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Apneas (breath-holds) are increasingly being tested in human subjects to understand how the human body operates. Apneas decrease heart rate and increase blood pressure. These findings are driving current research into the effects of oxygen concentrations on the heart rate and blood pressure responses to apneas and the effect of breath-hold training on these responses. The interest in apnea research is three-fold:
Despite this interest, little is known about the repeatability (the consistency within a single day) and reproducibility (the consistency between days) in the heart rate and blood pressure responses to apneas. This uncertainty limits the scientific interpretations from previous results. This study aims to determine the repeatability and reproducibility of heart rate and blood pressure responses to apneas. The goals of the study are:
The study requires 20 healthy volunteers (10 females) and will measure heart rate, blood pressure, breathing parameters (expired gas concentrations, breathing volume and rate), and oxygen saturation. During the protocol, participants will complete two maximal voluntary apneas and five test apneas. The test apneas will all be the same length based on the longer of the two maximal voluntary apneas. Before each apnea, participants will also breathe low oxygen concentrations (hypoxia). Hypoxia provides a bigger decrease in heart rate during apneas than room air which makes it easier to see changes in heart rate responses between apneas (i.e., bigger signal-to-noise ratio). Participants will complete two identical test sessions on back-to-back days. The differences in heart rate and blood pressure responses to the five apneas within each session will determine repeatability and the differences between sessions will determine reproducibility. The investigators hypothesize that repeatability will be good and that repeatability within a session will be better than reproducibility between sessions.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Apnea Following Isocapnic Hypoxia | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Apnea Following Isocapnic Hypoxia | Other | Decreasing end-tidal partial pressure of oxygen to 50 mmHg for five minutes, targeting 80-85% peripheral oxygen saturation. The end-tidal partial pressure of carbon dioxide will remain +1 mmHg above baseline levels. After five minutes of hypoxia, participants will complete an apnea. |
| Measure | Description | Time Frame |
|---|---|---|
| Heart Rate | Electrocardiogram (lead II) | Continuous collection during both visits (2 hours on back-to-back days). Data will be extracted during free breathing (1 minute average before each apnea) and during apneas (beat-by-beat extraction from the 10 beats preceding resumption of breathing). |
| Measure | Description | Time Frame |
|---|---|---|
| Blood Pressure | Finger Photoplethysmography | Continuous collection during both visits (2 hours on back-to-back days). Data will be extracted during free breathing (1 minute average before each apnea) and during apneas (beat-by-beat extraction from the 10 beats preceding resumption of breathing). |
| Cardiac Arrhythmias |
| Measure | Description | Time Frame |
|---|---|---|
| End-Tidal Oxygen | S-3A/I Oxygen Analyzer & Model N-22M Sensor, AEI Technologies | Continuous collection during both visits (2 hours on back-to-back days). Data will be extracted during free breathing (1 minute average before apnea). |
| End-Tidal Carbon Dioxide |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Alberta | Edmonton | Alberta | T6G 2E1 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29357505 | Background | Busch SA, Davies H, van Diepen S, Simpson LL, Sobierajski F, Riske L, Stembridge M, Ainslie PN, Willie CK, Hoiland R, Moore JP, Steinback CD. Chemoreflex mediated arrhythmia during apnea at 5,050 m in low- but not high-altitude natives. J Appl Physiol (1985). 2018 Apr 1;124(4):930-937. doi: 10.1152/japplphysiol.00774.2017. Epub 2017 Dec 21. | |
| 32038287 |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 26, 2024 | Jun 26, 2024 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Jun 25, 2024 | Jun 26, 2024 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D000860 | Hypoxia |
| D001049 | Apnea |
| ID | Term |
|---|---|
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012120 | Respiration Disorders |
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Assessed using electrocardiogram (lead II) by a trained researcher and reviewed by a cardiologist. Arrhythmias observable in lead II will be reported as a binary (i.e., yes/no) for each individual for each apnea. Example arrhythmias are premature atrial contractions and sinus pauses, though many more exist. |
| Continuous collection during both visits (2 hours on back-to-back days). Data will be extracted during apneas (beat-by-beat observation from the 10 beats preceding the resumption of breathing). |
| Peripheral Oxygen Saturation | Pulse Oximetry | Continuous collection during both visits (2 hours on back-to-back days). Data will be extracted during free breathing (1 minute average before each apnea) and during apneas (10 beats preceding the resumption of breathing to 1 minute after apnea end). |
| Rating of Perceived Exertion | Participants Rate the Effort of their Apnea using the Modified Borg Scale with scores from 1 to 10 with 1 representing no effort and 10 representing a maximal effort. | Apnea (immediately following apnea) |
| Apnea Duration | Time, in seconds, from the end of the last breath preceding the apnea to the resumption of breathing. | Start to end of apnea: apnea start determined using cessation of flow through the pneumotachometer, apnea end determined using respiratory belt strain gauge. Estimated apnea durations are 15-30 seconds. |
CD-3A Carbon Dioxide Analyzer & P-61B Sensor
| Continuous collection during both visits (2 hours on back-to-back days). Data will be extracted during free breathing (1 minute average before apnea). |
| Minute Ventilation | Pneumotachometer | Continuous collection during both visits (2 hours on back-to-back days). Data will be extracted during free breathing (1 minute average before apnea). |
| Busch SA, van Diepen S, Steele AR, Meah VL, Simpson LL, Figueroa-Mujica RJ, Vizcardo-Galindo G, Villafuerte FC, Tymko MM, Ainslie PN, Moore JP, Stembridge M, Steinback CD. Global REACH: Assessment of Brady-Arrhythmias in Andeans and Lowlanders During Apnea at 4330 m. Front Physiol. 2020 Jan 22;10:1603. doi: 10.3389/fphys.2019.01603. eCollection 2019. |
| 10942874 | Background | Stanforth PR, Gagnon J, Rice T, Bouchard C, Leon AS, Rao DC, Skinner JS, Wilmore JH. Reproducibility of resting blood pressure and heart rate measurements. The HERITAGE Family Study. Ann Epidemiol. 2000 Jul;10(5):271-7. doi: 10.1016/s1047-2797(00)00047-8. |
| 10907753 | Background | Hopkins WG. Measures of reliability in sports medicine and science. Sports Med. 2000 Jul;30(1):1-15. doi: 10.2165/00007256-200030010-00001. |
| 15705040 | Background | Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005 Feb;19(1):231-40. doi: 10.1519/15184.1. |
| D012140 | Respiratory Tract Diseases |