Li Taomei, Tan Lu, Furian Michael, Zhang Yanyan, Luo Lian, Lei Fei, Xue Xiaofang, He Jiaming, Tang Xiangdong
Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China.
Sleep Disorders Center, Department of Respiratory Medicine, University Hospital of Zurich, 8091 Zurich, Switzerland.
J Clin Med. 2022 May 19;11(10):2869. doi: 10.3390/jcm11102869.
Importance: To date, there is no established evidence of sex-specific differences in altitude-induced sleep-disordered breathing (SDB) during polysomnography-confirmed sleep. Objective: The aim of this study was to investigate whether differences in sex play a pivotal role in incidences of SDB and acute mountain sickness (AMS) when staying overnight at high altitude. Design: This was a prospective cohort study. Setting: Participants underwent overnight polysomnography (PSG) and clinical assessment in a sleep laboratory at 500 m and two consecutive days at 3270 m. Participants: The participants comprised 28 (18 women) healthy, young, low-altitude residents with a median (interquartile range) age of 26.0 (25.0, 28.0) years. Exposures: Altitude exposure. Main outcomes and Measures: The primary outcome was altitude-induced change in the PSG-confirmed apnea−hypopnea index (AHI) at 3270 m compared to 500 m between men and women. Secondary outcomes included sex differences in other parameters related to SDB, sleep structure, AMS, psychomotor vigilance test reaction time and parameters from arterial and venous blood analyses. Results: The median (interquartile range) AHIs at 500 m and 3270 m on night 1 and on night 2 were 6.5/h (3.6, 9.1), 23.7/h (16.2, 42.5) and 15.2/h (11.8, 20.9) in men, respectively, and 2.2/h (1.0, 5.5), 8.0/h (5.3, 17.0) and 7.1/h (4.9, 11.5) in women, respectively (p < 0.05 nights 1 and 2 at 3270 m vs. 500 m in men and women). The median difference (95% CI) of altitude-induced change in AHI (3270 m night 1 compared to 500 m) between men and women was 11.2/h (1.9 to 19.6) (p < 0.05). Over the time course of 2 days at 3270 m, 9 out of 18 (50%) women and 1 out of 10 (10%) men developed AMS (p < 0.05 women versus men). Conclusions and Relevance: This prospective cohort study showed that men were more susceptible to altitude-induced SDB but that they had a lower AMS incidence when staying for 2 days at 3270 m than women. These findings indicate that sex-related prevention and intervention strategies against SDB and AMS are highly warranted. Trial Registration: This trial was registered at the Chinese Clinical Trial Registry; No. ChiCTR1800020155.
迄今为止，在多导睡眠图确诊的睡眠期间，尚无关于海拔高度诱发的睡眠呼吸障碍（SDB）存在性别差异的确凿证据。目的：本研究旨在调查性别差异在高海拔过夜时SDB和急性高山病（AMS）的发病率中是否起关键作用。设计：这是一项前瞻性队列研究。设置：参与者在海拔500米的睡眠实验室以及海拔3270米处连续两天接受过夜多导睡眠图（PSG）检查和临床评估。参与者：参与者包括28名（18名女性）健康、年轻的低海拔居民，年龄中位数（四分位间距）为26.0（25.0，28.0）岁。暴露因素：海拔暴露。主要结局和测量指标：主要结局是与500米相比，海拔3270米处男性和女性经PSG确诊的呼吸暂停低通气指数（AHI）的海拔诱发变化。次要结局包括与SDB、睡眠结构、AMS、精神运动警觉测试反应时间以及动脉和静脉血液分析参数相关的其他参数的性别差异。结果：男性在500米、海拔3270米处第1晚和第2晚的AHI中位数（四分位间距）分别为6.5次/小时（3.6，9.1）、23.7次/小时（16.2，42.5）和15.2次/小时（11.8，20.9），女性分别为2.2次/小时（1.0，5.5）、8.0次/小时（5.3，17.0）和7.1次/小时（4.9，11.5）（男性和女性在海拔3270米处第1晚和第2晚与500米相比，p<0.05）。男性和女性之间AHI海拔诱发变化的中位数差异（95%CI）（海拔3270米处第1晚与500米相比）为11.2次/小时（1.9至19.6）（p<0.05）。在海拔3270米处的2天时间里，18名女性中有9名（50%）出现AMS，10名男性中有1名（10%）出现AMS（女性与男性相比，p<0.05）。结论和相关性：这项前瞻性队列研究表明，男性更容易受到海拔诱发的SDB影响，但在海拔3270米处停留2天时，他们的AMS发病率低于女性。这些发现表明，针对SDB和AMS的性别相关预防和干预策略非常有必要。试验注册：本试验在中国临床试验注册中心注册；注册号为ChiCTR1800020155。
