Mellor Adrian, Bakker-Dyos Josh, OʼHara John, Woods David Richard, Holdsworth David A, Boos Christopher J
Defence Medical Services, Lichfield, United Kingdom.
Department of Anaesthesia, James Cook University Hospital, Middlesbrough, United Kingdom.
Clin J Sport Med. 2018 Jan;28(1):76-81. doi: 10.1097/JSM.0000000000000427.
The autonomic system and sympathetic activation appears integral in the pathogenesis of acute mountain sickness (AMS) at high altitude (HA), yet a link between heart rate variability (HRV) and AMS has not been convincingly shown. In this study we investigated the utility of the smartphone-derived HRV score to predict and diagnose AMS at HA.
Twenty-one healthy adults were investigated at baseline at 1400 m and over 10 days during a trek to 5140 m. HRV was recorded using the ithlete HRV device.
Acute mountain sickness occurred in 11 subjects (52.4%) at >2650 m. HRV inversely correlated with AMS Scores (r = -0.26; 95% CI, -0.38 to -0.13: P < 0.001). HRV significantly fell at 3700, 4100, and 5140 m versus low altitude. HRV scores were lower in those with both mild (69.7 ± 14.0) and severe AMS (67.1 ± 13.1) versus those without AMS (77.5 ± 13.1; effect size n = 0.043: P = 0.007). The HRV score was weakly predictive of severe AMS (AUC 0.74; 95% CI, 0.58-0.89: P = 0.006). The change (delta) in the HRV Score (compared with baseline at 1400 m) was a moderate diagnostic marker of severe AMS (AUC 0.80; 95% CI, 0.70-0.90; P = 0.0004). A fall in the HRV score of >5 had a sensitivity of 83% and specificity of 60% to identify severe AMS (likelihood ratio 1.9). Baseline HRV at 1400 m was not predictive of either AMS at higher altitudes.
The ithlete HRV score can be used to help in the identification of severe AMS; however, a baseline score is not predictive of future AMS development at HA.
自主神经系统和交感神经激活在高原急性高山病（AMS）的发病机制中似乎起着不可或缺的作用，但心率变异性（HRV）与AMS之间的联系尚未得到令人信服的证实。在本研究中，我们调查了通过智能手机得出的HRV评分对高原AMS的预测和诊断效用。
21名健康成年人在海拔1400米的基线水平接受调查，并在徒步前往5140米的过程中进行了为期10天的观察。使用ithlete HRV设备记录HRV。
11名受试者（52.4%）在海拔>2650米处发生了急性高山病。HRV与AMS评分呈负相关（r = -0.26；95%CI，-0.38至-0.13：P < 0.001）。与低海拔相比，在海拔3700米、4100米和5140米处HRV显著下降。轻度（69.7±14.0）和重度AMS患者（67.1±13.1）的HRV评分低于无AMS患者（77.5±13.1；效应量n = 0.043：P = 0.007）。HRV评分对重度AMS的预测能力较弱（AUC 0.74；95%CI，0.58 - 0.89：P = 0.006）。HRV评分的变化（与1400米处的基线相比）是重度AMS的中度诊断标志物（AUC 0.80；95%CI，0.70 - 0.90；P = 0.0004）。HRV评分下降>5对识别重度AMS的敏感性为83%，特异性为60%（似然比1.9）。1400米处的基线HRV不能预测更高海拔处的AMS。
ithlete HRV评分可用于帮助识别重度AMS；然而，基线评分不能预测高原地区未来AMS的发生。
