High Altitude and Man

199 Pages·1984·9.226 MB·English

by  John B. West (auth.), John B. West, Sukhamay Lahiri (eds.)

High Altitude and Man
Christopher Pizzo, MD, taking alveolar gas samples on
the summit of Mount Everest, October 24, 1981, during the course of the
American Medical Research Expedition to Everest.
High Altitude and Man
John B. West
EDITED BY
Section of Physiology
Department of Medicine
University of California, San Diego
La Jolla, California
Sukhamay Lahiri
Department of Physiology
Institute for Environmental Medicine
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania
SPRINGER NEW YORK 1984
PUBLICATIONS COMMITTEE
H. E. Morgan, Chairman
F. E. Farhi
E. E. Windhager
SUBCOMMITTEE ON CLINICAL SCIENCES
F. M. Abboud, Chairman
G. F. Cahill, Jr.
A. S. Fauci
H. A. Fozzard
J. A. Oates
S. R. Geiger, Publications Manager and Executive Editor
B. B. Rauner, Production Manager
R. L. Hopkins, Copy Editor
C. J. Gillespie, Indexer
ISBN 978-1-4614-7525-5 (eBook)
DOI 10.1007/978-1-4614-7525-5
© Copyright 1984, American Physiological Society 1984
Originally published by American Physiological Society in 1984
Softcover reprint of the hardcover 1s t edition 1984
Library of Congress Catalog Card Number 84-2933
International Standard Book Number 0-683-08945-5
Preface
There is a rich history on the subject of human physiology at high altitude.
The wide-ranging features of acclimatization have long fascinated physiolo
gists and physicians who see the topic as one of the best examples of how man
can respond to a hostile environment. The subject has its own intrinsic
scientific importance, and no one needs to justify an interest in it.
Nevertheless the last few years have seen a burgeoning of interest in the
physiology of man at high altitude. There are several reasons for this. One of
the most dramatic was the ascent of Mount Everest by two climbers without
supplementary oxygen in 1978, a feat that many physiologists thought was
impossible. This provoked a great deal of interest in the physiology of extreme
altitudes. Another reason is the increasing concern in how to improve man's
well-being and physical performance at high altitude. A large number ofpeople
in the world are natives to altitudes over 3,000 m. Moreover in recent years a
substantial number of people have moved to these altitudes, and with increas
ing industrialization in those areas, man's ability to carry out physical work
becomes a matter of economic importance. In addition the armed forces are
concerned about how to maximize human performance under these conditions.
Finally, the study of man at high altitude provides unique information about
the effects of severe hypoxia, which are clearly relevant to the pathophysiology
of patients with lung and heart disease.
This monograph is an outgrowth of a symposium on man at high altitude
sponsored by the American Physiological Society. The symposium was in three
parts, covering the topics of man at extreme altitude, sleep and respiration at
high altitude, and physiology of permanent residents of high altitude. The
timing of the symposium was stimulated in part by the American Medical
Research Expedition to Everest, which took place in the fall of 1981. Although
the symposium was not solely devoted to results obtained by the expedition, a
number of papers stemmed from it, and we have included a brief introduction
to give some background to the expedition.
The Editors
Contents
Introduction: American Medical Research Expedition to Everest 1
JOHN B. WEST
Man at Extreme Altitude
1. Man on the Summit of Mount Everest 5
JOHN B. WEST
2. Hypoxic Ventilatory Response and Exercise Ventilation at
Sea Level and High Altitude 19
ROBERT B. SCHOENE
3. Human Cerebral Function at Extreme Altitude 31
BRENDA D. TOWNES, THOMAS F. HORNBEIN,
ROBERT B. SCHOENE, FRANK H. SARNQUIST, AND
IGOR GRANT
4. Metabolic and Endocrine Changes at Altitude 37
F. DUANE BLUME
5. Renin-Aldosterone System 47
JAMES S. MILLEDGE
6. Red CeH Function at Extreme Altitude 59
ROBERT M. WINSLOW
Sleep and Respiration at High Altitude
7. Sleep and Periodic Breathing at High Altitude: Sherpa
