Periodic breathing in healthy young adults in normobaric hypoxia equivalent to 3500 m, 4500 m, and 5500 m altitude

Sleep Breath. 2019 Jun;23(2):703-709. doi: 10.1007/s11325-019-01829-z. Epub 2019 Apr 10.


Purpose: The occurrence of periodic breathing (PB) at high altitude during sleep and the quality of sleep are individually different and influenced by multiple factors including sex. Although poor sleep quality at high altitude might not be directly linked to oxygen desaturations, the PB upsurge at high altitude leads to significant oscillations in oxygen saturation.

Methods: Thirty-three students were recruited. Participants were randomly assigned to three groups (A, B, C) sleeping one full night in a dormitory with normobaric hypoxia at a FIO2 of 14.29% (A), a FIO2 of 12.47% (B), or a FIO2 of 10.82% (C). Full polysomnography was performed in each participant.

Results: Mean total sleeping time decreased significantly with increasing hypoxia (p < 0.001). Respiratory events changed from central hypopneas to central apneas (CA) with increasing hypoxia: CA = 17.8%, 50.0%, 92.2% of AHI (37.96 events per hour (n/h), 68.55 n/h, 93.44 n/h). AHI (p = 0.014) and time duration of respiratory events (p = 0.003) were significantly different between sexes, both greater in men. REM sleep was reduced.

Conclusions: Men tend to be more prone to PB in normobaric hypoxia. Further research should implicate a longer acclimatization period around simulated 4500 m in order to find out if the exponential increase in PB between 4500 m and 5500 m could be shifted to lower hypoxic levels, i.e., higher altitudes.

Keywords: Altitude; Hypoxia; Periodic breathing; Polysomnography; Sleep.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acclimatization
  • Altitude*
  • Austria
  • Female
  • Germany
  • Humans
  • Hypoxia / diagnosis
  • Hypoxia / physiopathology*
  • Male
  • Polysomnography*
  • Sex Factors
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / physiopathology*
  • Time Factors
  • Young Adult