An interventional study of Terrestrial altitude and Cloud 9 in Hypoxia, Altitude Hypoxia and Altitude Sickness, sponsored by University of Applied Sciences and Arts of Southern Switzerland. Completed at 3 sites in Switzerland. Open to participants aged 18 Years to 50 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-02-19.
Sponsored by University of Applied Sciences and Arts of Southern Switzerland · Not applicable, Interventional, and Basic science
The aim of this study is to compare the psychophysiological effects of terrestrial altitude with a normobaric, hypoxic situation.
Research has consistently shown that exposure to extreme environments (such as high altitude stays) may affect cognitive function. For logistical reasons and to control the experimental set-ups, most of these examinations are carried out in the laboratory. By testing under such controlled conditions, researchers can remove any co-foundational factors and isolate the cause of stress, thereby better understanding the mechanisms by which impairment can occur. However, when people are exposed to such environments in the "real world" (such as altitude), they often experience a number of other additional stressors at the same time, which can also affect their performance. Surprisingly, however, little attention has been paid to the study of these additional stressors in combination.
Although the oxygen content remains constant at various altitudes (20.93%), the air pressure decreases exponentially as the altitude increases. As a result, the oxygen partial pressure in arterial blood and tissue is reduced (hypoxia), leading to a deterioration in both physical and cognitive performance. Hypoxic conditions also alter the perception of pain, which may be particularly relevant for patients suffering from hypoxic conditions. According to the authors' knowledge, there is limited literature investigating and comparing simulated and real psychophysiological responses.
Exclusion Criteria:
The participants are exposed to simulated altitude in a normobaric situation.
Behavioral: Cloud 9
The participants are exposed to terrestrial altitude in a hypobaric situation.
Behavioral: Terrestrial altitude
the participants are exposed to a normoxic and normobaric environment.
Terrestrial altitude: The volunteers are in an SAC hut at an altitude of 3000 m. By means of this exposure the psychophysiological effect under hypobaric and hypoxic conditions is determined. The subjects spend the night in this SAC hut and the measurements are repeated the next day.
Cloud 9 is a solid, certified product that complies with European Directives on Electromagnetic Compatibility, Machine Directive, Air Pressure Equipment and Low Voltage Equipment (89/336 / EEC, 91/368 / CEE, 93/68 / CEE, 97/23 / EC, EN61010-1 All directives are in writing in the Supplements to this Ethics Application. Simulated height: The subjects are in the laboratory of our institution and are connected to the Cloud 9 by means of a mask. Subjects are exposed to a simulated altitude of 3530m under normobaric conditions. By means of this intervention the psychophysiological effect under normobaric and hypoxic conditions is determined.
Oxygenation of the Brain
Brain oxygen saturation is measured non-invasively using a deep tissue oxygenation monitor (moorVMS-NIRS, moor instruments, www.moor.co.uk). For this purpose, adhesive electrodes are applied over the muscle and the forehead. This measurement is taken during the baseline measurements, and during the cognitive performance test. This outcome measure reports the change from baseline for the oxygenation of the brain.
Time frame: Baseline (participants seated for 15 minutes) and during the cognitive performance under normobaric hypoxia, hypobaric hypoxia, and control conditions (mean over time)
Oxygenation of the Blood
The oxygen saturation of the blood (SpO2) is measured with a portable pulse oximeter with finger clip probe (Nonin 7500, Nonin medical B.V., Plymouth, USA). This measurement is taken during the baseline measurements and after the step-up task. This outcome measure reports the change from baseline for the oxygenation of the blood.
Time frame: Continuously during the 15-minute seated baseline period before each trial (mean over 15min) and at the end of the step-up test (point measurement)
Mean Arterial Pressure
Blood pressure was measured using an automated sphygmomanometer monitor from the left brachial artery. MAP was calculated using the following formula: MAP = diastolic blood pressure + (systolic blood pressure-diastolic blood pressure) / 3.
Time frame: At the end of the 15-minute baseline seated period before each trial and at the end of the 3-minute submaximal step-test (Point measurements)
Heart Rate
The heart rate is measured using a pulse belt and an additional 2-point ECG (Actiheart, Camntech Ltd., Cambridge, UK). This measurement is taken during the baseline measurements and after the step-up task. This outcome measure reports the change from baseline for the heart rate.
