A narrative review of periodic breathing during sleep at high altitude: From acclimatizing lowlanders to adapted highlanders

Periodic breathing during sleep at high altitude is almost universal among sojourners. Here, in the context of acclimatization and adaptation, we provide a contemporary review on periodic breathing at high altitude, and explore whether this is an adaptive or maladaptive process. The mechanism(s), prevalence and role of periodic breathing in acclimatized lowlanders at high altitude are contrasted with the available data from adapted indigenous populations (e.g. Andean and Tibetan highlanders). It is concluded that (1) periodic breathing persists with acclimatization in lowlanders and the severity is proportional to sleeping altitude; (2) periodic breathing does not seem to coalesce with poor sleep quality such that, with acclimatization, there appears to be a lengthening of cycle length and minimal impact on the average sleeping oxygen saturation; and (3) high altitude adapted highlanders appear to demonstrate a blunting of periodic breathing, compared to lowlanders, comprising a feature that withstands the negative influences of chronic mountain sickness. These observations indicate that periodic breathing persists with high altitude acclimatization with no obvious negative consequences; however, periodic breathing is attenuated with high altitude adaptation and therefore potentially reflects an adaptive trait to this environment. image Abstract figure legend Upon ascent to high altitude in lowlanders, periodic breathing during sleep is almost universal among sojourners. With acclimatization in lowlanders (i.e. day to weeks at high altitude), periodic breathing persists and there appears to be a lengthening of cycle length. This increase in periodic breathing does not coalesce with poor sleep quality and has minimal impact on the average sleeping oxygen saturation. Despite persistence of periodic breathing in acclimatized lowlanders, high altitude adapted highlanders appear to demonstrate a blunting of periodic breathing, compared to lowlanders. This observation is suggestive that periodic breathing during sleep is an adaptive trait to high altitude. image