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      Periodic breathing in healthy young adults in normobaric hypoxia equivalent to 3500 m, 4500 m, and 5500 m altitude

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          Abstract

          Purpose

          The occurrence of periodic breathing (PB) at high altitude during sleep and the quality of sleep are individually different and influenced by multiple factors including sex. Although poor sleep quality at high altitude might not be directly linked to oxygen desaturations, the PB upsurge at high altitude leads to significant oscillations in oxygen saturation.

          Methods

          Thirty-three students were recruited. Participants were randomly assigned to three groups (A, B, C) sleeping one full night in a dormitory with normobaric hypoxia at a F IO2 of 14.29% (A), a F IO2 of 12.47% (B), or a F IO2 of 10.82% (C). Full polysomnography was performed in each participant.

          Results

          Mean total sleeping time decreased significantly with increasing hypoxia ( p < 0.001). Respiratory events changed from central hypopneas to central apneas (CA) with increasing hypoxia: CA = 17.8%, 50.0%, 92.2% of AHI (37.96 events per hour ( n/h), 68.55 n/h, 93.44 n/h). AHI ( p = 0.014) and time duration of respiratory events ( p = 0.003) were significantly different between sexes, both greater in men. REM sleep was reduced.

          Conclusions

          Men tend to be more prone to PB in normobaric hypoxia. Further research should implicate a longer acclimatization period around simulated 4500 m in order to find out if the exponential increase in PB between 4500 m and 5500 m could be shifted to lower hypoxic levels, i.e., higher altitudes.

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          Most cited references23

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          Influence of sex steroid hormones on cerebrovascular function.

          The cerebral vasculature is a target tissue for sex steroid hormones. Estrogens, androgens, and progestins all influence the function and pathophysiology of the cerebral circulation. Estrogen decreases cerebral vascular tone and increases cerebral blood flow by enhancing endothelial-derived nitric oxide and prostacyclin pathways. Testosterone has opposite effects, increasing cerebral artery tone. Cerebrovascular inflammation is suppressed by estrogen but increased by testosterone and progesterone. Evidence suggests that sex steroids also modulate blood-brain barrier permeability. Estrogen has important protective effects on cerebral endothelial cells by increasing mitochondrial efficiency, decreasing free radical production, promoting cell survival, and stimulating angiogenesis. Although much has been learned regarding hormonal effects on brain blood vessels, most studies involve young, healthy animals. It is becoming apparent that hormonal effects may be modified by aging or disease states such as diabetes. Furthermore, effects of testosterone are complicated because this steroid is also converted to estrogen, systemically and possibly within the vessels themselves. Elucidating the impact of sex steroids on the cerebral vasculature is important for understanding male-female differences in stroke and conditions such as menstrual migraine and preeclampsia-related cerebral edema in pregnancy. Cerebrovascular effects of sex steroids also need to be considered in untangling current controversies regarding consequences of hormone replacement therapies and steroid abuse.
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            Breathing and sleep at high altitude.

            We provide an updated review on the current understanding of breathing and sleep at high altitude in humans. We conclude that: (1) progressive changes in pH initiated by the respiratory alkalosis do not underlie early ( 48 h), complex cellular and neurochemical re-organization occurs both in the peripheral chemoreceptors as well as within the central nervous system. The latter is likely influenced by central acid-base changes secondary to the extent of the initial respiratory responses to initial exposure to high altitude; (3) sleep at high altitude is disturbed by various factors, but principally by periodic breathing; (4) the extent of periodic breathing during sleep at altitude intensifies with duration and severity of exposure; (5) complex interactions between hypoxic-induced enhancement in peripheral and central chemoreflexes and cerebral blood flow--leading to higher loop gain and breathing instability--underpin this development of periodic breathing during sleep; (6) because periodic breathing may elevate rather than reduce mean SaO2 during sleep, this may represent an adaptive rather than maladaptive response; (7) although oral acetazolamide is an effective means to reduce periodic breathing by 50-80%, recent studies using positive airway pressure devices to increase dead space, hyponotics and theophylline are emerging but appear less practical and effective compared to acetazolamide. Finally, we suggest avenues for future research, and discuss implications for understanding sleep pathology.
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              Gender differences in the polysomnographic features of obstructive sleep apnea.

