Feasibility of Delivering a 5-Day Normobaric Hypoxia Breathing in Healthy Volunteers in a Hospital Setting

BACKGROUND: Beneficial effects of breathing at FIO₂ < 0.21 on disease outcomes have been reported in previous preclinical and clinical studies. However, the safety and intra-hospital feasibility of breathing hypoxic gas for 5 d have not been established. In this study, we examined the physiologic effects of breathing a gas mixture with FIO₂ as low as 0.11 in 5 healthy volunteers. METHODS: All 5 subjects completed the study, spending 5 consecutive days in a hypoxic tent, where the ambient oxygen level was lowered in a stepwise manner over 5 d, from FIO₂ of 0.16 on the first day to FIO₂ of 0.11 on the fifth day of the study. All the subjects returned to an environment at room air on the sixth day. The subjects9 SpO₂, heart rate, and breathing frequency were continuously recorded, along with daily blood sampling, neurologic evaluations, transthoracic echocardiography, and mental status assessments. RESULTS: Breathing hypoxia concentration dependently caused profound physiologic changes, including decreased SpO₂ and increased heart rate. At FIO₂ of 0.14, the mean SpO₂ was 92%; at FIO₂ of 0.13, the mean SpO₂ was 93%; at FIO₂ of 0.12, the mean SpO₂ was 88%; at FIO₂ of 0.11, the mean SpO₂ was 85%; and, finally, at an FIO₂ of 0.21, the mean SpO₂ was 98%. These changes were accompanied by increased erythropoietin levels and reticulocyte counts in blood. All 5 subjects concluded the study with no adverse events. No subjects exhibited signs of mental status changes or pulmonary hypertension. CONCLUSIONS: Results of the current physiologic study suggests that, within a hospital setting, delivering FIO₂ as low as 0.11 is feasible and safe in healthy subjects, and provides the foundation for future studies in which therapeutic effects of hypoxia breathing are tested.