不同高原条件下焦虑与睡眠、症状及体征的关系
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摘要
目的：了解青年男性在高原暴露后的焦虑表现、睡眠及症状、体征表现，初步探讨高原环境下，焦虑情绪对于睡眠及各种症状表现的影响。探索高原不良情绪对于高原症状，尤其是睡眠状态的影响，为预防高原迁徙人员的身心不适提供心理学干预措施和理论依据。
方法：
1.急进高原后症状、体征、焦虑及睡眠状态的观察及后二者的关系
对2012年夏季将上高原作业的1505名青年男性，首先做平原的症状、体征、焦虑、睡眠状况的基础测量。症状采用诊断急性高原病（acute mountain sickness，AMS）的路易斯湖评分（Lake Louise score, LLS）评价，体征方面利用指尖便携式饱和度仪检测受试者的心率、氧饱和，腕式血压计记录人员的静息血压。衡量焦虑则采用焦虑自评分量表(SAS)；对于睡眠紊乱，夜间失眠情况采用阿森斯失眠评分，而白日困倦则采用爱普沃思困倦评分衡量。再次收集进入海拔3700m的拉萨的次日，以及驻留4400m羊八井习服5天后的数据。横向比较焦虑与非焦虑人群在每个海拔高度上睡眠、症状、体征方面表现的差异，寻找影响产生焦虑情绪的因素；纵向上观察平原焦虑非焦虑人群在高原暴露后各自焦虑情绪、睡眠状况及症状体征的变化转归情况。
2.高原习服人员的焦虑、睡眠状态、症状、体征及焦虑与其他因素关系
2011年夏季，对高原习服40天的426名人员跟踪观察。对其症状、体征、焦虑状态(焦虑自评量表)、睡眠状况(雅典失眠量表、爱普沃思困倦评分)做测量，然后人员经历13天的高原行进，至第14天时在4个小时内从海拔3600m高度急进至4400m的更高地区。并于次日对该人群的各项参数进行再次测量。考察人员在两次、两个不同海拔高度的焦虑、失眠、白日困倦的发生率，横断面做队列研究观察焦虑、非焦虑人群在失眠、白日困倦方面的异同，并比较从海拔3600m到海拔4400m这一过程中，分析人员的焦虑、睡眠状态的变化转归情况，并对急进4400米的AMS人群，用二元回归分析分析影响焦虑发生的因素。
3.高原返回后人员的焦虑、睡眠状态、症状、体征的观察及焦虑对于其他因素的影响
2011年在高原作业三个月的人员，我们追踪观察其在返回平原40天后的焦虑、睡眠紊乱情况、症状及体征表现做一系列的检测记录，分析高原脱适应状态下，焦虑、非焦虑人群在症状、体征、睡眠状况方面的不同，并考察焦虑评分与人口统计学资料、体征、心理学参数的相互关系。
结果
1.急进高原后对人员症状、体征、焦虑及睡眠状态的影响，以及焦虑与症状、体征、睡眠状态之间的相互关系
焦虑在500m、3700m及4400m海拔的发生率分别是4.2%(41/975)、15.2%(201/1325)及9.6%(62/646),失眠的发生率在三个海拔点的发生率分别是18.4%(152/826)、42.7%(566/1325)及31.4%(203/646),而白日困倦在三个海拔高度的发生率则分别为21.6%(219/1014)、41.7%(494/1184)及27.2%(163/596),按照平原上对焦虑与非焦虑人群的划分比较他们各自人群在达到3700m后的症状、体征及睡眠状态发现：平原焦虑人群在海拔3700m的SAS、AIS、ESS、LLS、SBP均显著高于平原非焦虑人群在此海拔高度上的指标参数(P均<0.01)，HR是焦虑人群略高于非焦虑人群(P<0.05)；而平原焦虑人群到了海拔4400m后只有SAS、AIS这两项指标显著高于平原非焦虑人群在此海拔高度上的指标参数(P均<0.01)。在观察每个海拔时间点横断面分析该处的焦虑人群与非焦虑人群在各种参数的差异，发现：海拔3700m时，LLS、SAS、AIS及ESS均是焦虑人群指标明显高于非焦虑人群(P均<0.01)，而心率是焦虑人群指标略高于非焦虑人群(P<0.05)；海拔4400m时，只有LLS、SAS、AIS及ESS几项指标是焦虑人群指标明显高于非焦虑人群(P均<0.01)。纵向观察焦虑及睡眠紊乱发生情况的变化，发现：从海拔400m上升到3700m，然后上到更高的4400m时候，原来焦虑的人群不一定继续保持焦虑，焦虑与非焦虑的转换似乎与海拔高度的变化无明显的相关关系。
