The Effect of Chronic or Intermittent Hypoxia on Cognition in Childhood: A Review of the Evidence

Bass, Joel L.; Corwin, Michael J.; Gozal, David; Moore, Carol; Nishida, Hiroshi; Parker, Steven J.; Schonwald, Alison; Wilker, Richard E.; Stehle, Sabine; Kinane, T. Bernard

doi:10.1542/peds.2004-0227

Cited by 377 publications

(255 citation statements)

References 87 publications

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“…A clear dose-effect gradient was observed, which concurs with the generally accepted hypothesis of a causal relationship between hypoxemia and neurocognitive impairment. 15 In addition to moderate hypoxemia (Յ90% SAT min ), mild hypoxemia (91%-93% SAT min ) was significantly associated with impaired performance. This is surprising given that this level of arterial oxygen saturation is frequent in children.…”

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confidence: 90%

Nocturnal Arterial Oxygen Saturation and Academic Performance in a Community Sample of Children

Urschitz¹,

Wolff²,

Sokollik³

et al. 2005

Pediatrics

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ABSTRACT. Objective. Hypoxemia, often assessed via pulse oximetry, is associated with neurocognitive deficits in children. The best way to qualify hypoxemia, or which level of hypoxemia already affects cognition, is unknown.Methods. We assessed the association of pulse oximetry-derived variables that qualify hypoxemia with impaired academic performance in mathematics in a population-based cross-section of 995 primary school children who underwent overnight home recordings of motion-resistant new-generation pulse oximeter saturation (SpO 2 ). Impaired academic performance in mathematics was based on the last school report and defined as grade 4 to 6 on a 6-point scale (ie, approximately the lowest quintile grades).Results. Of 10 variables under study, only the nadir of the SpO 2 values was significantly associated with impaired performance. Categories of this variable representing mild (ie, 91%-93% SpO 2 ; odds ratio: 1.65; 95% confidence interval: 1.06 -2.56) and moderate hypoxemia (ie, <90% SpO 2 ; odds ratio: 2.28; 95% confidence interval: 1.30 -4.01) both were associated with impaired performance in mathematics.Conclusions. We suggest using the nadir of the SpO 2 values in an overnight study to qualify hypoxemia in future studies. This variable may predict neurocognitive deficits in school children. Mild hypoxemia, as yet widely considered benign, may already affect cognition in childhood. A dverse impacts of chronic or intermittent hypoxemia on development, behavior, cognition, and academic performance have been reported in many well-designed and controlled studies in children with sleep-disordered breathing 1-6 or congenital heart disease. [7][8][9][10][11] Data for other clinical conditions that result in chronic or intermittent hypoxemia are sparse. In some studies, adverse effects have been noted at even mild levels of oxygen desaturation. 1 Application of pulse oximetry to detect chronic or intermittent hypoxemia is a valid, reliable, and frequently used method. 12 Several variables that qualify chronic and intermittent hypoxemia can be derived from pulse oximetry and reference ranges used to identify abnormal clinical conditions. 13 However, it is yet unclear which pulse oximetry-derived variable best predicts neurocognitive impairments in children and which level of oxygen desaturation is already harmful. The mean and nadir arterial oxygen saturation measured by pulse oximetry (Spo 2 ) have been reported and shown to have some relationship to decreased intelligence, 5 impaired attention, 5 and hyperactive behavior. 1,6 We recently performed a study on the association between sleep-disordered breathing and impaired academic performance in primary school children. 14 As part of this study, children were examined for the presence of nocturnal chronic and intermittent hypoxemia using pulse oximetry. Only a weak association between intermittent hypoxemia and impaired academic performance in mathematics was found. 14 These results, however, were recently challenged: the inclusion of children with perhaps "a...

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confidence: 90%

Nocturnal Arterial Oxygen Saturation and Academic Performance in a Community Sample of Children

Urschitz¹,

Wolff²,

Sokollik³

et al. 2005

Pediatrics

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“…18 Another recent study demonstrated that infants have reduced cerebral tissue oxygenation when in the prone position and hypothesized that this reduction in oxygenation may help explain the elevated risk of SIDS while the infant is in this position. 19 Tissue hypoxia clearly leads to increased risk of morbidity in neonates, which demonstrates the importance of identifying infants at risk for hypoxia before discharge to intervene early.…”

Section: Discussionmentioning

confidence: 99%

Car Seat Screening for Low Birth Weight Term Neonates

Davis

2015

Pediatrics

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BACKGROUND AND OBJECTIVE: Car seat tolerance screening (CSTS) is a common predischarge assessment of neonates. Almost half of nurseries and NICUs have low birth weight (LBW, ,2.5 kg) as an inclusion criterion, regardless of birth gestational age (GA). Little is known about the epidemiology of CSTS in this cohort. The objective of this study was to identify incidence and risk factors for CSTS failure in term LBW infants.

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“…Pulmonary hypertension is a well-recognised consequence of hypoxia, and the some of the cellular mechanisms are now being elucidated [10]. Chronic hypoxia (even mild levels) has detectable cognitive effects on children [11] and acute hypoxia at altitude affects the mental functioning of adult aircrew [12], even at altitudes <10,000 feet [13]. Thus it is not unreasonable to use hypoxia as a surrogate for clinical risk even though the individual risk of adverse effects from hypoxia remains uncertain.…”

Section: Predicting Risk Of Flight In Individuals: Not a Simple Taskmentioning

confidence: 99%

Problems of air travel for patients with lung disease: clinical criteria and regulations

Robson

2006

Breathe

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The Effect of Chronic or Intermittent Hypoxia on Cognition in Childhood: A Review of the Evidence

Cited by 377 publications

References 87 publications

Nocturnal Arterial Oxygen Saturation and Academic Performance in a Community Sample of Children

Nocturnal Arterial Oxygen Saturation and Academic Performance in a Community Sample of Children

Car Seat Screening for Low Birth Weight Term Neonates

Problems of air travel for patients with lung disease: clinical criteria and regulations

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