Sex differences in exercise‐induced arterial hypoxemia and pulmonary edema following high‐intensity exercise in highly trained endurance athletes

This study investigated sex differences in the development of pulmonary edema and exercise-induced arterial hypoxemia (EIAH) in well-trained endurance athletes during near-maximal exercise in a real-world setting. Twenty participants (10M vs. 10F; V̇O₂peak: 69.3 (8.8) vs. 50.7 (4.1) ml∙kg^-1∙min^-1) underwent a maximal incremental treadmill test (visit 1) and a time trial on a steep trail (~2.5 km, ~800 m elevation gain) in North Vancouver (visit 2). Pulmonary edema was evaluated using handheld lung ultrasound ~10-15 min post-exercise and oxygen saturation (SpO₂) was monitored using finger pulse oximetry. Males completed the time trial significantly faster than females (M: 31.5 (6.5) vs. F: 40.4 (7.5) min, p = 0.006), while females sustained a higher percentage of their visit 1 heart rate (M: 94 (1) vs. F: 96 (1) %max, p = 0.02). All participants developed EIAH, with no sex differences in end-exercise SpO₂ (M: 89 (4) % vs. F: 90 (3) %, respectively, p = 0.35). There was no evidence of pulmonary edema, assessed through ultrasound b-line scores, with no differences between sexes (M: 0.3 (1.0) vs. F: 0.5 (1.5), respectively, p = 0.60). Pulmonary edema is an unlikely contributor to EIAH in endurance athletes performing near-maximal time trial exercise in a real-world setting.