2.高原习服人员的焦虑、睡眠状态、症状、体征及焦虑与其他因素关系的考察
在高原习服40天后，检测人员的焦虑、睡眠状态、对人员进行各种症状做问卷记录，检测其心率、血压、氧饱和度等体征。结果显示在海拔3600m及4400m处的焦虑发生率为11.50%(49/426)及15.50%(51/329),失眠的发生率则分别为25.7%及27.1%，白日困倦的发生率分别为41.5%及41.4%。两地的心理学参数无统计学差异。在3700m的羊八井，焦虑人群在绝大部分症状(头痛、头晕、眼花、耳鸣、腹泻、便秘、腹胀、疲劳虚弱感、睡眠困难、活动减少、感觉异常、精神改变、嗜睡、咳嗽、胸闷、胸紧、心动过速)的发生率均明显高于非焦虑组(P均<0.01)，只有胃肠道症状发生率，焦虑组稍高于非焦虑组(P<0.05)。而在4400m的羊八井处，焦虑组所有的症状发生率均显著高于非焦虑组(P均<0.01)。从3700m到4400m，体征方面4400m处心率平均值显著高于3600m(P<0.01)；而氧饱和度平均值则是4400m处的显著低于3600m(P<0.01)。对于急进的4400m时间点，二元相关分析显示焦虑与HR、AIS、ESS均呈现明显的相关系(P均<0.05),进一步运用二元回归分析分析影响焦虑发生的因素，结果显示HR(OR=2.432,p=0.023)及AIS是最明显的危险因素，尤其是AIS(OR=4.524，p<0.001)。
3.脱适应状态下人员的焦虑、睡眠状态、症状、体征的考察及焦虑对于其他因素的影响
群体的焦虑发生率占到了总调查人群的12.26%(13/106)，焦虑人群的各项症状发生率表现均高于非焦虑人群的发生率(p均<0.05)，而体征方面则无明显差异。分析SAS与AIS、ESS的二元相关性，发现焦虑自评分与雅典失眠评分情况存在明显的正相关(p<0.05)。
结论：
1.焦虑和睡眠紊乱皆是高原暴露后常见的身心异常。一般海拔越高，高原暴露的适应期越短，焦虑的发生率越高，失眠和白日困倦的发生率也越高。而随着在高原习服时间的延长，焦虑和各种躯体不适会减少。快心率和失眠在发生急性高原病人群中是指示焦虑发生的重要指标。
2.在高原表现为焦虑的个体较之非焦虑人员表现出更为严重的躯体不适，以及更加严重的睡眠紊乱。
3.部分人群不遵从焦虑随海拔上升而加重的规律，即在平原焦虑的人群到了高原后不一定继续表现为焦虑，到了更高海拔后焦虑缓解或者加重的比例均分；且平原非焦虑的人群到了高原可能会表现为焦虑。
4.高原脱适应后，焦虑也仍然会发生于某些个体。这些焦虑的个体在各种症状的表现上均差于非焦虑个体，但是焦虑仍然与失眠发生密切相关。
Objective This study aimed to investigate the anxiety, sleep status, somatic symptomsand vital signs on young Chinese people exposed to high altitudes. And we sought toexplore the effects of anxiety on somatic symptoms and sleep status at high altitudes. Theexploration on the effects of unhealthy emotions on high altitudes symptoms, especially thesleeping status could enrich our theoretical fundamental on psychological intervention forplateau homework personnel.
