Richalet Jean-Paul, Julia Chantal, Lhuissier François J
Université Sorbonne Paris Nord, UMR INSERM U1272 Hypoxie et Poumon, Bobigny, France.
Institut National du Sport, de l'Expertise et de la Performance, Pôle Médical, Paris, France.
High Alt Med Biol. 2021 Dec;22(4):353-361. doi: 10.1089/ham.2020.0226. Epub 2021 Sep 9.
Richalet, Jean-Paul, Chantal Julia, and François J. Lhuissier. Evaluation of the Lake Louise Score for acute mountain sickness and its 2018 version in a cohort of 484 trekkers at high altitude. 22:353-361, 2021. The Lake Louise Score (LLS) is widely used in field studies and chamber studies for the diagnosis of Acute Mountain Sickness (AMS). This score aggregates symptoms that are nonspecific: headache, gastrointestinal symptoms, fatigue, dizziness and sleep disturbance can be due to a variety of causes unrelated to altitude hypoxia. The objectives of this study were to (1) reevaluate the need for a headache score >0 for the diagnosis of AMS, (2) evaluate the role of sleep disturbances, in relation with other symptoms, (3) evaluate the significance of dizziness. We analyzed LLS from 484 trekkers at high altitude. Among them, 212 suffered from moderate AMS (mAMS: 3 ≤ LLS < 6) and 115 from severe AMS (sAMS: LLS ≥ 6). Cluster analysis of AMS revealed three main groups presenting the following symptoms: Group 1 includes 254 subjects who had less than 2 symptoms; Group 2 includes 137 subjects who had fatigue, sleep disturbance, and headache, corresponding to mAMS; Group 3 includes 93 subjects who had headache, fatigue, dizziness and sleep disturbance, corresponding to sAMS. A headache score of zero was found in 25% of mAMS and 5% of sAMS subjects. Only the absence of headache associated with the absence of fatigue was specific of absence of sAMS. In subjects with a dizziness score > 1, end-tidal partial pressure of carbon dioxide during a hypoxic exercise test was lower than that in subjects with a dizziness score < 2. Subjects with high ventilatory response to hypoxia may develop dizziness with high altitude exposure. (1) An isolated headache score > 0 should not be mandatory to define AMS, (2) sleep disruption contributes to the diagnosis of AMS, (3) gastrointestinal symptoms and dizziness are weaker contributors to the LLS, (4) dizziness might be linked to a hyperresponsiveness to hypoxia and not to AMS itself.
里沙莱，让 - 保罗，尚塔尔·朱利亚，以及弗朗索瓦·J·卢西耶。对484名高海拔徒步旅行者队列中急性高山病的路易斯湖评分及其2018年版本的评估。22:353 - 361，2021年。路易斯湖评分（LLS）在野外研究和舱室研究中被广泛用于急性高山病（AMS）的诊断。该评分汇总了一些非特异性症状：头痛、胃肠道症状、疲劳、头晕和睡眠障碍可能由多种与海拔缺氧无关的原因引起。本研究的目的是：（1）重新评估诊断AMS时头痛评分>0的必要性；（2）评估睡眠障碍与其他症状相关时的作用；（3）评估头晕的意义。我们分析了484名高海拔徒步旅行者的LLS。其中，212人患有中度AMS（mAMS：3≤LLS<6），115人患有重度AMS（sAMS：LLS≥6）。AMS的聚类分析揭示了呈现以下症状的三个主要组：第1组包括254名症状少于2种的受试者；第2组包括137名有疲劳、睡眠障碍和头痛的受试者，对应mAMS；第3组包括93名有头痛、疲劳、头晕和睡眠障碍的受试者，对应sAMS。在25%的mAMS受试者和5%的sAMS受试者中发现头痛评分为零。只有无头痛且无疲劳才是无sAMS的特异性表现。在头晕评分>1的受试者中，低氧运动试验期间的呼气末二氧化碳分压低于头晕评分<2的受试者。对缺氧通气反应高的受试者在高海拔暴露时可能会出现头晕。（1）孤立的头痛评分>0不应成为定义AMS的必要条件；（2）睡眠中断有助于AMS的诊断；（3）胃肠道症状和头晕对LLS的贡献较小；（4）头晕可能与对缺氧的高反应性有关，而不是与AMS本身有关。
