1. Network Analysis Reveals Distinct Clinical Syndromes Underlying Acute Mountain Sickness
- Author
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Sorrel Cosens, David Hall, J K Baillie, Matthew G.D. Bates, Stewart J. Jackson, Alexander T. Phythian-Adams, A. A. Roger Thompson, David A. Hume, David Collier, Nina Marie Rzechorzek, David Hope-Jones, Ian J. C. MacCormick, and Tom C. Freeman
- Subjects
FOS: Computer and information sciences ,Male ,Pediatrics ,Anatomy and Physiology ,Critical Care and Emergency Medicine ,Pulmonology ,Visual Analog Scale ,Vasodilator Agents ,lcsh:Medicine ,Altitude Sickness ,030204 cardiovascular system & hematology ,Quantitative Biology - Quantitative Methods ,Severity of Illness Index ,Tanzania ,Antioxidants ,Piperazines ,0302 clinical medicine ,Surveys and Questionnaires ,Pathology ,Sulfones ,lcsh:Science ,Quantitative Methods (q-bio.QM) ,Fatigue ,Altitude sickness ,Sleep disorder ,Multidisciplinary ,Headaches ,Altitude ,Headache ,Syndrome ,Effects of high altitude on humans ,3. Good health ,Neurology ,Acute Disease ,Expeditions ,Medicine ,Female ,medicine.symptom ,Research Article ,Adult ,Sleep Wake Disorders ,Bolivia ,medicine.medical_specialty ,Clinical Pathology ,Visual analogue scale ,Statistics - Applications ,Sildenafil Citrate ,Young Adult ,03 medical and health sciences ,Respiratory Failure ,Diagnostic Medicine ,Severity of illness ,medicine ,Humans ,Applications (stat.AP) ,business.industry ,Acute Cardiovascular Problems ,Cluster headache ,lcsh:R ,medicine.disease ,Mountaineering ,Purines ,FOS: Biological sciences ,Sleep and Ventilation Disorders ,Physical therapy ,lcsh:Q ,Physiological Processes ,Sleep ,Sleep Disorders ,business ,030217 neurology & neurosurgery - Abstract
Acute mountain sickness (AMS) is a common problem among visitors at high altitude, and may progress to life-threatening pulmonary and cerebral oedema in a minority of cases. International consensus defines AMS as a constellation of subjective, non-specific symptoms. Specifically, headache, sleep disturbance, fatigue and dizziness are given equal diagnostic weighting. Different pathophysiological mechanisms are now thought to underlie headache and sleep disturbance during acute exposure to high altitude. Hence, these symptoms may not belong together as a single syndrome. Using a novel visual analogue scale (VAS), we sought to undertake a systematic exploration of the symptomatology of AMS using an unbiased, data-driven approach originally designed for analysis of gene expression. Symptom scores were collected from 292 subjects during 1110 subject-days at altitudes between 3650 m and 5200 m on Apex expeditions to Bolivia and Kilimanjaro. Three distinct patterns of symptoms were consistently identified. Although fatigue is a ubiquitous finding, sleep disturbance and headache are each commonly reported without the other. The commonest pattern of symptoms was sleep disturbance and fatigue, with little or no headache. In subjects reporting severe headache, 40% did not report sleep disturbance. Sleep disturbance correlates poorly with other symptoms of AMS (Mean Spearman correlation 0.25). These results challenge the accepted paradigm that AMS is a single disease process and describe at least two distinct syndromes following acute ascent to high altitude. This approach to analysing symptom patterns has potential utility in other clinical syndromes.
- Published
- 2014
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