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Network analysis reveals distinct clinical syndromes underlying acute mountain sickness.

TitleNetwork analysis reveals distinct clinical syndromes underlying acute mountain sickness.
Publication TypeJournal Article
Year of Publication2014
AuthorsHall DP, MacCormick IJC, Phythian-Adams AT, Rzechorzek NM, Hope-Jones D, Cosens S, Jackson S, Bates MGD, Collier DJ, Hume DA, Freeman T, Thompson AARoger, Baillie JKenneth
JournalPLoS One
Date Published2014
KeywordsAcute Disease, Adult, Altitude, Altitude Sickness, Antioxidants, Bolivia, Expeditions, Fatigue, Female, Headache, Humans, Male, Mountaineering, Piperazines, Purines, Severity of Illness Index, Sildenafil Citrate, Sleep Wake Disorders, Sulfones, Surveys and Questionnaires, Syndrome, Tanzania, Vasodilator Agents, Visual Analog Scale, Young Adult

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.

Alternate JournalPLoS ONE
PubMed ID24465370
PubMed Central IDPMC3898916
Grant List090385/Z/09/Z / / Wellcome Trust / United Kingdom
101113 / / Wellcome Trust / United Kingdom
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