Nocturnal hypoxemia in children and adolescents with cystic fibrosis

Ramos, Regina Terse Trindade; Santana, Maria Angélica; Almeida, Priscila de Carvalho; Machado, Almério de Souza; Araújo-Filho, José Bouzas; Salles, Cristina

doi:10.1590/s1806-37132013000600005

Cited by 23 publications

(37 citation statements)

References 27 publications

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“…Based on previous data, sleep hypoxemia was defined as more than 5% of TST spent with SpO 2 < 90% . Following categorization of children based on the presence of hypoxemia, both pFEV1 and AHI were compared between the two groups using Student's t ‐test.…”

Section: Methodsmentioning

confidence: 99%

“…14 Based on previous data, sleep hypoxemia was defined as more than 5% of TST spent with SpO 2 < 90%. 15 Following categorization of children based on the presence of hypoxemia, both pFEV1 and AHI were compared between the two groups using Student's t-test. Next, the ability of clinical and PSG parameters to predict the severity of sleep hypoxemia (TSpO 2 < 90) was measured by linear regression analysis.…”

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confidence: 99%

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Predictors of sleep hypoxemia in children with cystic fibrosis

Isaiah¹,

Daher

Sharma

et al. 2019

Pediatric Pulmonology

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Objectives To identify the determinants of nocturnal hypoxemia in children with CF using clinical parameters, polysomnography (PSG), and lung function. Hypothesis Sleep hypoxemia in children with CF is predicted by both apnea hypopnea index (AHI) and percent predicted forced expiratory volume in one second (pFEV1). Design Retrospective case series. Methods Children aged 5‐18 years were included based on (i) a diagnosis of CF; and (ii) availability of concurrent PSG and pFEV1 data. The impact of (i) demographic and clinical parameters; and (ii) PSG and pFEV1, on the total sleep time spent with arterial oxygen saturation below 90% (TSpO2 < 90) was measured using regression analysis. P‐value <0.05 was considered significant. Results The mean age was 11.6 years (95% confidence interval: 9.5, 13.1). Twenty of 35 (57%) were boys and the mean body mass index percentile was 42.1 (31.5, 52.6). The most common ethnicity was white (66%). OSA was diagnosed in 50%. Neither demographic predictors nor clinical variables predicted the severity of hypoxemia (R2 = 0.23, P = 0.09). While pFEV1 and PSG variables accounted for significant proportion of the overall variance in TSpO2 < 90 (R2 = 0.53, P < 0.001), pFEV1 was identified as the single best predictor of sleep hypoxemia. A pFEV1 cut‐off of 53% indicated a sensitivity of 0.80 and a specificity of 0.87 in predicting sleep hypoxemia. Conclusions pFEV1 is the best predictor of sleep hypoxemia in children with CF and referred for PSG. No demographic or clinical predictors of hypoxemia were identified in this population.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Predictors of sleep hypoxemia in children with cystic fibrosis

Isaiah¹,

Daher

Sharma

et al. 2019

Pediatric Pulmonology

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“…There was a negative correlation between FVC and desaturation index. Ramos et al similarly found negative correlations between nocturnal hypoxemia and pulmonary function values in patients with CF . These results show that as the severity of lung disease determined by spirometry increases, the risk of nocturnal hypoxia increases in patients with BO.…”

Section: Discussionmentioning

confidence: 81%

Sleep disordered breathing and sleep quality in children with bronchiolitis obliterans

Uyan

Turan

et al. 2015

Pediatr Pulmonol.