Methods
Ⅰ.The investigation on somatic symptoms, vital signs, anxiety and sleep status amongpopulation when ascended rapidly
We marched along the groups with1505young Chinese males who will go to highaltitude for task assignment. Before departure, we collected baseline data on somaticsymptoms, vital signs, anxiety and sleep status. Self-made questionnaire were used tomeasure the somatic symptoms, portable fingertip oxygen instruments was used to recordthe heart rate and oxygen saturation, wrist sphygmomanometers were applied to measurethe blood pressure. The self-rating anxiety scale (SAS) was used to measure anxiety. Forsleeping status, the Athens insomnia scale (AIS) were used to assess the nocturnal sleepstatus, the Epworth sleepiness scale (ESS) was applied to evaluate the excessive daytimesleepiness. All the data were collected again at the day after the arrival of Lhasa (3700m)and at the6th day after arriving at Yangbajing (4400m). And we compared the differenceson somatic symptoms, sleep status and vital signs between anxiety ones and non-anxietyones. The factors which defined the anxiety occurrence were also explored. In thelongitudinal view, we surveyed the changes and prognosis of anxiety and sleep statusbetween anxiety ones and non-anxiety ones.
Ⅱ.The investigation on somatic symptoms, vital signs, anxiety and sleep status onhigh altitude acclimated person.
We followed and surveyed along with426young males who had acclimated at highaltitudes for40days. The somatic symptoms, vital signs, anxiety state(SAS),sleepstatus(AIS and ESS).The subjects began a journey last for13days, and the group arrivedat a destination with4400m in4hrs from3600m.And the data were collected for the secondtime the day after their arrival at4400m.We investigated the incidence of anxiety, insomniaand daytime sleepiness between the two high altitudes, a cross-sectional study was appliedfor investigating outcome of anxiety and sleep status at the two high altitudes in ourcross-sectional study. And we sought to find the risk factors accounting for anxietyoccurrence by binary logistic regression.
Ⅲ. The investigationon anxiety, sleeping status, somatic symptoms, signs and theeffect of anxiety on other factors for the high altitude de-adaption population.
For the population who had worked on the high altitude for3months in2011, wesurveyed their states on anxiety, sleeping disturbance, somatic symptoms, and signs40daysafter their return to the plain, and analyzed the difference of somatic symptoms, signs andsleeping status between anxiety and non-anxiety. Further we explored the correlationbetween AIS, demographical data, signs and psychological parameters.
Results
Ⅰ. The investigation on somatic symptoms, vital signs, anxiety and sleep status inrapid ascending population
The anxiety incidence was4.2%(41/975)、15.2%(201/1325)and9.6%(62/646)respectively at500m,3700m and4400m,while the insomnia incidence was18.4%m(152/826)、42.7%(566/1325)and31.4%(203/646) respectively at the three altitudes, anddaytime sleepiness at the three altitudes was1.6%(219/1014)、41.7%(494/1184)and27.2%(163/596). According to the calssification of anxiety at the plain, we compared theirfollowing somatic symptoms, vital signs and sleep status at3700m, we found that,parameters (SAS, AIS, ESS, LLS and SBP) of anxiety ones were significantly higher thanthose of non-anxiety ones with HR slightly higher in comparison at3700m.Further in4400m, only LLS, SAS, AIS and ESS of anxiety ones were higher than those ofnon-anxiety ones. Analyzing anxiety and sleep status alteration in longitudinal view, wefound that, the one diagnosed as anxiety would not always presented as anxiety, and thecharacter of anxiety at plain could not predicate anxiety at high altitudes.
