Effects of intermittent hypoxia on erythropoietin, soluble erythropoietin receptor and ventilation in humans

Erythropoietin (EPO) and soluble EPO receptors (sEPOR) have been proposed to play a central role in the ventilatory acclimatisation to continuous hypoxia in mice. In this study, we demonstrated for the first time in humans (n=9) that sEPOR is downregulated upon daytime exposure to 4 days of intermittent hypoxia (IH; 6 h·day-1, cycles of 2 min of hypoxia followed by 2 min of reoxygenation; peak end-tidal oxygen tension (PET,O2) 88 Torr, nadir PET,O2 45 Torr), thereby allowing EPO concentration to rise. We also determined the strength of the association between these haematological adaptations and alterations in the acute hypoxic ventilatory response (AHVR). We observed a nadir in sEPOR on day 2 (-70%), concomitant with the peak in EPO concentration (+50%). Following exposure to IH, tidal volume (VT) increased, respiratory frequency remained unchanged, and minute ventilation (V′E) was increased. There was a negative correlation between EPO and sEPOR (r= -0.261; p=0.05), and between sEPOR and VT (r= -0.331; p=0.02). EPO was positively correlated with V′E (r=0.458; p=0.001). In conclusion, the downregulation of sEPOR by IH modulates the subsequent EPO response. Furthermore, the alterations in AHVR and breathing pattern following IH appear to be mediated, at least in part, by the increase in EPO.