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Acute Mountain Sickness at Moderate Altitudes
- Georg Roeggla, MD;
- Martin Roeggla, MD; and
- Andreas Wagner, MD
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TO THE EDITOR:
Scientific research in alpine medicine has dealt primarily with small groups of healthy, athletic persons in high altitude, even though most mountain tours are in medium-high altitude and most mountaineers are not trained athletes. Honigman and colleagues' study of the incidence of acute mountain sickness in a general tourist population at moderate altitude [1] is important because of the impressive number of participants and the identification of easily evaluable predictors for acute mountain sickness such as the height of permanent residence.
Nonetheless, we have serious reservations about the methods and conclusions of this study. The reported incidence of acute mountain sickness at moderate altitudes ranges from 1.4% to 25%, a variability mainly related to the different instruments used. Whereas this study used a questionnaire, Hackett and colleagues [2] based the diagnosis of acute mountain sickness on a scoring system (structured interview and a short physical examination by an experienced investigator). Using only a questionnaire may result in classifying acute mountain sickness through nonspecific signs such as a maladaptation to travel or to unusual surroundings. The reported 25% incidence of full-blown acute mountain sickness at 9700 feet in altitude is far from alpine medical or aeromedical experience and much higher than that reported in two recent studies of the incidence of acute mountain sickness in leisure alpinists in the European Alps. Our data show an increase in the incidence of acute mountain sickness from 3.1% at 6600 feet, to 3.4% at 7514 feet, to 6.3% at 8299 feet, to 9.5% at 10 246 feet. The most common signs and symptoms of acute mountain sickness were insomnia and peripheral or periorbital edema [3]. These results correspond well to those of a study done in the Swiss Alps, in which an incidence of 9% at 9405 feet, increasing to 53% at 15 044 feet, was reported [4].
In short, we believe that the incidence of acute mountain sickness was overestimated by Honigman and colleagues.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