              We examined the influence of gender on the polysomnographic features of obstructive sleep apnea (OSA) in a retrospective study of 830 patients with OSA diagnosed by overnight polysomnography (PSG). The severity of OSA was determined from the apnea- hypopnea index (AHI) for total sleep time (AHI(TST)), and was classified as mild (5 to 25 events/h), moderate (26 to 50 events/h), and severe (> 50/events/h). Differences in OSA during different stages of sleep were assessed by comparing the AHI during non-rapid eye movement (NREM) (AHI(NREM)) and rapid eye movement (REM) (AHI(REM)) sleep and calculating the "REM difference" (AHI(REM) - AHI(NREM)). Additionally, each overnight polysomnographic study was classified as showing one of three mutually exclusive types of OSA: (1) mild OSA, which occurred predominantly during REM sleep (REM OSA); (2) OSA of any severity, which occurred predominantly in the supine position (S OSA); or (3) OSA without a predominance in a single sleep stage or body position (A OSA). The mean AHI(TST) for men was significantly higher than that for women (31.8 +/- 1.0 versus 20.2 +/- 1.5 events/h, p < 0. 001). The male-to-female ratio was 3.2:1 for all OSA patients, and increased from 2.2:1 for patients with mild OSA to 7.9:1 for those with severe OSA. Women had a lower AHI(NREM) than did men (14.6 +/- 1.6 versus 29.6 +/- 1.1 events/h, p < 0.001), but had a similar AHI(REM) (42.7 +/- 1.6 versus 39.9 +/- 1.2 events/h). Women had a significantly higher REM difference than did men (28.1 +/- 1.5 versus 10.3 +/- 1.1 events/h, p < 0.01). REM OSA occurred in 62% of women and 24% of men with OSA. S OSA occurred almost exclusively in men. We conclude that: (1) OSA is less severe in women because of milder OSA during NREM sleep; (2) women have a greater clustering of respiratory events during REM sleep than do men; (3) REM OSA is disproportionately more common in women than in men; and (4) S OSA is disproportionately more common in men than in women. These findings may reflect differences between the sexes in upper airway function during sleep in patients with OSA.
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                Author and article information

                Contributors
                +49 (0)1636286366 , S.Pramsohler@gmx.net
                Journal
                Sleep Breath
                Sleep Breath
                Sleep & Breathing = Schlaf & Atmung
                Springer International Publishing (Cham )
                1520-9512
                1522-1709
                10 April 2019
                10 April 2019
                2019
                : 23
                : 2
                : 703-709
                Affiliations
                [1 ]Dept. of Psychology and Sports Science, Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, University of Innsbruck, Ghersburgstr. 9, 83043 Bad Aibling, Germany
                [2 ]ISNI 0000 0000 9149 4843, GRID grid.443867.a, University Hospitals of Cleveland and Case University School of Medicine, ; 11100 Euclid Avenue, Cleveland, OH 44106 USA
                [3 ]Charité-Universitätsmedizin Berlin, Institute for Vegetative Physiology, Chariteplatz 1, 10117 Berlin, Germany
                [4 ]ISNI 0000 0001 2151 8122, GRID grid.5771.4, Dept. of Psychology and Sport Science, , University Innsbruck, ; Fürstenweg 185, 6020 Innsbruck, Austria
                [5 ]ISNI 0000 0004 1936 9748, GRID grid.6582.9, Division of Sports Medicine and Rehabilitation, Department of Medicine, , University Ulm, ; Leimgrubenweg 14, 89070 Ulm, Germany
                Article
                1829
                10.1007/s11325-019-01829-z
                6529391
                30972693
                5084555f-c80d-4769-8d86-aaa81e90fc89
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 27 December 2018
                : 18 February 2019
                : 21 March 2019
                Funding
                Funded by: University of Innsbruck and Medical University of Innsbruck
                Categories
                Hypoxia • Original Article
                Custom metadata
                © Springer Nature Switzerland AG 2019

                Medicine
                hypoxia,periodic breathing,sleep,polysomnography,altitude
                Medicine
                hypoxia, periodic breathing, sleep, polysomnography, altitude

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