Oxygen saturation, periodic breathing, and sleep apnea in infants aged 1-4 months old living at 3200 meters above sea level

Abstract

Objectives:To describe, in infants aged 1-4 months old living at 3200 meters above sea level (MASL), oxygen saturation (SpO 2 ), sleep apnea indices, and periodic breathing (PB) during sleep. Polysomnographies were done in 18 healthy infants. Results: The median SpO 2 was 87%, and the median PB was 7.2% for the total sleep time. The median central sleep apnea index was 30.5/hour, which decreased to 5.4/hour once sleep apneas associated with PB were excluded. The 5 th percentile for SpO 2 was 76% among awake infants, and 66% among asleep infants. Conclusions: The SpO 2 was lower than that observed at sea level, whereas PB and the central sleep apnea index were higher, once sleep apneas associated with PB were excluded. The latter was similar to that observed at sea level. At 3200 MASL, different cut-off points are required for a normal SpO 2 , one for infants during the waking state and one for infants during sleep.

Normal values for respiratory sleep polygraphy in children aged 4 to 9 years at 2,560 m above sea level

“…In this study, we describe obstructive and central respiratory events as well as gaseous exchange measures of oxygen saturation indices and transcutaneous CO 2 measurements in 32 healthy non-snoring children aged 4 to 9 years living at 2,560 m a. s. l. Our results show that the median AHI was 10.2 times higher than normal values established at sea level for children 3-5 years old and 13.5 times higher than for children aged 6-7 years (Montgomery-Downs et al, 2006). This increase among children living at moderate to high altitude has already been reported in several studies (Burg et al, 2013;Duenas-Meza et al, 2015;Ucrós et al 2015, Ucrós et al 2017 and can be attributed to two potential mechanisms: firstly, due to a primarily obstructive breathing pattern as demonstrated by the current study and also observed in a study carried out at 3,200 m a. s. l. in 7-to 16-year-old children in Bolivia ; secondly, exclusively due to central events, as reported in a study conducted on preschoolers (3-5 years old) living at 1,600 m a. s. l. in Denver, USA (Burg et al, 2013). The predominance of central events found in Denver was not seen in studies in Bolivia or in the current study.…”

“…OAHI and ODI recommended by European and American guidelines are derived from studies conducted at sea level (Chan et al, 2004;Kaditis et al, 2016;Uliel et al, 2004), which cannot be extrapolated to people living at high altitudes. In such locations, respiratory sleep physiology in children and adults is different (Burg et al, 2013;Duenas-Meza et al, 2015;Pham et al, 2017;San et al, 2013;Ucrós et al, 2015;Ucrós., et al 2017). It has been shown that at 3,200 m above sea level (m a.s.l.)…”

Breathing Patterns and Oxygenation Saturation During Sleep in Children Habitually Living at High Altitude in the Andes: A Systematic Review

“…This is probably related to central nervous system (CNS) maturation ( 3 ). However, in young infants living at high altitude, the percentage of PB is higher in comparison with low altitude ( 5 , 6 , 8 ). It has been suggested that some individuals are prone to PB because CNS oxygen receptors have increased chemosensivity to hypoxia ( 15 ).…”

Reference Interval for Pulse Oxygen Saturation in Neonates at Different Altitudes: A Systematic Review

“…In a study of neonates born at altitudes of 1,371–2,484 meters, Ravert et al found no significant differences in SpO 2 values measured at different resting states ( 21 ). However, a study on infants aged 1–4 months living at 3,200 meters altitude did find differences in SpO 2 recorded during awake vs. sleeping states ( 25 ). Whether the contradictory results are due to differences in altitude or differences in the ages of the study participants is unclear.…”