Ⅱ. The investigation on anxiety, sleeping status, somatic symptoms, signs and thecorrelation between anxiety and other factors
After acclimation on the plateau for40days, we measured the anxiety, sleep status,questionnaires and other vital signs(HR, BP and SO2).The results demonstrated that,anxiety incidence at3600m,4400m were11.50%(49/426) and15.50%(51/329)respectively; and insomnia incidence was25.7%and27.1%respectively; daytimesleepiness incidence was41.5%and41.4%respectively. There was no significantlydifference between the psychological parameters at the two altitudes. AtYangbajing(3700m), incidence of somatic symptoms (headache, diziness, dazzle, tinitus,diahrea, constipation, abdomen distension, fatigue or weakness, difficulty sleep, reductionin activity, paresthesia, mental change, lethargy, cough, chest tightness, chest distress,palpitation) in anxiety group were significantly higher than those of non-anxiety group (allp<0.01). Only the incidence of GI in anxiety group was slightly higher than that ofnon-anxiety group (p<0.05). When at Yangbajing (4400m), incidences of all the symptomsamong anxiety group were higher than those of non-anxiety group. From3600m to4400m,the mean heart rate in subjects was elevated, while the mean oxygen saturation wasdecreased. The binary correlation analysis indicated that, anxiety was correlated with HR,AIS and ESS. Further, we found that, elevated heart rate (OR=2.432, p=0.023) and theAIS(OR=4.524，p<0.001) were the highest risk factors by binary logistic regressionanalysis.
Ⅲ. The investigation on somatic symptoms, vital signs, anxiety and sleep status inhigh altitude de-acclimatization population.
Anxiety ones account to12.26%(13/106) among the total subjects, and all the somaticsymptoms in anxiety group presented higher scores compared with non-anxiety group (allp<0.05), but there were no significantly difference in vital signs between the two groups.Analyzing the binary correlation between SAS and AIS, ESS, etc., there was a significantlypositive correlation between SAS and AIS (p <0.05).
Conclusion
1. Both anxiety and sleep disturbance were very common psychosomatic problems athigh altitudes. With altitude increased and acclimation period shorten, the incidence ofanxiety get higher, and so do the incidence of insomnia and daytime sleepiness. With the increasing acclimation period, anxiety and all the somatic discomforts would be relieved.Quick heart rate and insomnia were the important index of the occurrence of anxiety amongthe AMS subjects.
2. The anxiety ones may present poorer somatic symptoms and more severe sleepdisturbance than the non-anxiety ones at high altitudes.
3. Part of the participants don’t follow the rule that anxiety aggravates with altitudeincrease, i.e., the one who presented as anxiety would not always presented as anxiety, andthe portion of alleviation or aggravation is approximately equal, and those who werenon-anxiety may present as anxiety when asending.
