Acclimation to intermittent hypobaric hypoxia modifies responses to cold at sea level

INTRODUCTION: Residence at high altitude modifies thremoregulatory responses to cold stress upon return to lower altitude. These changes are difficult to explain since several stresses related to high altitude may interact, including hypoxia, cold, solar radiation, and physical exertion. We hypothesized that adaptation to hypoxia without cold exposure would produce at least part of the observed changes. METHODS: Five men underwent acclimation to intermittent hypoxia (AIH) in a hypobaric chamber (8 h daily for 4 d, and 6 h on the last day, 4500 to 6000 m) at 24 degrees C. Cold stress responses were tested during a whole-body standard cold air test (1 degrees C, 2 h at rest at sea level) both before and after AIH. RESULTS: Increased reticulocyte counts and percentages confirmed acclimation to hypoxia after AIH. Changes in thermoregulation during the cold test included lower mean skin temperature after 60-80 min (18.8 +/- 0.7 degrees C vs. 19.4 +/- 0.7 degrees C); higher mean metabolic heat production (127 +/- 8 W x m(-2) vs. 118 +/- 6 W x m(-2)); and lower heat debt (7.7 +/- 1.3 kJ x kg(-1) vs. 10.3 +/- 1.2 kJ x kg(-1)), without significant change in rectal temperature. Time to onset for continuous shivering decreased after AIH (12 +/- 5 min vs. 21 +/- 6.3 min), and shivering activity occurred at higher mean skin but not rectal temperatures. CONCLUSION: AIH in comfortable ambient temperature leads to a normothermic-insulative-metabolic general cold adaptation. We conclude that AIH modifies the thermoregulatory responses to cold at sea level without cold exposure leading to a cross-adaptation.     

Ventricular performance and glucose uptake in rats during chronic hypobaric hypoxia

To identify changes of ventricular performance and their relationship to myocardial glucose uptake in Sprague-Dawley rats exposed to hypobaric hypoxia, radionuclide angiocardiograms (n = 34) and 2-[14C]deoxyglucose (2-[14C]DG) autoradiography (n = 14) were performed on rats maintained either for two weeks in air at 380 mmHg (hypoxic group), two weeks in hypobaric hypoxia followed by two weeks of air (recovered group), or in air (control group). Right ventricular ejection fraction (RVEF) was 66% +/- 2% (mean +/- s.e.m.) in controls, 40% +/- 3% during hypoxia, and 60% +/- 2% in recovered rats. LVEF remained unchanged. In controls, RV 2-[14C]DG uptake was 77% +/- 3% of LV uptake. During hypoxia, 2-[14C]DG uptake increased. This increase was greater within the RV than the LV and septum (85 +/- 16% versus 51 +/- 10%, p less than 0.005). The alterations of RV 2-[14C]DG uptake correlated with systolic pulmonary artery pressure (r = 0.77, p = 0.002).     

Thyroidal handling of radioiodine in sea level residents exposed to hypobaric hypoxia

In the present investigation thyroidal accumulation of radioiodine and its release were assessed by direct testing of thyroid function using radioactive iodine, in vivo, in sea level residents intermittently exposed to hypobaric hypoxia. Thyroidal accumulation of radioiodine and its turnover were examined daily for 14 days. Twelve healthy human male volunteers were divided into three groups, with an equal number of individuals in each group. A decompression chamber was used to expose each group of subjects to hypoxic conditions at a simulated altitude of 3810 m for 8 h/day for 14 days. An oral dose of 25Ci iodine-131 was administered to each individual of the first group immediately before the initiation of intermittent hypoxia. The second group of subjects received a tracer dose at the beginning of the 4th day of the 14 days, intermittent exposure to hypoxia, while the third group received the tracer dose 1 week after the completion of the exposure. Control studies were carried out on the subjects before they were subjected to the experimental conditions. Thyroidal accumulation of¹³¹I in experimental subjects during the hypoxic state and in the post-hypoxic state was higher than in the control studies. The pattern of accumulation during exposure to hypoxia and in the post-hypoxic state showed multiple peaks of radioactive iodine uptake (PRAIU), a unique feature. The multiple PRAIU by the thyroid in experimental subjects were sharp and of short duration, reflecting an increased rate of¹³I release from the thyroid. Control subjects had a single PRAIU by the thyroid 24 h after the administration of tracer.     

