan than Han residents of Lhasa (3658 m). Respir Physiol. 1996;103(1):75–82.

    Article  CAS  PubMed  Google Scholar 

  58. Sawka MN, et al. Altitude acclimatization and blood volume: effects of exogenous erythrocyte volume expansion. J Appl Physiol (1985). 1996;81(2):636–42.

    Article  CAS  Google Scholar 

  59. Leon-Velarde F, et al. Consensus statement on chronic and subacute high altitude diseases. High Alt Med Biol. 2005;6(2):147–57.

    Article  PubMed  Google Scholar 

  60. Villafuerte FC, Corante N. Chronic mountain sickness: clinical aspects, etiology, management, and treatment. High Alt Med Biol. 2016;17(2):61–9.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Leon-Velarde F, Richalet JP. Respiratory control in residents at high altitude: physiology and pathophysiology. High Alt Med Biol. 2006;7(2):125–37.

    Article  PubMed  Google Scholar 

  62. Kryger M, McCullough R, Doekel R, Collins D, Weil JV, Grover RF. Excessive polycythemia of high altitude: role of ventilatory drive and lung disease. Am Rev Respir Dis. 1978;118(4):659–66.

    Article  CAS  PubMed  Google Scholar 

  63. Richalet JP, Rivera M, Bouchet P, Chirinos E, Onnen I, Petitjean O, et al. Acetazolamide: a treatment for chronic mountain sickness. Am J Respir Crit Care Med. 2005;172(11):1427–33.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. John D. Dingell VAMC, Wayne State University, Detroit, MI, USA

    Divya Venkat

  2. Wayne State University, Detroit, MI, USA

    Kurwandeep Dhillon & James A. Rowley

  3. Division of Pulmonary, Critical Care & Sleep Medicine, Harper University Hospital, 3990 John R, 3 Hudson, Detroit, MI, 48201, USA

    James A. Rowley

Authors
  1. Divya Venkat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kurwandeep Dhillon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James A. Rowley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James A. Rowley.

Ethics declarations

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest

Drs. Divya Venkat, Kunwardeep Dhillon, and James A. Rowley declare no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Sleeping and Breathing

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Venkat, D., Dhillon, K. & Rowley, J.A. Effects of High Altitude on Sleep and Respiratory System. Curr Pulmonol Rep 10, 103–109 (2021). https://doi.org/10.1007/s13665-021-00276-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13665-021-00276-0

Keywords

Search

Navigation