4. For the high altitude de-adaptation individuals, anxiety could still exist in someperson. And the anxiety ones would present poorer somatic symptoms than the non-anxietyones; nevertheless the occurrence of anxiety is always closely correlated with insomnia.
方法：
1.急进高原后症状、体征、焦虑及睡眠状态的观察及后二者的关系
对2012年夏季将上高原作业的1505名青年男性，首先做平原的症状、体征、焦虑、睡眠状况的基础测量。症状采用诊断急性高原病（acute mountain sickness，AMS）的路易斯湖评分（Lake Louise score, LLS）评价，体征方面利用指尖便携式饱和度仪检测受试者的心率、氧饱和，腕式血压计记录人员的静息血压。衡量焦虑则采用焦虑自评分量表(SAS)；对于睡眠紊乱，夜间失眠情况采用阿森斯失眠评分，而白日困倦则采用爱普沃思困倦评分衡量。再次收集进入海拔3700m的拉萨的次日，以及驻留4400m羊八井习服5天后的数据。横向比较焦虑与非焦虑人群在每个海拔高度上睡眠、症状、体征方面表现的差异，寻找影响产生焦虑情绪的因素；纵向上观察平原焦虑非焦虑人群在高原暴露后各自焦虑情绪、睡眠状况及症状体征的变化转归情况。
2.高原习服人员的焦虑、睡眠状态、症状、体征及焦虑与其他因素关系
2011年夏季，对高原习服40天的426名人员跟踪观察。对其症状、体征、焦虑状态(焦虑自评量表)、睡眠状况(雅典失眠量表、爱普沃思困倦评分)做测量，然后人员经历13天的高原行进，至第14天时在4个小时内从海拔3600m高度急进至4400m的更高地区。并于次日对该人群的各项参数进行再次测量。考察人员在两次、两个不同海拔高度的焦虑、失眠、白日困倦的发生率，横断面做队列研究观察焦虑、非焦虑人群在失眠、白日困倦方面的异同，并比较从海拔3600m到海拔4400m这一过程中，分析人员的焦虑、睡眠状态的变化转归情况，并对急进4400米的AMS人群，用二元回归分析分析影响焦虑发生的因素。
3.高原返回后人员的焦虑、睡眠状态、症状、体征的观察及焦虑对于其他因素的影响
2011年在高原作业三个月的人员，我们追踪观察其在返回平原40天后的焦虑、睡眠紊乱情况、症状及体征表现做一系列的检测记录，分析高原脱适应状态下，焦虑、非焦虑人群在症状、体征、睡眠状况方面的不同，并考察焦虑评分与人口统计学资料、体征、心理学参数的相互关系。
结果
1.急进高原后对人员症状、体征、焦虑及睡眠状态的影响，以及焦虑与症状、体征、睡眠状态之间的相互关系
焦虑在500m、3700m及4400m海拔的发生率分别是4.2%(41/975)、15.2%(201/1325)及9.6%(62/646),失眠的发生率在三个海拔点的发生率分别是18.4%(152/826)、42.7%(566/1325)及31.4%(203/646),而白日困倦在三个海拔高度的发生率则分别为21.6%(219/1014)、41.7%(494/1184)及27.2%(163/596),按照平原上对焦虑与非焦虑人群的划分比较他们各自人群在达到3700m后的症状、体征及睡眠状态发现：平原焦虑人群在海拔3700m的SAS、AIS、ESS、LLS、SBP均显著高于平原非焦虑人群在此海拔高度上的指标参数(P均<0.01)，HR是焦虑人群略高于非焦虑人群(P<0.05)；而平原焦虑人群到了海拔4400m后只有SAS、AIS这两项指标显著高于平原非焦虑人群在此海拔高度上的指标参数(P均<0.01)。在观察每个海拔时间点横断面分析该处的焦虑人群与非焦虑人群在各种参数的差异，发现：海拔3700m时，LLS、SAS、AIS及ESS均是焦虑人群指标明显高于非焦虑人群(P均<0.01)，而心率是焦虑人群指标略高于非焦虑人群(P<0.05)；海拔4400m时，只有LLS、SAS、AIS及ESS几项指标是焦虑人群指标明显高于非焦虑人群(P均<0.01)。纵向观察焦虑及睡眠紊乱发生情况的变化，发现：从海拔400m上升到3700m，然后上到更高的4400m时候，原来焦虑的人群不一定继续保持焦虑，焦虑与非焦虑的转换似乎与海拔高度的变化无明显的相关关系。
2.高原习服人员的焦虑、睡眠状态、症状、体征及焦虑与其他因素关系的考察
在高原习服40天后，检测人员的焦虑、睡眠状态、对人员进行各种症状做问卷记录，检测其心率、血压、氧饱和度等体征。结果显示在海拔3600m及4400m处的焦虑发生率为11.50%(49/426)及15.50%(51/329),失眠的发生率则分别为25.7%及27.1%，白日困倦的发生率分别为41.5%及41.4%。两地的心理学参数无统计学差异。在3700m的羊八井，焦虑人群在绝大部分症状(头痛、头晕、眼花、耳鸣、腹泻、便秘、腹胀、疲劳虚弱感、睡眠困难、活动减少、感觉异常、精神改变、嗜睡、咳嗽、胸闷、胸紧、心动过速)的发生率均明显高于非焦虑组(P均<0.01)，只有胃肠道症状发生率，焦虑组稍高于非焦虑组(P<0.05)。而在4400m的羊八井处，焦虑组所有的症状发生率均显著高于非焦虑组(P均<0.01)。从3700m到4400m，体征方面4400m处心率平均值显著高于3600m(P<0.01)；而氧饱和度平均值则是4400m处的显著低于3600m(P<0.01)。对于急进的4400m时间点，二元相关分析显示焦虑与HR、AIS、ESS均呈现明显的相关系(P均<0.05),进一步运用二元回归分析分析影响焦虑发生的因素，结果显示HR(OR=2.432,p=0.023)及AIS是最明显的危险因素，尤其是AIS(OR=4.524，p<0.001)。
3.脱适应状态下人员的焦虑、睡眠状态、症状、体征的考察及焦虑对于其他因素的影响
群体的焦虑发生率占到了总调查人群的12.26%(13/106)，焦虑人群的各项症状发生率表现均高于非焦虑人群的发生率(p均<0.05)，而体征方面则无明显差异。分析SAS与AIS、ESS的二元相关性，发现焦虑自评分与雅典失眠评分情况存在明显的正相关(p<0.05)。
结论：
1.焦虑和睡眠紊乱皆是高原暴露后常见的身心异常。一般海拔越高，高原暴露的适应期越短，焦虑的发生率越高，失眠和白日困倦的发生率也越高。而随着在高原习服时间的延长，焦虑和各种躯体不适会减少。快心率和失眠在发生急性高原病人群中是指示焦虑发生的重要指标。
2.在高原表现为焦虑的个体较之非焦虑人员表现出更为严重的躯体不适，以及更加严重的睡眠紊乱。
3.部分人群不遵从焦虑随海拔上升而加重的规律，即在平原焦虑的人群到了高原后不一定继续表现为焦虑，到了更高海拔后焦虑缓解或者加重的比例均分；且平原非焦虑的人群到了高原可能会表现为焦虑。
4.高原脱适应后，焦虑也仍然会发生于某些个体。这些焦虑的个体在各种症状的表现上均差于非焦虑个体，但是焦虑仍然与失眠发生密切相关。