Capillary supply and fiber morphometry in rat myocardium after intermittent exposure to hypobaric hypoxia

Three groups of male rats were submitted to an intermittent hypobaric hypoxia (IHH) program for 22 days (4 h/day, 5 days/week) in a hypobaric chamber at a simulated altitude of 5000 m. Hearts were removed at the end of the program (H group) and 20 and 40 days later (P20 and P40 groups). A control group (C) was maintained at sea-level pressure. Transverse sections from myocardium were cut and histochemically stained in order to measure fiber morphometry and capillaries. We observed a progressive increase from C to H to P20 animals in capillary (4124 to 4733 to 4816 capillaries/mm(2)) and fiber densities (2844 to 3125 to 3284 fibers/mm(2)) associated with significant reductions in fiber area (273, 235, and 227 microm(2)), perimeter (69, 64, and 62 microm), and diffusion distances (18.2, 16.9, and 16.6 microm). The most significant differences between C and hypoxic groups were found when morphometrical and vascular fiber parameters were combined. The myocardium of the latter had more capillaries per fiber area and per fiber perimeter. These findings indicate that the IHH program elicits an adaptive response of rat myocardium to a more efficient O2 delivery to mitochondria of cardiac muscle cells. Capillarization and fiber morphometric changes showed marked differences over time. In all cases, P20 had higher capillarization parameters and fiber morphometry reductions than H, thus indicating that a delay of about 20 days exists after the hypoxic stimulus ceases to reach complete angiogenesis and fiber morphometry changes. However, P40 animals showed a recovery to basal values of the parameters related to fiber morphometry (area, perimeter, and diffusion distances), but maintained high capillarity values (capillary density, NCF, CCA, CCP).     

Differences in cardio-ventilatory responses to hypobaric and normobaric hypoxia: a review

The presence of differences in physiological response to a lowered inspired Po2 mediated by hypobaric hypoxia (HH) or normobaric hypoxia (NH) is controversial. This review examines the brief, acute, and subacute respiratory, cardiovascular, and subjective symptom response to intermediate and severe hypoxic exposure in NH and HH. Brief exposures lead to similar physiological responses; this is not the case in acute/subacute exposures. Extrapolating data from NH studies to HH in longer exposures is inappropriate as physiological responses to hypoxia seem to be influenced by the prevailing ambient pressure, especially in chronic exposures where acute mountain sickness severity is greater in HH than NH. Explanations for the discrepancy between the two modalities include differences in ventilatory patterns, alveolar gas disequilibrium, and dissimilar acute hypoxic ventilatory responses. Awareness and consideration of these key differences between NH and HH is essential to their proper application to kinesiology, altitude, and aviation medicine.     

Improvement of myocardial perfusion in coronary patients after intermittent hypobaric hypoxia

BACKGROUND: Persons living at high altitude (exposed to hypoxia) have a greater number of coronary and peripheral branches in the heart than persons living at sea level. In this study we investigated the effect of intermittent hypobaric hypoxia on myocardial perfusion in patients with coronary heart disease. METHODS AND RESULTS: We studied 6 male patients (aged>or=53 years) with severe stable coronary heart disease. All patients were born at sea level and lived in that environment. They underwent 14 sessions of exposure to intermittent hypobaric hypoxia (equivalent to a simulated altitude of 4200 m). Myocardial perfusion was assessed at baseline and after treatment with hypoxia by use of exercise perfusion imaging with technetium 99m sestamibi. After the sessions of hypoxia, myocardial perfusion was significantly improved. The summed stress score for hypoperfusion, in arbitrary units, decreased from 9.5+ to 4.5+ after treatment (P=.036). There was no evidence of impairment of myocardial perfusion in any patient after treatment. CONCLUSIONS: Intermittent hypobaric hypoxia improved myocardial perfusion in patients with severe coronary heart disease. Though preliminary, our results suggest that exposure to intermittent hypobaric hypoxia could be an alternative for the management of patients with chronic coronary heart disease.     

