Τομέας Υγείας - Μητέρας - ΠαιδιούLibrary of the School of Health Sciences
Χριστίνα Κανακά-Gantenbein, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Γεώργιος Χρούσος, Ομότιμος Καθηγητής, Ιατρική, ΕΚΠΑ
Γεώργιος Ρασιδάκης, Καθηγητής, Ιατρική, ΕΚΠΑ
Αθανάσιος Καδίτης, Αναπληρωτής Καθηγητής (επιβλέπων), Ιατρική, ΕΚΠΑ
Αθανάσιος Μίχος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Παναγιώτα Περβανίδου, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Σουλτάνα Σιαχανίδου, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Διαταραχές της οξυγόνωσης στη διάρκεια της νύχτας σε βρέφη και παιδιά: σύγκριση απόφραξης ανώτερου αεραγωγού και οξείας ή χρόνιας νόσου των πνευμόνων
Nocturnal oximetry in children with obstructive lung disease or sleep-disordered breathing
Aims: Although progress has been made in the standardized interpretation of nocturnal oximetry in children with obstructive sleep-disordered breathing (SDB), no evidence exists on oximetry abnormalities in other respiratory disorders such as viral bronchiolitis and obstructive lung disease. We aimed to compare nocturnal oximetry parameters in: (a) viral bronchiolitis; (b) obstructive lung disease; with: (c) upper airway obstruction during sleep i.e. SDB; and (d) controls without upper airway obstruction or lung disease.
Methods: (A) Infants with bronchiolitis underwent pulse oximetry during the first night after hospital admission and a subgroup of them had repeat oximetry before hospital discharge. Oximetry was also performed in: (i) infants with partial upper airway obstruction and without lung disease; (ii) infants without upper airway obstruction or lung disease (controls). The three groups were compared regarding: (i) oxygen desaturation of hemoglobin index (SpO2 drops ≥3%/h-ODI3) and (ii) basal SpO2 (average SpO2 between SpO2 drops). (B) We analyzed oximetry recordings from children with: (i) obstructive lung disease (i.e. obliterative bronchiolitis or cystic fibrosis); (ii) snoring and adenotonsillar hypertrophy (SDB); and (iii) no respiratory disorder (controls). The three groups were compared in terms of: (i) oxygen desaturation of hemoglobin index (SpO2 drops ≥3%/h-ODI3) and (ii) basal SpO2 (average SpO2 between SpO2 drops). The associations of oximetry parameters (natural logarithm) with study group were tested using linear regression including age as covariate.
Results: (A) Twenty one infants with bronchiolitis, 11 with upper airway obstruction and 21 controls were recruited. Participants with bronchiolitis had lower basal SpO2 [median (10th, 90th percentiles): 93.7% (91.1, 96.8)] than subjects with upper airway obstruction [96.9% (95.3, 98.1)] or controls [98.7% (96.9, 99.3)] (P<0.05). The bronchiolitis group was similar to the upper airway obstruction group regarding ODI3 [23.3 desaturation episodes/h (10.3, 46.6) and 15.5 episodes/h (5.4, 36.4), respectively], but differed significantly from controls [3.1 episodes/h (0.3, 5.5)] (P<0.05). In 10 subjects with bronchiolitis who underwent follow-up oximetry before discharge, basal SpO2 and ODI3 improved (P<0.01), bu
t they were still abnormal relative to values in controls (P<0.01). (B) Data of 16 subjects with obstructive lung disease (median age: 7.3 years; 25th, 75th percentiles: 5.4, 12), 22 children with SDB (6.3 years; 4, 9) and 22 controls (6.8 years; 5.6, 10.3) were analyzed. Children with obstructive lung disease or SDB had significantly lower basal SpO2 than controls (91.9% [90.8, 93.4] vs. 96.3% [96, 97.4] vs. 97.6% [97.1, 97.9]; P <0.01). No subjects in the SDB or control groups had basal SpO2 <95%. Children with SDB had significantly higher ODI3 than children with obstructive lung disease or controls [8.4 episodes/h (6.2, 16.6) vs. 4.4 episodes/h (3.6, 6.6) vs. 2 episodes/h (1.3, 2.7); P <0.01]. Obstructive lung disease had the greatest negative effect on basal SpO2 (R2=0.62; P <0.001) and SDB the most positive effect on ODI3 (R2=0.35; P <0.001).
Conclusions: Bronchiolitis is characterized by low nocturnal basal SpO2 and intermittent SpO2 drops, while obstructive lung disease is mostly accompanied by low nocturnal basal SpO2.
Main subject category:
Obstructive lung disease, Nocturnal oximetry, Sleep apnea, Sleep disordered breathing, Infants, Children
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