Objective This study aimed to investigate the anxiety, sleep status, somatic symptomsand vital signs on young Chinese people exposed to high altitudes. And we sought toexplore the effects of anxiety on somatic symptoms and sleep status at high altitudes. Theexploration on the effects of unhealthy emotions on high altitudes symptoms, especially thesleeping status could enrich our theoretical fundamental on psychological intervention forplateau homework personnel.
Methods
Ⅰ.The investigation on somatic symptoms, vital signs, anxiety and sleep status amongpopulation when ascended rapidly
We marched along the groups with1505young Chinese males who will go to highaltitude for task assignment. Before departure, we collected baseline data on somaticsymptoms, vital signs, anxiety and sleep status. Self-made questionnaire were used tomeasure the somatic symptoms, portable fingertip oxygen instruments was used to recordthe heart rate and oxygen saturation, wrist sphygmomanometers were applied to measurethe blood pressure. The self-rating anxiety scale (SAS) was used to measure anxiety. Forsleeping status, the Athens insomnia scale (AIS) were used to assess the nocturnal sleepstatus, the Epworth sleepiness scale (ESS) was applied to evaluate the excessive daytimesleepiness. All the data were collected again at the day after the arrival of Lhasa (3700m)and at the6th day after arriving at Yangbajing (4400m). And we compared the differenceson somatic symptoms, sleep status and vital signs between anxiety ones and non-anxietyones. The factors which defined the anxiety occurrence were also explored. In thelongitudinal view, we surveyed the changes and prognosis of anxiety and sleep statusbetween anxiety ones and non-anxiety ones.
Ⅱ.The investigation on somatic symptoms, vital signs, anxiety and sleep status onhigh altitude acclimated person.
We followed and surveyed along with426young males who had acclimated at highaltitudes for40days. The somatic symptoms, vital signs, anxiety state(SAS),sleepstatus(AIS and ESS).The subjects began a journey last for13days, and the group arrivedat a destination with4400m in4hrs from3600m.And the data were collected for the secondtime the day after their arrival at4400m.We investigated the incidence of anxiety, insomniaand daytime sleepiness between the two high altitudes, a cross-sectional study was appliedfor investigating outcome of anxiety and sleep status at the two high altitudes in ourcross-sectional study. And we sought to find the risk factors accounting for anxietyoccurrence by binary logistic regression.
Ⅲ. The investigationon anxiety, sleeping status, somatic symptoms, signs and theeffect of anxiety on other factors for the high altitude de-adaption population.
For the population who had worked on the high altitude for3months in2011, wesurveyed their states on anxiety, sleeping disturbance, somatic symptoms, and signs40daysafter their return to the plain, and analyzed the difference of somatic symptoms, signs andsleeping status between anxiety and non-anxiety. Further we explored the correlationbetween AIS, demographical data, signs and psychological parameters.
