A comparison of pulse oximetry and cerebral oxygenation in children with severe sleep apnea–hypopnea syndrome: a pilot study

Abstract

Near infrared spectroscopy (NIRS) has been used to assess the impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) on cerebral oxygenation. However, the relationship between the variations in the cerebral tissue oxygen saturation (ΔTOI) and pulse oximetry (ΔSpO ) has not been assessed in children with OSAHS. Consecutive clinically stable children with severe OSAHS [apnea-hypopnea index (AHI) >15 events h ] diagnosed during a night-time polygraphy with simultaneous recording of cerebral oxygenation with NIRS (NIRO-200NX, Hamamatsu Photonics KK) were included between September 2015 and June 2016. Maximal ΔSpO (SpO drop from the value preceding desaturation to nadir) and concomitant variations in transcutaneous carbon dioxide (ΔPtcCO ), maximal ΔTOI and maximal variations in cerebral oxygenated (O Hb) and deoxygenated (HHb) haemoglobin were reported. The relationships between ΔSpO , ΔPtcCO and ΔTOI, ΔO Hb and ΔHHb were investigated. The data from five children (three boys, aged 9.6 ± 6.7 years, AHI 16-91 events h ) were analysed. Strong correlations were found between ΔSpO and ΔTOI (r = 0.887, P < 0.001), but also with ΔO Hb and ΔHHb with a particular pattern in the youngest child with a dark skin pigmentation. Mean ΔSpO was 20 ± 17% and mean ΔTOI was 8 ± 7%. Maximal ΔSpO of approximately 70% were coupled with ΔTOI of no more than 35%. ΔPtcCO correlated only weakly with the cerebral oxygenation indexes. This pilot study shows a strong relationship between pulse oximetry and cerebral oxygenation in children with OSAHS, with lower changes in TOI compared to SpO . Future studies should address the clinical impact of respiratory events on cerebral oxygenation and its consequences.

A Review of Cerebral Hemodynamics During Sleep Using Near-Infrared Spectroscopy

“…Previous studies have investigated changes in NIRS parameters associated with different types of apnea. Significant oscillations of cerebral hemodynamics with declined HbO 2 , tHb, and TOI/StO 2 accompanied by a synchronized increase in HHb were observed during the initiation of apneic episodes, and reverse changes of hemoglobin indices accompanied by inconsistent changes in tHb were obtained after the termination of apnea (71)(72)(73)(74)(75)(76)(77)(78)(79). An example of the changes of NIRS indices in response to apnea is shown in Figure 4.…”

“…The occurrence of apneic episodes was accompanied by fluctuations in cerebral hemodynamics. The majority of studies have investigated the changes in cerebral tissue hemoglobin indices (HbO 2 , HHb, tHb) with and without CPAP or noninvasive ventilation (NIV) treatment in patients with OSA to evaluate the effect of treatment (72,77,78,89,97). Consistent reductions in the fluctuations of HbO 2 , HHb, and TOI were found in children and adults during CPAP.…”

Pulse Oximetry Monitoring In Pediatrics and The Role Of The Nurse

“…Pulse oksimetre kullanımı; yoğun bakım gerektiren, özellikle oksijenasyonu stabil olmayan ve sedatize edilmiş çocuklarda, hipokseminin ciddi sonuçlarının azaltılmasını, düzeltilmesini ve erken belirlenmesini sağlamaktadır. (16) Santral kateter yerleştirilmesi, bronkoskopi, endoskopi ve kardiyak kateterizasyon gibi invaziv işlemler, çocukta hipoksemi riskini arttırdığı için oksijen saturasyonu pulse oksimetre kullanılarak daha doğru olarak değerlendirilebilmektedir. (17) Pulse oksimetre, obstrüktif uyku apnesi şüphesi olan çocukların değerlendirilmesini de sağlamaktadır.…”

“…Bu nedenle yapılan işlemin ağrı ve acı vermeyeceği çocuk ve ailesine anlatılmalı ve örnek olarak hemşire kendi üzerinde örnek bir ölçüm gerçekleştirerek çocuk ve ailenin rahatlamasını sağlamalıdır. (16) Probu yerleştirmeden önce probun yerleştirildiği bölgenin kuru ve temiz olması sağlanmalıdır. Prob çocuğun ayak ya da el parmağına yerleştirilecekse çocuğun tırnağında oje olup olmadığına bakılmalıdır.…”

Sleep disordered breathing in children disrupts the maturation of autonomic control of heart rate and its association with cerebral oxygenation

“…Furthermore, adult studies have demonstrated decreased cerebral oxygenation in patients with OSA compared with controls (Hayakawa et al 1996;Valipour et al 2002;Schwarz et al 2018). There have been only three studies assessing cerebral oxygenation in children with SDB and although they identified that changes in brain oxygenation are seen in relation to obstructive events without changes in peripheral oxygenation, only small differences in cerebral oxygenation were found between children with SDB and non-snoring control children when averaged across the sleep stages (Khadra et al 2008;Olmo Arroyo et al 2017;Tamanyan et al 2018). It is possible that the repetitive bradycardia and tachycardia which occur during and following respiratory events, respectively, are accompanied by repetitive changes in cerebral oxygenation.…”