White Matter Status of Participants in Altitude Chamber Research and Training

INTRODUCTION: Magnetic resonance imaging (MRI) brain scans of U.S. Air Force (USAF) altitude workers show increased white matter hyperintensities (WMH) that appear related to decompression stress. Relevant exposure thresholds are unknown. This MRI survey compares the white matter status of UK participants (UKP) in altitude chamber research and training with USAF cohorts having background and increased WMH. METHODS: UKP (N = 20) comprised 13 research subjects and 7 military altitude chamber instructors ages 33 to 50 yr (16 men, 4 women), encompassing 1417 decompressions over a 15,000-ft (4572 m) pressure altitude (range 11-189; median 50). High resolution MRI reproduced USAF sequences and data were analyzed at the University of Maryland to validate comparison with age-matched USAF control (DOC; N = 85) and aerospace operational physiologist (PHY; N = 55) cohorts. RESULTS: UKP data are dichotomous: 17 subjects (85%) had normal scans (total 19 WMH) and three outliers had excess (>15) WMH (total of 83 lesions). WMH were not associated with metrics of decompression history (total exposures, rapid decompression, pressure breathing, hypoxia familiarization, decompression sickness, or exposure intensity). Ranked data indicate that UKP have fewer WMH than PHY but not DOC. UKP outliers' excess WMH are attributable to past mild traumatic brain injury. CONCLUSIONS: WMH in UKP are unrelated to subjects' low intensity (brief, infrequent) experience of altitude chamber decompression, encompassing occasional hypobaric hypoxia and mild decompression sickness, even with cumulative experience over many years. Such low intensity hypobaric exposure appears 'subthreshold' for promotion of WMH.Connolly DM, Lee VM, Hodkinson PD. White matter status of participants in altitude chamber research and training. Aerosp Med Hum Perform. 2018; 89(9):777-786.