Throughout the expedition, participants with increased AMS symptoms had poorer physical and mental health, higher heart rate, and lower fluid intake. Upper respiratory symptoms, heart rate, arterial oxygen saturations, and fluid intake also predicted AMS symptoms the following day, and thus, these predictor variables were consistent with being causally related to AMS. However, contrary to our hypotheses, this study found no increase in diarrhea with altitude, and no causal effect of diarrhea Alpelisib chemical structure and anxiety on AMS. The incidence of AMS in the present study is consistent with previous studies using similar ascent profiles,

as recently reviewed.[28] Although a landmark early study suggested no association between upper respiratory infections and AMS incidence,[2] subsequent studies provided data consistent with a greater number of respiratory symptoms and diarrhea being associated with a greater number of symptoms and severity of AMS.[10] Nevertheless, conclusive evidence that general illness caused AMS was still lacking. The present study thus extends previous findings by providing empirical support, using a longitudinal regression design that upper respiratory symptoms increase Cell Cycle inhibitor with altitude and are associated with AMS. Of course individuals may not be able to differentiate between symptoms

of upper respiratory symptoms and AMS, as evidenced by the reporting of “AMS” symptoms at low altitude. This highlights that misdiagnosis may occur and incorrect treatment may be administered. Nevertheless, previous authors have suggested that upper Temsirolimus respiratory symptoms may predispose to AMS.[5, 10] The exact cause for this relationship remains unclear, but if any upper respiratory symptoms are due to infection, then one

plausible mechanism is that an immune response such as inflammation may increase AMS,[5, 29] although such a mechanism remains to be proven. In contrast to upper respiratory symptoms, in the present study, diarrhea did not increase with altitude and was not causally associated with AMS. Similarly, anxiety was increased at altitude but inconsistently so, and like diarrhea was not causally associated with AMS. Although previous studies have shown relationships between diarrhea[10] and anxiety[11] with AMS, they could not establish whether data were consistent with causality as was tested in the present study. Possibly, diarrhea may cause symptoms such as dehydration headache rather than AMS per se, and anxiety may be a consequence, rather than a cause of AMS. Previous authors have also suggested that arterial oxygen saturation may predict AMS susceptibility.[10, 30-32] However, arterial oxygen saturation testing has failed to gain widespread acceptance, and some authors[33, 34] have found that resting oxygen saturation may be inferior to other predictor variables of AMS, albeit often only acute exposure was investigated.