Day–night Differences in Oxygen Saturation and the Frequency of Desaturations in the First 24 Hours in Patients With Acute Stroke

Ali, Khalid; Cheek, Elizabeth; Sills, Sheila; Crome, Peter; Roffe, Christine

doi:10.1016/j.jstrokecerebrovasdis.2007.07.004

Cited by 17 publications

(11 citation statements)

References 30 publications

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“…At night almost a quarter of the stroke group had desaturations below 90%. The same group also looked further at the differences between day and night oxygen saturations [28]. In stroke patients who were not hypoxic (defined as SaO 2 less than 90%) during the day, baseline daytime saturations were measured between 9am and 9pm and nocturnal saturation between 10pm and 6am.…”

Section: Hypoxia In the Context Of A Strokementioning

confidence: 99%

Hypoxia after stroke: a review of experimental and clinical evidence

Ferdinand

Roffe

2016

Exp & Trans Stroke Med

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102

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BackgroundHypoxia is a common occurrence following stroke and associated with poor clinical and functional outcomes. Normal oxygen physiology is a finely controlled mechanism from the oxygenation of haemoglobin in the pulmonary capillaries to its dissociation and delivery in the tissues. In no organ is this process more important than the brain, which has a number of vascular adaptions to be able to cope with a certain threshold of hypoxia, beyond which further disruption of oxygen delivery potentially leads to devastating consequences. Hypoxia following stroke is common and is often attributed to pneumonia, aspiration and respiratory muscle dysfunction, with sleep apnoea syndromes, pulmonary embolism and cardiac failure being less common but important treatable causes. As well as treating the underlying cause, oxygen therapy is a vital element to correcting hypoxia, but excessive use can itself cause molecular and clinical harm. As cerebral vascular occlusion completely obliterates oxygen delivery to its target tissue, the use of supplemental oxygen, even when not hypoxic, would seem a reasonable solution to try and correct this deficit, but to date randomised clinical trials have not shown benefit.ConclusionWhilst evidence for the use of supplemental oxygen therapy is currently lacking, it is vital to rapidly identify and treat all causes of hypoxia in the acute stroke patient, as a failure to will lead to poorer clinical outcomes. The full results of a large randomised trial looking at the use of supplemental oxygen therapy are currently pending.

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Section: Hypoxia In the Context Of A Strokementioning

confidence: 99%

Hypoxia after stroke: a review of experimental and clinical evidence

Ferdinand

Roffe

2016

Exp & Trans Stroke Med

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102

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“…It has been recommended that patients at risk for hypoxic conditions be monitored using pulse oximetry. 12,14,[33][34][35][36][37] Hypoxia is commonly found in the elderly 38 and those at risk for coronary vascular disease, 39 coronary artery disease, 39 sleep disordered breathing, 39 disorders of balance, hypertension, 39 chronic migraines, and anxiety and mood disorders, 39 all of which can be present within a population of chiropractic patients. See Table 1 for a complete list of clinical signs and symptoms indicating use of pulse oximetry.…”

Section: Conceptual Model Of Pulse Oximetry In a Chiropractic Settingmentioning

confidence: 99%

“…7,8,57,61 Conversely, daytime values less than 90% are cause for alarm and immediate attention. 12,13,33,34 Because SpO 2 values may fall 4% to 6% or more at night, daytime values of 90% to 95% may mean nighttime values less than 90%, which would also be cause for concern. 13,34 Chiropractors that detect daytime saturation values less than 97% should monitor this patient's SpO 2 each visit, whereas values less than 90% should prompt immediate referral for medical assessment.…”

Section: How It Workmentioning

confidence: 99%

“…It is used to detect hypoxemia 1 or deficient oxygenation in the blood. 12 More specifically, it measures the percentage of hemoglobin bound to oxygen in arterial blood, denoted as SpO 2 . 1 Hypoxemia often leads to hypoxia (ie, reduced tissue oxygenation 13 ), which results in oxidative stress, a condition associated with a wide variety of degenerative processes.…”

Section: Introductionmentioning

confidence: 99%

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The role of pulse oximetry in chiropractic practice: a rationale for its use

Hall

Jensen

2012

Journal of Chiropractic Medicine

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Objective: Pulse oximetry is used regularly to assess oxygen saturation levels. The objective of this commentary is to discuss a rationale for using pulse oximetry in chiropractic practice. Discussion: Pulse oximetry may offer doctors of chiropractic a way to monitor patients' oxygen saturation levels. Quantification of saturation values with heart rate may give clinical aid to the management of chiropractic patients. Markedly reduced saturation levels may necessitate medical referral, whereas mildly reduced levels could lead to changes in chiropractic management. Conclusions: Pulse oximetry has the potential to be an integral part of chiropractic practice.

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“…Patients are more likely to be hypoxic at night [9,10], hypoxia is more likely to be missed at this time, and nocturnal hypoxemia carries a greater risk of brain tissue hypoxia [11]. Nocturnal oxygen supplementation does not interfere with the patient’s daytime mobility and therefore does not affect early mobilization [12].…”

Section: Introductionmentioning

confidence: 99%

Statistical analysis plan for the Stroke Oxygen Study (SO2S): a multi-center randomized controlled trial to assess whether routine oxygen supplementation in the first 72 hours after a stroke improves long-term outcome

Sim

Gray

Nevatte

et al. 2014

Trials

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BackgroundThe Stroke Oxygen Study (SO2S) is a multi-center randomized controlled trial of oxygen supplementation in patients with acute stroke. The main hypothesis for the trial is that fixed-dose oxygen treatment during the first 3 days after an acute stroke improves outcome. The secondary hypothesis is that restricting oxygen supplementation to night time only is more effective than continuous supplementation. This paper describes the statistical analysis plan for the study.Methods and designPatients (n = 8000) are randomized to three groups: (1) continuous oxygen supplementation for 72 hours; (2) nocturnal oxygen supplementation for three nights; and (3) no routine oxygen supplementation. Outcomes are recorded at 7 days, 90 days, 6 months, and 12 months. The primary outcome measure is the modified Rankin scale at 90 days. Data will be analyzed according to the intention-to-treat principle. Methods of statistical analysis are described, including the handling of missing data, the covariates used in adjusted analyses, planned subgroups analyses, and planned sensitivity analyses.Trial registrationThis trial is registered with the ISRCTN register, number ISRCTN52416964 (30 September 2005).

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Day–night Differences in Oxygen Saturation and the Frequency of Desaturations in the First 24 Hours in Patients With Acute Stroke

Cited by 17 publications

References 30 publications

Hypoxia after stroke: a review of experimental and clinical evidence

Hypoxia after stroke: a review of experimental and clinical evidence

The role of pulse oximetry in chiropractic practice: a rationale for its use

Statistical analysis plan for the Stroke Oxygen Study (SO2S): a multi-center randomized controlled trial to assess whether routine oxygen supplementation in the first 72 hours after a stroke improves long-term outcome

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