Peripheral Arterial Desaturation Is Further Exacerbated by Exercise in Adolescents With Acute Mountain Sickness Sarah A. Major, DPhil, Ryan J.K. Hogan,

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Peripheral Arterial Desaturation Is Further Exacerbated by Exercise in Adolescents With Acute Mountain Sickness Sarah A. Major, DPhil, Ryan J.K. Hogan, MBChB, Elizabeth Yeates, BM, Chris H.E. Imray, FRCS Wilderness & Environmental Medicine Volume 23, Issue 1, Pages 15-23 (March 2012) DOI: 10.1016/j.wem.2011.12.008 Copyright © 2012 Wilderness Medical Society Terms and Conditions

Figure 1 Expedition altitude ascent profiles. Group 1 (blue line) recorded data for 23 days, and group 2 (red line) recorded data for 17 days. Wilderness & Environmental Medicine 2012 23, 15-23DOI: (10.1016/j.wem.2011.12.008) Copyright © 2012 Wilderness Medical Society Terms and Conditions

Figure 2 Median Lake Louise Self-Assessment Questionnaire (LLSAQ) scores versus altitude. Different numbers of recordings were collected within the various altitude ranges. The median scores were identified for each altitude range. Wilderness & Environmental Medicine 2012 23, 15-23DOI: (10.1016/j.wem.2011.12.008) Copyright © 2012 Wilderness Medical Society Terms and Conditions

Figure 3 Peripheral oxygen (O2) saturation versus altitude. Pre-exercise oxygen saturation measurements (diamonds) at increasing altitude (mean ± 95% confidence interval) show an association of oxygen saturation with altitude (rho = −0.59, P = .001). Wilderness & Environmental Medicine 2012 23, 15-23DOI: (10.1016/j.wem.2011.12.008) Copyright © 2012 Wilderness Medical Society Terms and Conditions

Figure 4 Pre-exercise pulse rate measurements (diamonds) are shown for the whole group at increasing altitude (mean ± 95% confidence interval). A significant increase on ascent to 3500 m is shown, with no clear association with further altitude gain (rho = 0.02, P = .6). bpm, beats per minute. Wilderness & Environmental Medicine 2012 23, 15-23DOI: (10.1016/j.wem.2011.12.008) Copyright © 2012 Wilderness Medical Society Terms and Conditions

Figure 5 Correlation of Lake Louise Self-Assessment Questionnaire (LLSAQ) against physiological measurements. (A) Association of pulse rate with LLSAQ score (regression line r = 0.15, P < .001). (B) Association of oxygen (O2) saturation with LLSAQ score (regression line r = −0.16, P = .005). Correlation lines represent Spearman's correlation coefficients. bpm, beats per minute. Wilderness & Environmental Medicine 2012 23, 15-23DOI: (10.1016/j.wem.2011.12.008) Copyright © 2012 Wilderness Medical Society Terms and Conditions

Figure 6 Individual resting pre-exercise peripheral oxygen (O2) saturation readings plotted against altitude. Readings are shown corresponding to Lake Louise Self-Assessment Questionnaire (LLSAQ) acute mountain sickness (AMS) scores: <3, no AMS (blue dots); 3 to 4, mild AMS (green dots); 5 to 6, moderate AMS (yellow dots); and ≥7, severe AMS (red dots). Wilderness & Environmental Medicine 2012 23, 15-23DOI: (10.1016/j.wem.2011.12.008) Copyright © 2012 Wilderness Medical Society Terms and Conditions

Figure 7 Mean peripheral oxygen (O2) saturation results for all recordings at 5 altitude ranges: sea level (red), 3000 m to 3500 m (green), 3501 m to 4499 m (yellow), 4500 m to 5000 (orange), and 5001 m to 5200 m (blue). Before exercise (Baseline), after 2-minute exercise (Post step), and after 1-minute rest (1 min rest) measurements were averaged separately (mean ± 95% confidence interval). Wilderness & Environmental Medicine 2012 23, 15-23DOI: (10.1016/j.wem.2011.12.008) Copyright © 2012 Wilderness Medical Society Terms and Conditions