medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2008, Number 4

<< Back Next >>

Rev Invest Clin 2008; 60 (4)

Day-night fluctuation of pulse oximetry: An exploratory study in pediatric inpatients

Vargas MH, Heyaime-Lalane J, Pérez-Rodríguez L, Zúñiga-Vázquez G, Furuya MEY

Language: English
References: 29
Page: 303-310
PDF size: 497.56 Kb.


ABSTRACT

Background. Pulse oximetry is a simple and non-invasive procedure widely used nowadays in the clinical practice. However, it is unclear if SpO2 values are constant throughout the 24 hours of the day or have periodic fluctuations. In the present study we evaluated if progressive day-night variations of SpO2 values occur in children. Material and methods. Pulse oximetry (Nonin 2500) was carried out approximately every 2 hours during a 24-hours period in pediatric patients hospitalized due to different diseases but without acute or chronic respiratory diseases. Measurements were analyzed through the cosinor method (sinusoidal curve fitting). Results. A total of 131 patients (23 days to 16 years old) were studied. A sinusoidal fitting of the SpO2 values was accomplished in 84.7% of children. According to these curves, maximal SpO2 values occurred in the late afternoon [4:53 PM (3:49-5:32 PM), median (quartile 1-quartile 3)], while minimal values appeared in the first hours of the day [3:06 AM (2:12-4:08 AM)]. This pattern was the same in sleeping or awake children. More than half of these sinusoidal curves had a period near to 24 hours (between 20 and 28 hours). An additional finding was that maximal and minimal SpO2 values diminished with age (~0.15 and ~0.13% SpO2 per year, respectively). In children less than six years old 5th percentile of SpO2 values were 93.8% in the late afternoon and 89.8% in the early hours of the day, while corresponding figures for older children were 91.0% and 88.5%, respectively. Conclusions. Our results suggested that, regardless of the sleep influence, in most children the SpO2 follows a progressive fluctuation during a 24-hours cycle, a pattern which is suggestive of a circadian rhythm. A prospective study in healthy children is warranted.


REFERENCES

  1. Tremper KK. Pulse oximetry. Chest 1989; 95; 713-5.

  2. Jubran A. Pulse oximetry. Intensive Care Med 2004; 30: 2017-20.

  3. Marcus CL, Omlin KJ, Basinski DJ, Bailey SL, Rachal AB, von Pechmann WS, et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 1992; 146: 1235-9.

  4. Gamponia MJ, Babaali H, Yugar F, Gilman RH. Reference values for pulse oximetry at high altitude. Arch Dis Child 1998; 78: 461-5.

  5. Urschitz MS, Wolff J, von Einem V, Urschitz-Duprat PM, Schlaud M, Poets C. Reference values for nocturnal home pulse oximetry during sleep in primary school children. Chest 2003; 123: 96-101.

  6. Uliel S, Tauman R, Greenfeld M, Sivan Y. Normal polysomnographic respiratory values in children and adolescents. Chest 2004; 125: 872-8.

  7. Catterall JR, Calverley PM, Shapiro CM, Flenley DC, Douglas NJ. Breathing and oxygenation during sleep are similar in normal men and normal women. Am Rev Respir Dis 1985; 132: 86-8.

  8. Gries RE, Brooks LJ. Normal oxyhemoglobin saturation during sleep. How low does it go? Chest 1996; 110: 1489-92.

  9. Hernández-Zenteno RJ, Pérez-Padilla R, Vázquez JC. Normal breathing during sleep at an altitude of 2240 meters. Arch Med Res 2002; 33: 489-94.

  10. Reinberg A, Gervais P. Circadian rhythms in respiratory functions, with special reference to human chronophysiology and chronopharmacology. Bull Physiopathol Respir 1972; 8: 663-77.

  11. Updike PA, Accurso FJ, Jones RH. Physiologic circadian rhythmicity in preterm infants. Nurs Res 1985; 34: 160-3.

  12. Postma DS, Koeter GH, vd Mark TW, Reig RP, Sluiter HJ. The effect of oral slow-release terbutaline on the circadian variation in spirometry and arterial blood gas levels in patients with chronic airflow obstruction. Chest 1985; 87: 653-7.

  13. Salyer JW. Neonatal and pediatric pulse oximetry. Respir Care 2003; 48: 386-96.

  14. Torre-Bouscoulet L, Chávez-Plascencia E, Vázquez-García JC, Pérez-Padilla R. Precisión y exactitud de un oxímetro de pulso “de bolsillo” en la ciudad de México. Rev Invest Clin 2006; 58: 28-33.

  15. Refinetti R, Cornélissen G, Halberg F. Procedures for numerical analysis of circadian rhythms. Biol Rhythms Res 2007; 38: 275-325.

  16. Smolensky MH, D’Alonzo GE. Medical chronobiology: Concepts and applications. Am Rev Respir Dis 1993; 147: S2-S19.

  17. Vázquez-García JC, Meza-Vargas S, Pérez-Padilla R. Síndrome de apnea obstructiva del sueño en infantes. En: Hernández-Alvídrez E, Furuya MEY (eds.). Enfermedades respiratorias pediátricas. 1a Ed. México/Bogotá: El Manual Moderno; 2002, p. 535-47.

  18. Panda S, Hogenesch JB, Kay SA. Circadian rhythms from flies to human. Nature 2002; 417: 329-35.

  19. Spengler CM, Shea SA. Endogenous circadian rhythm of pulmonary function in healthy humans. Am J Respir Crit Care Med 2000; 162: 1038-46.

  20. Vargas MH, Ruiz-Gutiérrez HH, Espinosa-Serafin C, Zúñiga-Vázquez G, Furuya MEY. Underestimation of the peak flow variability in asthmatic children. Evaluation of a new formula. Pediatr Pulmonol 2005; 39: 325-31.

  21. Barnes P, Fitzgerald G, Brown M, Dollery C. Nocturnal asthma and changes in circulating epinephrine, histamine and cortisol. N Engl J Med 1980; 303: 263-7.

  22. Saaresranta T, Polo O. Hormones and breathing. Chest 2002; 122: 2165-82.

  23. Wanner A, Horvath G, Brieva JL, Kumar SD, Mendes ES. Nongenomic actions of glucocorticoids on the airway vasculature in asthma. Proc Am Thorac Soc 2004; 1: 235-8.

  24. Shepard JW Jr. Gas exchange and hemodynamics during sleep. Med Clin North Am 1985; 69: 1243-64.

  25. Griefahn B, Gross J, Robens S. Quantification of circadian phase shifts with the cross-correlation technique. Chronobiol Int 2007; 24: 449-61.

  26. Vázquez-García JC, Arellano-Vega SL, Regalado-Pineda J, Pérez- Padilla JR. Respuesta ventilatoria normal a hipoxia e hipercapnia a una altitud de 2240 metros. Rev Invest Clin 1998; 50: 323-9.

  27. Pérez Martínez SO, Pérez-Padilla JR. Valores gasométricos en sujetos sanos reportados en la población mexicana: revisión y análisis. Rev Invest Clin 1992; 44: 353-62.

  28. Beall CM. Adaptations to altitude: a current assessment. Annu Rev Anthropol 2001; 30: 423-56.

  29. Pérez-Padilla R. Population distribution residing at different altitudes: implications for hypoxemia. Arch Med Res 2002; 33: 162-6.




2020     |     www.medigraphic.com