Physiological responses during ascent to high altitude and the incidence of acute mountain sickness

Alexandra B. Cobb, Denny Z.H. Levett, Kay Mitchell, Wynne Aveling, D. Hurlbut, Edward Gilbert-Kawai, Philip J. Hennis, Monty G. Mythen, Michael P.W. Grocott, Daniel S. Martin,

Research output: Contribution to journalArticlepeer-review

Abstract

Acute mountain sickness (AMS) occurs when there is failure of acclimatisation to high altitude. The aim of this study was to describe the relationship between physiological variables and the incidence of AMS during ascent to 5300 m. A total of 332 lowland-dwelling volunteers followed an identical ascent profile on staggered treks. Self-reported symptoms of AMS were recorded daily using the Lake Louise score (mild 3–4; moderate-severe ≥5), alongside measurements of physiological variables (heart rate, respiratory rate (RR), peripheral oxygen saturation (SpO2) and blood pressure) before and after a standardised Xtreme Everest Step-Test (XEST). The overall occurrence of AMS among participants was 73.5% (23.2% mild, 50.3% moderate–severe). There was no difference in gender, age, previous AMS, weight or body mass index between participants who developed AMS and those who did not. Participants who had not previously ascended >5000 m were more likely to get moderate-to-severe AMS. Participants who suffered moderate-to-severe AMS had a lower resting SpO2 at 3500 m (88.5 vs. 89.6%, p = 0.02), while participants who suffered mild or moderate-to-severe AMS had a lower end-exercise SpO2 at 3500 m (82.2 vs. 83.8%, p = 0.027; 81.5 vs. 83.8%, p < 0.001 respectively). Participants who experienced mild AMS had lower end-exercise RR at 3500 m (19.2 vs. 21.3, p = 0.017). In a multi-variable regression model, only lower end-exercise SpO2 (OR 0.870, p < 0.001) and no previous exposure to altitude >5000 m (OR 2.740, p-value 0.003) predicted the development of moderate-to-severe AMS. The Xtreme Everest Step-Test offers a simple, reproducible field test to help predict AMS, albeit with relatively limited predictive precision.

Original languageEnglish
Article numbere14809
JournalPhysiological Reports
Volume9
Issue number7
DOIs
Publication statusPublished - 27 Apr 2021

Bibliographical note

Funding Information:
This work was supported by Mr. John Caudwell, BOC Medical (now part of Linde Gas Therapeutics), Eli Lilly, the London Clinic, Smiths Medical, Deltex Medical, the Rolex Foundation, Atlantic Customer Solutions, the Association of Anaesthetists of Great Britain and Ireland, the United Kingdom Intensive Care Foundation, the Sir Halley Stewart Trust, the National Institute of Academic Anaesthesia, the Rhinology and Laryngology Research Fund, The Physiological Society, the Royal Free Hospital NHS Trust Charity, the Special Trustees of University College London Hospital NHS Foundation Trust, the Southampton University Hospital Charity, the UCL Institute of Sports Exercise and Health, University College London, the University of Southampton, Duke University Medical School, and the Caudwell Xtreme Everest, Caudwell Xtreme Everest 2009 and Xtreme Everest 2 volunteer participants who trekked to Everest Base Camp. Dr Martin was a Critical Care Scholar of the London Clinic and Dr Levett was a Fellow of the Association of Anaesthetists of Great Britain and Ireland. Some of this work was undertaken at University College London Hospital–University College London Comprehensive Biomedical Research Centre, which received a proportion of funding from the United Kingdom Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. Some of this work was undertaken at University Hospital Southampton‐University of Southampton Respiratory Biomedical Research Unit, which received a proportion of funding from the United Kingdom Department of Health's National Institute for Health Research Biomedical Research Units funding scheme. All funding was unrestricted.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Keywords

  • altitude
  • altitude sickness
  • exercise
  • hypoxia

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