BACKGROUND Exposure to high altitude (HA) results in sympathetic nervous system (SNS) activation. This might interact with HA related illness. HRV is a technique to quantify SNS and parasympathetic nervous system (PNS) interactions and thus offers a noninvasive index in extreme environments. OBJECTIVE To quantify the changes in HRV in elite athletes (AT), acclimatized for 2 mo. at Everest base camp (BC) prior to summiting, relative to a control group (CT) (climbing and acclimatizing to BC in 3 wks). METHODS AT (N=4, Age=35±10 y, BMI=22±2, M/F ratio 2/2) and CT (N=8, Age=35±10 y, BMI=26±2, M/F ratio 8/0) performed autonomic tests consisting of quiet breathing, paced breathing prior to, mid‐way at BC and at 2 wks post expedition. RESULTS At BC, AT had (compared to CT) higher HR (p=0.07) and reduced HRV (SDNN, p=0.09). For AT and CT combined: measures of HRV were reduced at BC (SDNN, p=0.05, Poincare length, p=0.05) and remained below baseline 2 wks post climb (SDNN, p=0.01; PCL, p=0.01). CONCULSION HRV is reduced with HA exposure in both AT and CT and remains reduced 2 wks post exposure, suggesting either SNS activation and/or PNS withdrawal. FUNDING : Mayo Clinic & The North Face.