DL-3-n-butylphthalide improved physical and learning and memory performance of rodents exposed to acute and chronic hypobaric hypoxia

Background: Studies have revealed the protective effect of DL-3-n-butylphthalide (NBP) against diseases associated with ischemic hypoxia. However, the role of N...     

Aldosterone, cortisol, and electrolyte responses to hypobaric hypoxia in moderate-altitude natives

Serum aldosterone, cortisol, and electrolyte concentration, and urinary aldosterone and electrolyte excretion responses were examined in seven low-altitude natives (LAN) (373 m or less, aged 19-25 yr) and nine moderate-altitude natives (MAN) (1,830-2,200 m, aged 19-23 yr) for 2 d at their own residence (home) altitude (PB 740 or 585 mm Hg, respectively) and later for 2 d during decompression at a simulated altitude of 4,270 m (PB 447 mm Hg). The LAN group demonstrated higher (p less than 0.05) serum cortisol concentrations and respiration rates, and lower (p less than 0.05) serum aldosterone and potassium, and urinary aldosterone, sodium, and potassium concentrations at certain times during decompression compared to their home responses. Moderate-altitude native responses, on the other hand, were generally unchanged. Manifestations of acute mountain sickness at PB 447 mm Hg were also significantly greater in the LAN group. Thus, it appears that the MAN subjects were influenced less by the drop in ambient oxygen tension associated with PB 447 mm Hg.     

不同高度急性低压缺氧时大鼠脑组织的腺苷三磷酸酶及琥珀酸脱氢酶变化

目的从腺苷三磷酸酶（ATPase）和琥珀酸脱氢酶（SDH）在脑组织内含量变化的观察分析，探讨急性高空低压缺氧时大白鼠脑组织病理学的改变。方法将雄性Wistar大鼠随机分成5组：即对照组，3000、5000、8000及10000m实验组，于低压舱内缺氧30min后分别处死，取大脑顶叶、海马和小脑，行病理学常规切片染色、酶组织化学染色和图像分析。结果大鼠各部位脑组织随缺氧高度增加渐发生脑细胞水肿、变性等组织学改变；在顶叶和海马中ATPase和SDH的活性在3000m时轻度增高；5000－8000m时下降，SDH下降更明显；10000m时ATPase有显著降低，并认为SDH较ATPase对缺氧更敏感，而小脑则相对不稳定。结论大鼠在急性高空低压缺氧时，随高度上升，其生理紊乱、组织形态学改变及酶活性变化之间呈平行关系。脑组织的ATPase和SDH的活性变化直接影响了脑的生理功能。     

间断缺氧习服大鼠血浆、肺组织血管内皮生长因子变化及意义

目的 探讨间断缺氧习服对在鼠血浆、肺组织血管内皮生长因子（VEGF）含量的影响,为进一步认识高原水肿发病及高原习服机理提供实验依据。方法 40只雄性Wistar大鼠分为常氧对照组、急性缺氧组和3组间断缺氧习服组（IHa、b、c）。急性缺氧组直接在低压舱中模拟海拔8000m缺氧4h,间断缺氧习服组分别在低压舱中模拟不同海拔高度及不同时间进行间断缺氧习服,每天4h,间断缺氧习服后的大鼠再进行急性缺氧（低压舱中模拟8000m,4h）。用酶标记免疫吸附测定法测定大鼠血浆VEGF水平,免疫组化方法测定肺组织VEGF表达。结果 缺氧大鼠血浆及肺组织VEGF较对照组明显升高,差异有非常显著性意义（P＜0．01）,以急性缺氧组升高明显（P＜0．01）;急性缺氧组肺组织有液体渗出及微血管内血球淤积现象;间断缺习服大鼠血浆及肺组织VEGF升高幅度较急性缺氧组明显降低,差异有显著性意义（P＜0．05）,而且随间断缺氧习服时间的延长,升高幅度呈下降趋势,肺组织液体渗出明显好转。结论 极度缺氧导致VEGF显著升高可能是血管通透性增加的重要原因;VEGF与高原肺水肿的发病及高原习服密切相关。     

