Erythropoietic responses to a series of repeated maximal dynamic and static apnoeas in elite and non-breath-hold divers

Serum erythropoietin (EPO) concentration is increased following static apnoea-induced hypoxia. However, the acute erythropoietic responses to a series of dynamic apnoeas in non-divers (ND) or elite breath-hold divers (EBHD) are unknown. Participants were stratified into EBHD (n=8), ND (n=10) and control (n=8) groups. On two separate occasions EBHD and ND performed a series of five maximal dynamic apnoeas (DYN) or two sets of five maximal static apnoeas (STA). Control performed a static eupnoeic (STE) protocol to control against any effects of water immersion and diurnal variation on EPO. Peripheral oxygen saturation (SpO2) levels were monitored up to 20s post each maximal effort. Blood samples were collected at 30, 90, and 180-min after each protocol for EPO, haemoglobin and haematocrit concentrations. No between group differences were observed at baseline (p>0.05). For EBHD and ND, mean end-apnoea SpO2 was lower in DYN (EBHD,62±10%,p=0.024;ND,85±6%;p=0.020) than STA (EBHD,76±7%;ND,96±1%) and control (98±1%) protocols. EBHD attained lower end-apnoeic SpO2 during DYN and STA than ND (p<0.001). Serum EPO increased from baseline following the DYN protocol in EBHD only (EBHD,p<0.001;ND,p=0.622). EBHD EPO increased from baseline (6.85±0.9mlU/mL) by 60% at 30-min (10.82±2.5mlU/mL,p=0.017) and 63% at 180-min (10.87±2.1mlU/mL,p=0.024). Serum EPO did not change after the STA (EBHD,p=0.534;ND,p=0.850) and STE (p=0.056) protocols. There was a significant negative correlation (r=-0.49,p=0.003) between end-apnoeic SpO2 and peak post-apnoeic serum EPO concentrations. The novel findings demonstrate that circulating EPO is only increased after DYN in EBHD. This may relate to the greater hypoxemia achieved by EBHD during the DYN.