Chilean Miners Commuting from Sea Level to 4500 m: A Prospective Study

Abstract

The development of mining activities in North Chile involves a great number of workers intermittently exposed to high altitude for a long period of time (chronic intermittent hypoxia, CIH). A 2½-year prospective study aimed to characterize this model of exposure to CIH and to know whether this condition may progressively lead to a chronic pattern. Twenty-nine miners, aged 25 ± 5 yr, working 7 days at HA (3800 to 4600 m) and resting 7 days at sea level (SL) were studied. Subjects underwent a physical examination, EKG, hematological status, maximal exercise test, ventilatory and cardiac response to hypoxia (F_iO2 = 0.114) at rest and exercise, pulmonary vascular response to hypoxia by echocardiography, and 24-h monitoring of EKG and arterial pressure. Basal evaluations were performed at SL before the first exposure to hypoxia. HA measurements were daily AMS score, sleep status, and 24-h monitoring of EKG and arterial pressure. All these measurements were repeated after a mean period of 12, 19, and 31 months. Hematocrit increased but reached values lower than those observed in chronic permanent exposure. Systemic and pulmonary arterial pressures measured at SL did not change, but were higher in hypoxia. Right ventricle showed a slight dilatation. Exercise performance at SL declined with exposure to CIH to reach a 12.3% decrease after 31 months of CIH, associated with a 6.8% decrease in maximal heart rate. Signs of ventilatory acclimatization were observed after 12 months. Symptoms of AMS and sleep disturbances were still seen on the first 2 days at HA, whatever the time of exposure to CIH. In conclusion, CIH induced a clear acclimatization process. Subjects did not reach a health status comparable to that seen in permanent residents at HA and remained at risk of acute altitude-induced illnesses.