Endogenous ethanol in the blood and tissues of rats with hypobaric hypoxia

Albino male rats weighing 160-180 g were used to study the effect of short-term hypobaric hypoxia (ascent in an altitude chamber to 2500 m and 5000 m for 1 hr) on endogenous ethanol measured in blood, brain and liver; simultaneously enzymes responsible for ethanol and acetaldehyde metabolism were determined. Endogenous ethanol in blood and tissues was found to be a very sensitive marker of hypoxia which was not correlated with lactate, pyruvate, lipid peroxidation or 11-hydroxycorticosteroids. The latter parameters varied in response to severe hypoxia.     

红景天对急性低压缺氧大鼠内皮素分泌的干预

目的：观察急性中，生度缺氧对大鼠内皮素（ET）的影响及红景天类药物的干预，初步探讨红景天类药物抗缺氧机制，方法：36只雄性SD大鼠，随机分成盐水组，（5000米和8000米）低压缺氧组，三组又各分红景天组和盐水组，盐水组，红景天组每天灌胃生理盐水，红景天浓缩深，共7天。检测盐水和低压暴露5h后缺氧组血浆，脑组织ET含量。结果；急性5000米，8000米缺氧盐水组与地面盐水组比较血浆ET含量显著升高（P＜0．05，P＜0．01），地面药牧组与其盐水组相比血浆ET含量无生差异，急性5000米，80000米缺氧药物组与其盐水组相比血浆ET含量上降（P＜0．05，P＜0．01），急性8000米缺氧药物组与其盐水组相比脑组织ET含量显著下急性中，重度低压缺氧引起机体内皮素的异常升高。     

Sustained acclimatization in Chilean mine workers subjected to chronic intermittent hypoxia

Farias, Jorge G., Jorge Osorio, Gustavo Soto, Julio Brito, Patricia Siques, and Juan G. Reyes. Sustained acclimatization in Chilean mine workers subjected to chronic intermittent hypoxia. High Alt. Med. Biol. 7:302-306, 2006--We wanted to know if sea-level mine workers exposed previously to chronic intermittent hypoxia reached a steady acclimatization at 36 months under hypobaric hypoxia. An intermittently exposed group of mine workers (IE, n = 25) were subjected to submaximal exercise (100 W) at 4500 m. Their systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and hemoglobin oxygen saturation (HbSatO(2)) were monitored. Two comparison groups of unacclimatized sea-level workers (n = 17) were studied. A nonexposed group (NE) performed 5 min of submaximal exercise at sea level. Some kind of exercise was performed both by an acutely exposed group (AE) and IE group at 4500 m. No statistical differences were found for HR, SBP, and DBP (p > 0.05) during exercise between IE and AE groups. Resting HbSatO(2) of IE (87 +/- 6%) was lower than NE (97 +/- 3%) (p < 0.05), but was higher than AE (82 +/- 4%) (p < 0.05). In the exercise condition, HbSatO(2) of IE (85 +/- 5%) was lower than NE (95 +/- 3%) (p < 0.05), but was higher than AE (76 +/- 2%) (p < 0.05). These responses were maintained through the 6 months of the study period. Thus, mine workers subjected to intermittent hypobaric condition for 3 years showed a good degree of acclimatization that was maintained through time.     