Results
Ⅰ. The investigation on somatic symptoms, vital signs, anxiety and sleep status inrapid ascending population
The anxiety incidence was4.2%(41/975)、15.2%(201/1325)and9.6%(62/646)respectively at500m,3700m and4400m,while the insomnia incidence was18.4%m(152/826)、42.7%(566/1325)and31.4%(203/646) respectively at the three altitudes, anddaytime sleepiness at the three altitudes was1.6%(219/1014)、41.7%(494/1184)and27.2%(163/596). According to the calssification of anxiety at the plain, we compared theirfollowing somatic symptoms, vital signs and sleep status at3700m, we found that,parameters (SAS, AIS, ESS, LLS and SBP) of anxiety ones were significantly higher thanthose of non-anxiety ones with HR slightly higher in comparison at3700m.Further in4400m, only LLS, SAS, AIS and ESS of anxiety ones were higher than those ofnon-anxiety ones. Analyzing anxiety and sleep status alteration in longitudinal view, wefound that, the one diagnosed as anxiety would not always presented as anxiety, and thecharacter of anxiety at plain could not predicate anxiety at high altitudes.
Ⅱ. The investigation on anxiety, sleeping status, somatic symptoms, signs and thecorrelation between anxiety and other factors
After acclimation on the plateau for40days, we measured the anxiety, sleep status,questionnaires and other vital signs(HR, BP and SO2).The results demonstrated that,anxiety incidence at3600m,4400m were11.50%(49/426) and15.50%(51/329)respectively; and insomnia incidence was25.7%and27.1%respectively; daytimesleepiness incidence was41.5%and41.4%respectively. There was no significantlydifference between the psychological parameters at the two altitudes. AtYangbajing(3700m), incidence of somatic symptoms (headache, diziness, dazzle, tinitus,diahrea, constipation, abdomen distension, fatigue or weakness, difficulty sleep, reductionin activity, paresthesia, mental change, lethargy, cough, chest tightness, chest distress,palpitation) in anxiety group were significantly higher than those of non-anxiety group (allp<0.01). Only the incidence of GI in anxiety group was slightly higher than that ofnon-anxiety group (p<0.05). When at Yangbajing (4400m), incidences of all the symptomsamong anxiety group were higher than those of non-anxiety group. From3600m to4400m,the mean heart rate in subjects was elevated, while the mean oxygen saturation wasdecreased. The binary correlation analysis indicated that, anxiety was correlated with HR,AIS and ESS. Further, we found that, elevated heart rate (OR=2.432, p=0.023) and theAIS(OR=4.524，p<0.001) were the highest risk factors by binary logistic regressionanalysis.
Ⅲ. The investigation on somatic symptoms, vital signs, anxiety and sleep status inhigh altitude de-acclimatization population.
Anxiety ones account to12.26%(13/106) among the total subjects, and all the somaticsymptoms in anxiety group presented higher scores compared with non-anxiety group (allp<0.05), but there were no significantly difference in vital signs between the two groups.Analyzing the binary correlation between SAS and AIS, ESS, etc., there was a significantlypositive correlation between SAS and AIS (p <0.05).
Conclusion
1. Both anxiety and sleep disturbance were very common psychosomatic problems athigh altitudes. With altitude increased and acclimation period shorten, the incidence ofanxiety get higher, and so do the incidence of insomnia and daytime sleepiness. With the increasing acclimation period, anxiety and all the somatic discomforts would be relieved.Quick heart rate and insomnia were the important index of the occurrence of anxiety amongthe AMS subjects.
2. The anxiety ones may present poorer somatic symptoms and more severe sleepdisturbance than the non-anxiety ones at high altitudes.
3. Part of the participants don’t follow the rule that anxiety aggravates with altitudeincrease, i.e., the one who presented as anxiety would not always presented as anxiety, andthe portion of alleviation or aggravation is approximately equal, and those who werenon-anxiety may present as anxiety when asending.
4. For the high altitude de-adaptation individuals, anxiety could still exist in someperson. And the anxiety ones would present poorer somatic symptoms than the non-anxietyones; nevertheless the occurrence of anxiety is always closely correlated with insomnia.
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