Time frame: at baseline and the end of the submaximal step test (point measurements)
Concentration of Blood Lactate
Lactate measurements are performed by capillary blood measurement. This measurement is taken during the baseline measurements and after the step-up task.
Time frame: at the end of 15min baseline period and the end of the step-up test (point measurements)
Sleep Quality
Sleep quality of the night before the experimental day was assessed using the validated and reliable GSQS, consisting of a 16-item true or false questionnaire. GSQS scores ranged from 0 to 16 whereas higher scores indicated lower subjective sleep quality.
Time frame: Before the cognitive performance test (point measurement)
Altitude Sickness
Altitude sickness is measured with "Lake Louis acute mountain sickness scale", choosing the most appropriate answer from 5 questions. Questions range from 0 (=no symptoms) to 4 (=severe symptoms). LLAMS symptoms were assessed at the end of each experimental measurement.
Time frame: After performing the 3-min step-test (point measurment)
Concentration of Salivary Cortisol
Salivary cortisol was assessed from the n = 10 female participants to assess the daily stress level after each experimental day. Through a straw, 3mL of saliva was collected and stored in a refrigerator until the analyses were performed the next day using the enzyme-linked immunosorbent assay (ELISA) method.
Time frame: After each experimental day, in the evening between 8:30 PM and midnight, measured once before participants went to bed (point measurment)
This is a randomised crossover trials. The same 20 participants were tested in all conditions
| Milestone | Experimental: Normobaric Normoxia, Normobaric Hypoxia and Then Hypobaric Hypoxia |
|---|---|
| Started | 20 |
| Normobaric normoxia | 20 |
| Normobaric hypoxia | 20 |
| Hypobaric hypoxia first day | 20 |
| Hypobaric hypoxia after overnight | 20 |
| Completed | 20 |
| Not completed | 0 |
Brain oxygen saturation is measured non-invasively using a deep tissue oxygenation monitor (moorVMS-NIRS, moor instruments, www.moor.co.uk). For this purpose, adhesive electrodes are applied over the muscle and the forehead. This measurement is taken during the baseline measurements, and during the cognitive performance test. This outcome measure reports the change from baseline for the oxygenation of the brain.
| percentage of oxygen saturation | Simulated Altitude | Terrestrial Altitude | Control |
|---|---|---|---|
| rest | 54.6 ± 4.6 | 54.3 ± 4.9 | 59.4 ± 3.8 |
| during congnitive performance test | 55.4 ± 4.5 | 55.6 ± 5.1 | 60.7 ± 3.8 |
The oxygen saturation of the blood (SpO2) is measured with a portable pulse oximeter with finger clip probe (Nonin 7500, Nonin medical B.V., Plymouth, USA). This measurement is taken during the baseline measurements and after the step-up task. This outcome measure reports the change from baseline for the oxygenation of the blood.
| % SpO2 | Simulated Altitude | Terrestrial Altitude (Day 1) | Terrestrial Altitude (Day 2) | Control |
|---|---|---|---|---|
| Rest | 91.3 ± 1.7 | 89.5 ± 1.8 | 90.7 ± 1.8 | 95.8 ± 1.2 |
| after 3-min step-test | 80.5 ± 80.5 | 78.7 ± 3.1 | 80.5 ± 3.0 | 90.7 ± 2.8 |
Blood pressure was measured using an automated sphygmomanometer monitor from the left brachial artery. MAP was calculated using the following formula: MAP = diastolic blood pressure + (systolic blood pressure-diastolic blood pressure) / 3.
| mmHg | Simulated Altitude | Terrestrial Altitude (Day 1) | Terrestrial Altitude (Day 2) | Control |
|---|---|---|---|---|
| Rest | 93.6 ± 8.3 | 97.4 ± 8.8 | 98.1 ± 7.7 | 94.0 ± 8.1 |
| 3-min step-test | 114.7 ± 11.8 | 110.6 ± 28.0 | 122.1 ± 10.5 | 116.8 ± 12.7 |
The heart rate is measured using a pulse belt and an additional 2-point ECG (Actiheart, Camntech Ltd., Cambridge, UK). This measurement is taken during the baseline measurements and after the step-up task. This outcome measure reports the change from baseline for the heart rate.