Effects of intermittent hypobaric hypoxia on blood lipid concentrations in male coronary heart disease patients

The objective of the study was to evaluate the effects of intermittent hypobaric hypoxia (IHH) on plasma lipid concentrations of male coronary heart disease (CHD) patients. Forty-six male coronary patients were enrolled in the study. Thirty had a history of myocardial infarction and 16 had ischemic episodes documented by ergometer testing or Holter monitoring. The patients underwent acclimation to hypoxia by means of a protocol of intermittent exposure in a hypobaric chamber. Lipid profiles, including coefficient of atherogenity (CA) by A.N. Klimov, were assessed at baseline, on completion of the study, and at 3-, 6-, and 10-month follow-ups. Total cholesterol decreased by 7% on completion of the IHH and by 9% at 3 months and persisted on that level to month 6. HDL levels increased by 12% at 3-month follow-up and remained significantly higher than baseline until month 6. LDL levels declined on completion of IHH, but the changes from baseline were most prominent at 3-month (13%) and 6-month (11%) follow-ups. Similar changes were found in levels of VLDL and TG. CA declined by 26% on treatment completion and by 37% at 3-month follow-up and increased to baseline at 10 months. No changes in lipid profiles were found in patients with CA < 3 (n = 22). In subjects with CA > 3 (n = 24), beneficial effects were more pronounced. IHH in CHD patients with abnormal lipid metabolism leads to favorable changes of plasma lipid patterns persisting to month 6 following IHH.     

Chronic intermittent hypoxia at high altitude exposure for over 12 years: assessment of hematological, cardiovascular, and renal effects

The aim of this cross-sectional study was to assess the health status of subjects weekly commuting between sea level and 3550-m altitude for at least 12 yr (average 22.1 +/- 5.8). We studied 50 healthy army men (aged 48.7 +/- 2.0) working 4 days in Putre at 3550-m altitude, with 3 days rest at sea level (SL) at Arica, Chile. Blood pressure, heart rate, Sa(O(2) ), and altitude symptoms (AMS score and sleep status) were measured at altitude (days 1, 2, and 4) and at SL (days 1, 2, and 3). Hematological parameters, lipid profile, renal function, and echocardiography were performed at SL on day 1. The results showed signs of acute exposure to hypoxia (tachycardia, high blood pressure, low Sa(O(2) )), AMS symptoms, and sleep disturbances on day 1, which rapidly decreased on day 2. In addition, echocardiographic findings showed pulmonary hypertension (PAPm > 25 mmHg, RV and RA enlargement) in 2 subjects (4%), a PAPm > 20 mmHg in 14%, and a right ventricle thickness >40 mm in 12%. Hematocrit (45 +/- 2.7) and hemoglobin (15 +/- 1.0) were elevated, but lower than in permanent residents. There was a remarkably high triglyceride level (238 +/- 162) and a mild decrease of glomerular filtration rate (34% under 90 mL/min and 8% under 80 mL/min of creatinine clearance). In conclusion, in these preliminary results, in chronic intermittent hypoxia exposure even over longer periods, most subjects still show symptoms of acute altitude illnesses, but a faster recovery. Findings in triglycerides, in the pulmonary circulation and in renal function, are also a matter of concern.     

Maximal exercise during hypobaric hypoxia (447 Torr) in moderate-altitude natives

Six low-altitude natives (LAN) (373 m or less, aged 19-25 yr) and eight moderate-altitude natives (MAN) (1830-2200 m, aged 19-23 yr) were studied at both their residence (home) altitude (740 Torr and 587 Torr, respectively) and in a hypobaric chamber at a simulated altitude of 4270 m (447 Torr). Following a 2-d adaptation period, subjects performed an incremented test on the cycle ergometer until voluntary exhaustion. Significantly (P less than 0.05) greater differences in percent change of maximum exercise variables (total exercise time, exercise intensity, VO2, VCO2, VE/VO2 and HR) were noted in the LAN group than in the MAN group, going from their residence altitude to 447 Torr. The decrement in VO2max was 15% in the MAN group compared to 34% in the LAN group. The anaerobic threshold (% VO2max), estimated from VE BTPS measurements, was similar in both groups at residence altitude and at 447 Torr. In the morning prior to exercise testing at 447 Torr, LAN subjects reported greater (P less than 0.001) symptoms of acute mountain sickness (AMS) than MAN subjects. Our results indicate that, with respect to maximum exercise performance, moderate-altitude natives are at an advantage during early adaptation to hypobaric hypoxia.