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Alternations of Heart Rate Variability at Lower Altitude in the Predication of Trekkers With Acute Mountain Sickness at High Altitude

Huang, Hsien-Hao MD*†‡; Tseng, Chia-Ying MD†§; Fan, Ju-Sing MD*†‡; Yen, David Hung-Tsang MD, PhD*†‡; Kao, Wei-Fong MD*†; Chang, Shi-Chuan MD, PhD‡¶ ; Kuo, Terry B J MD, PhD; Huang, Chun-I MD*†; Lee, Chen-Hsen MD*†

Clinical Journal of Sport Medicine: January 2010 - Volume 20 - Issue 1 - p 58-63
doi: 10.1097/JSM.0b013e3181cae6ba
Original Research

Objective: To determine the change and relationship of spectral components of heart rate variability (HRV) measurements in subjects with or without acute mountain sickness (AMS) at both low and high altitude.

Design: A prospective study.

Setting: A 12-day itinerary by trekking to the Namche Bazaar, 3440 m in Nepal.

Participants: A total of 32 subjects were recruited.

Interventions: The alternations were measured by heart rate (HR), arterial oxygen saturation (SpO2), and spectral analysis of HRV at sea level, 1317 m, 3440 m, 1317 m, and sea level, respectively.

Main Outcome Measures: Spectral analysis of HRV.

Results: There were statistically significant increases in HR and decreases in SpO2 in all subjects at high altitude. In HRV, the values of R-R interval, total variance, high frequency (HF), low frequency (LF), and HF% were significantly lower at 3440 m than at sea level, respectively (P < 0.05). The subjects with AMS had significantly lower total variance, HF, and HF%, respectively, but higher LF:HF ratio (P < 0.05) at 3440 m. Subjects with both HF% < 20% (nu) and LF:HF ratio > 1.3 measured at 1317 m had odds ratios of 7.00 (95% confidence interval, 1.11 to 44.06; P = 0.047) to get AMS at 3440 m.

Conclusions: The HRV measurements in total variances, HF, and HF% in trekkers with AMS were statistically significantly lower at high altitude. HF% < 20% (nu) or LF:HF ratio > 1.3 at lower altitudes could be an important predication parameter of trekkers with AMS at higher altitudes.

From the *Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; †Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; ‡Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C; §Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan, R.O.C.; ¶Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; and ‖Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan, R.O.C.

Submitted for publication March 9, 2009; accepted November 12, 2009.

The authors state that they have no financial interest in the products mentioned within this article.

Reprints: David Hung-Tsang Yen, MD, PhD, Department of Emergency Medicine, Taipei Veterans General Hospital, 201 Sec 2, Shih-Pai Rd, Taipei, Taiwan, R.O.C (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.