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The incidence of sleep-disordered breathing (SDB) increases in chronic lung diseases. Our aim was to evaluate SDB and sleep quality in children with postinfectious bronchiolitis obliterans (BO) and assess associated risk factors. We hypothesized that children with BO are at increased risk for SDB and have impaired sleep quality. We also hypothesized that severity of SDB and impairment of sleep quality is related to the severity of lung disease. Sleep Related Breathing Disorder (SRBD) subscale of the Pediatric Sleep Questionnaire (PSQ) and Pittsburgh Sleep Quality Index (PSQI) questionnaires; spirometry, impulse oscillometry (IOS), and overnight polysomnography (PSG) were performed. Twenty-one patients (14 male, median age: 8.3 years) were enrolled. Five patients (25%) had a PSQ score of >0.33, predictive of a SDB. Ten patients (48%) had poor sleep quality. Four patients (19%) had an OAHI of >1/hr. Nineteen patients (90%) had a high desaturation index. Four patients (19%) had a mean oxygen saturation of <93%. Median central apnea time was 7.5 (IQR: 6.9-9.1) seconds. Central apnea index of the patients correlated positively with R5, R10, R15, R20, Z5, and negatively with X10 and X15 at IOS. There was a positive correlation between the lowest oxygen saturation and FVC, FEV1 , X5, X10, X15, X20 while there was a negative correlation between lowest saturation and the central apnea index at PSG, R5, R10, and Z5 at IOS. Mean oxygen saturation during PSG correlated positively with FVC, FEV1, FEF(25-75), X5, X10, X15, X20 results. The risk of nocturnal hypoxia is increased in patients with BO and correlated to the severity of lung disease determined by pulmonary function tests. Although BO patients have a shorter duration of central apneas, they are more prone to desaturate.

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“…In a case report of post‐infectious bronchiolitis obliterans (PIBO), a low basal SpO 2 that was defined as the average of nocturnal SpO 2 readings after excluding any abrupt SpO 2 drops, improved following administration of high‐dose intravenous methylprednisolone . There is no definition of clinically important nocturnal hypoxemia accompanying cystic fibrosis (CF) lung disease, but the majority of pediatric patients with CF have a normal McGill oximetry score as opposed to children with SDB . In a consensus report from the UK on the management of children with disorders of sleep physiology, it has been proposed that a basal SpO 2 < 95% is indicative of lung disease, obstructive hypoventilation, or cyanotic heart disease .…”

Section: Introductionmentioning

confidence: 99%

Nocturnal oximetry in children with obstructive lung disease or sleep‐disordered breathing

Katsouli

Polytarchou

Tsaoussoglou

et al. 2019

Pediatric Pulmonology

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Objectives: 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. We aimed to compare obstructive lung disease (OLD) and SDB regarding nocturnal oximetry parameters. Methods:We analyzed oximetry recordings from children with (i) OLD (obliterative bronchiolitis; cystic fibrosis); (ii) snoring and adenotonsillar hypertrophy (SDB); and (iii) no respiratory disorder (controls). The three groups were compared regarding:(i) oxygen desaturation of hemoglobin index (SpO 2 drops ≥3%/h-ODI3) and (ii) basal SpO 2 (average SpO 2 between SpO 2 drops). The associations of oximetry parameters (natural logarithm) with study group were tested using linear regression including age as covariate.Results: Data of 16 subjects with OLD (median age: 7.3 years; Q25, Q75: 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 OLD or SDB had significantly lower basal SpO 2 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 SpO 2 < 95%. Children with SDB had significantly higher ODI3 than children with OLD 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]. OLD had the greatest negative effect on basal SpO 2 (R 2 = 0.62; P < 0.001) and SDB the greatest positive effect on ODI3 (R 2 = 0.34; P < 0.001).Conclusion: OLD is associated mostly with reduced basal SpO 2 , whereas SDB is characterized by elevated ODI3. K E Y W O R D S adenotonsillar hypertrophy, cystic fibrosis, obliterative bronchiolitis, obstructive sleep apnea, sleep hypopnea

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Nocturnal hypoxemia in children and adolescents with cystic fibrosis

Cited by 23 publications

References 27 publications

Predictors of sleep hypoxemia in children with cystic fibrosis

Predictors of sleep hypoxemia in children with cystic fibrosis

Sleep disordered breathing and sleep quality in children with bronchiolitis obliterans

Nocturnal oximetry in children with obstructive lung disease or sleep‐disordered breathing

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