| beats per minute | Simulated Altitude | Terrestrial Altitude (Day 1) | Terrestrial Altitude (Day 2) | Control |
|---|---|---|---|---|
| Rest | 77.6 ± 10.2 | 75.0 ± 9.6 | 86.0 ± 11.2 | 71.0 ± 10.9 |
| 3-min step-test | 141.6 ± 10.4 | 141.9 ± 10.6 | 144.9 ± 5.8 | 137.4 ± 12.9 |
Lactate measurements are performed by capillary blood measurement. This measurement is taken during the baseline measurements and after the step-up task.
| mmol/l | Simulated Altitude | Terrestrial Altitude (Day 1) | Terrestrial Altitude (Day 2) | Control |
|---|---|---|---|---|
| rest | 2.0 ± 0.9 | 2.4 ± 0.8 | 2.3 ± 0.8 | 1.7 ± 0.6 |
| 3-min step-test | 5.0 ± 1.4 | 4.9 ± 1.5 | 4.8 ± 1.6 | 4.7 ± 2.4 |
Sleep quality of the night before the experimental day was assessed using the validated and reliable GSQS, consisting of a 16-item true or false questionnaire. GSQS scores ranged from 0 to 16 whereas higher scores indicated lower subjective sleep quality.
| score on a scale | Simulated Altitude | Terrestrial Altitude (Day 1) | Control | Terrestrial Altitude (Day 2) |
|---|---|---|---|---|
| Sleep Quality | 5.6 ± 1.3 | 7.0 ± 1.8 | 5.5 ± 1.9 | 5.8 ± 1.6 |
Altitude sickness is measured with "Lake Louis acute mountain sickness scale", choosing the most appropriate answer from 5 questions. Questions range from 0 (=no symptoms) to 4 (=severe symptoms). LLAMS symptoms were assessed at the end of each experimental measurement.
| score on a scale | Simulated Altitude | Terrestrial Altitude (Day 1) | Control | Terrestrial Altitude (Day 2) |
|---|---|---|---|---|
| Altitude Sickness | 0.6 ± 0.7 | 1.4 ± 1.3 | 0.4 ± 0.5 | 0.6 ± 0.9 |
Salivary cortisol was assessed from the n = 10 female participants to assess the daily stress level after each experimental day. Through a straw, 3mL of saliva was collected and stored in a refrigerator until the analyses were performed the next day using the enzyme-linked immunosorbent assay (ELISA) method.
| μg/l | Simulated Altitude | Terrestrial Altitude (Day 1) | Terrestrial Altitude (Day 2) | Control |
|---|---|---|---|---|
| Concentration of Salivary Cortisol | 0.24 ± 0.16 | 0.31 ± 0.19 | 0.25 ± 0.12 | 0.23 ± 0.19 |
Collected over From baseline (prior to first experimental condition) through completion of the last experimental condition for each participant (approximately 3 months).. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Simulated Altitude | 0/20 (0%) | 0/20 (0%) | 0/20 (0%) |
| Terrestrial Altitude | 0/20 (0%) | 0/20 (0%) | 0/20 (0%) |
| Control | 0/20 (0%) | 0/20 (0%) | 0/20 (0%) |
This is a crossover design
| Age, Continuous(years) | Experimental: Normobaric Normoxia, Normobaric Hypoxia and Then Hypobaric Hypoxia |
|---|---|
| Females | 24.8 ± 5.1 |
| Males | 30.3 ± 6.3 |
| Sex: Female, Male(Participants) | Experimental: Normobaric Normoxia, Normobaric Hypoxia and Then Hypobaric Hypoxia |
|---|---|
| Female | 10 |
| Male | 10 |
| Race and Ethnicity Not Collected(Participants) | Experimental: Normobaric Normoxia, Normobaric Hypoxia and Then Hypobaric Hypoxia |
|---|
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University of Applied Sciences and Arts of Southern Switzerland