Natives Versus Sojourners 73
SUKHAMAY LAHIRI, KARL H. MARET, MINGMA G. SHERPA,
AND RICHARD M. PETERS, JR.
8. Ventilatory Control During Sleep in Normal Humans 91
JOHN V. WEIL, DAVID P. WHlTE, NEIL J. DOUGLAS, AND
CLIFFORD W. ZWILLICH
9. Hypoxia and Brain Blood Flow 101
NORMAN H. EDELMAN, TEODORO V. SANTIAGO, AND
JUDITH A. NEUBAUER
10. Hypoxic Versus Hypocapnic Effects on Periodic Breathing
During Sleep 115
AN NE BERSSENBRUGGE, JEROME DEMPSEY, AND
JAMES SKATRUD
vii
11. Mechanisms for Recurrent Apneas at Altitude 129
NEIL S. CHERNIACK, BARBARA GOTHE, AND
KINGMAN P STROHL
12. Effects of Acclimatization on Sleep Hypoxemia at Altitude 141
JOHN R. SUTTON, GARY w. GRAY, CHARLES S. HOUSTON,
AND A. C. PETER POWLES
Physiology of Permanent Residents of High Altitude
13. Respiratory Control in Andean and Himalayan High-
Altitude Natives 147
SUKHAMAY LAHIRI
14. High-Altitude Polycythemia 163
ROBERT M. WINSLOW
15. Ventilatory Function in Adaptation to High Altitude:
Studies in Tibet 173
S. Y. HUANG, x. H. NING, z. N. ZHOU, z. z. GU,
AND s. T. HU
16. Ventilation in Human Populations Native to High Altitude 179
PETER H. HACKETT, JOHN T. REEVES, ROBERT F. GROVER,
AND JOHN V. WEIL
Index 193
Introduction: American Medical Research
Expedition to Everest
JOHN B. WEST
Section of Physiology, Department of Medicine,
University of California, San Diego, La Jolla, California
SEVERAL CHAPTERS OF THIS BOOK describe work carried out during the
course of the 1981 American Medical Research Expedition to Everest. The
purpose of this brief introduction is to give some of the background to this
unusual expedition.
Expeditions to high altitude have traditionalIy contributed a great deal to
our understanding of high-altitude physiology. Some of the most memorable
examples include the International Expedition to Pike's Peak in 1911, with
its controversial evidence for oxygen secretion; Barcroft's expedition to Cerro
de Pasco, Peru, in 1921-1922, which first drew attention to the remarkable
adaptation of high-altitude natives; the International High Altitude Expedition
to Aucanquilcha in the Chilean Andes in 1935, which laid the foundations of
our knowledge of blood biochemistry at high altitude; and the Himalayan
Scientific and Mountaineering Expedition of 1960-1961, which obtained the
first measurements in man above 6,000 m.
The principal objective of the 1981 American Medical Research Expedi
tion to Everest was to obtain information on human physiology at extreme
altitudes, including the first measurements over 8,000 m. In line with this
objective, the design of the expedition was very unusual. First, there was a
group of six experienced Himalayan climbers, including John P. Evans, Climb
ing Leader. Next, there were six "climbing scientists," alI ofwhom were strong
climbers, but each was a medical doctor with an interest in high-altitude
physiology. Their responsibility was to obtain the data at extreme altitudes.
FinalIy, there was a third group of eight physiologists who worked in the two
laboratories at Camp II (6,300 m) and Base Camp (5,400 m). The expedition
was supported by 42 high-altitude Sherpas.
Figure 1 shows the four sites on the southern approach to Mount Everest
at which physiological measurements were made. The Base Camp is readily
accessible via the Khumbu Glacier. The laboratory there was a rigid prefab
ricated hut (Fig. 2) that was the site of an extensive research program during
the months of S~ptember and October. Above the Base Camp is the steep and
treacherous Khumbu IcefalI, which leads into a high, relatively level valIey,
the Western Cwm. This was the site of the Main Laboratory Camp, altitude
6,300 m (Fig. 3). This laboratory was constructed of fiberglass blankets
covering an aluminum frame, and there was a plywood floor. Both laboratories
1
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FIG. 1. Research program of the 1981 American Medical Research Expedition to Everest,
indicating the four sites on the mountain at which measurements were made.
FIG. 2. Prefabricated hut used as the physiologicallaboratory at Base Camp (5,300 m).