Dr. Karen Parejo, President of the Colombian\u00a0Association of Sleep Medicine, Dr. Santiago\u00a0Ucr\u00f3s, Dr. Claudia Granados, M. Sc., Dr. Fernando\u00a0Guill\u00e9n, Dr. Fausto Ortega, Dr. Sonia\u00a0Restrepo, Fabi\u00e1n Gil, M. Sc. and fellow Miriam\u00a0Guill\u00e9n, presented important research titled:\u00a0\u201cOxygen saturation, periodic breathing and apnea\u00a0during sleep in infants 1 to 4 month old living\u00a0at 2,560 meters above sea level.\u201d Research\u00a0recently published in the Arch Argent Pediatr\u00a02015;113(4): 341-344.<\/p>\n
ABSTRACT<\/strong> DISCUSSION<\/strong> CONCLUSION<\/strong> <\/p>\n","protected":false},"excerpt":{"rendered":" Dr. Karen Parejo, President of the Colombian\u00a0Association of Sleep Medicine, Dr. Santiago\u00a0Ucr\u00f3s, Dr. Claudia Granados, M. Sc., Dr. Fernando\u00a0Guill\u00e9n, Dr. Fausto Ortega, Dr. Sonia\u00a0Restrepo, Fabi\u00e1n Gil, M. Sc. and fellow Miriam\u00a0Guill\u00e9n, presented important research titled:\u00a0\u201cOxygen saturation, periodic breathing and apnea\u00a0during sleep in infants 1 to 4 month old living\u00a0at 2,560 meters above sea level.\u201d Research\u00a0recently […]<\/p>\n","protected":false},"author":2,"featured_media":822929,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[17,18],"tags":[],"class_list":["post-744687","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-latin-america","category-sleep-medicine"],"acf":[],"_links":{"self":[{"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/posts\/744687","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/comments?post=744687"}],"version-history":[{"count":0,"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/posts\/744687\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/media\/822929"}],"wp:attachment":[{"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/media?parent=744687"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/categories?post=744687"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/neurovirtual.com\/latam\/wp-json\/wp\/v2\/tags?post=744687"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nThere are few data in the literature related\u00a0to polysomnography in infants in altitudes\u00a0from 2,200 m to 2,800 m. The main objective\u00a0of this investigation was to describe oxygen\u00a0saturation (SpO2) levels during sleep in infants\u00a0aged between 1 and 4 months living at an altitude\u00a0of 2,560 m. The secondary objectives were the\u00a0description of periodic breathing (PB) and apnea\u00a0indexes. Polysomnography was performed\u00a0in 35 healthy infants aged 1-4 months in Cuenca\u00a0(Ecuador) at 2,560 m. The median for SpO2 was\u00a092% and 4.9% for PB. The median for the central\u00a0apnea
\nindex was 23.7\/hour and 15.4\/hour when related\u00a0to PB. No correlation was found between PB\u00a0and SpO2. Conclusion: SpO2 was lower than the\u00a0values at sea level and PB and central apnea indices
\nwere higher. When apneas associated with\u00a0PB were not considered, the central apnea index\u00a0was similar to that found at sea level.
\nThe research team used the Neurovirtual BW2\u00a0PSG and Sleepvirtual sensors to compile the data\u00a0for this study. The Neurovirtual development\u00a0team actively participated in aiding the research
\nteam when required. A listing of the research\u00a0parties are listed below:
\na. Department of Pediatrics. Fundaci\u00f3n Santa Fe\u00a0de Bogot\u00e1.
\nb. Departments of Pediatrics and Clinical Epidemiology\u00a0and Biostatistics.Pontificia Universidad\u00a0Javeriana.
\nc. Department of Neurology and Sleep Lab. Fundaci\u00f3n\u00a0Cl\u00ednica Shaio. Bogot\u00e1, Colombia.
\nd. Department of Pediatrics. Hospital del R\u00edo.\u00a0Universidad del Azuay. Cuenca, Ecuador.
\ne. Department of Pediatrics. Hospital Luis Fernando\u00a0Mart\u00ednez. Ca\u00f1ar, Ecuador.
\nf. Departments of Pediatrics. Hospital de La Misericordia,\u00a0Fundaci\u00f3n Santa Fe de Bogot\u00e1, Universidad\u00a0de los Andes.
\ng. Biostatistician. Department of ClinicalEpidemiology\u00a0and Biostatistics. Pontificia Universidad\u00a0Javeriana. Bogot\u00e1, Colombia.
\nh. Medical Student. Universidad del Azuay.\u00a0Cuenca, Ecuador.<\/p>\n
\nIn this study we present the description of the\u00a0SpO2 and other respiratory polysomnography\u00a0parameters in infants 1-4 months of age, at 2,560\u00a0meters above sea level. The SpO2 we found wasclearly lower than values described at sea level by Schl\u00fcter et al., who for children aged 1-4 months, reported a median of 98.1% (p5, 95% \u2013 p95, 99.5%). PB, on the other hand, was significantly higher than data recorded at sea level by Kelly et al., which was lower than 1% in infants 2-4 months old, and by Schl\u00fcter et al., who found PB below 0.5% in children aged 1-4 months.The fact that PB increases with altitude has physiological bases and has been previously reported in infants. In our study, PB was significantly higher during REM sleep compared with NREM sleep; this finding is recognized since 1977.
\nThe data on CAI that we have found is higher than that reported by Schl\u00fcter et al., who recorded a median at sea level of 5-10\/hour for infants aged 1-4 months. However, in our data, when central apneas associated with PB were discounted, the CAI median was close to the value reported by these authors. These results indicate that the discrimination between isolated apneas and PB-associated apneas becomes important in high altitude conditions in this age group. If ignored, the CAI values will be largely a reflection of the PB percentage. An increase in central apneas associated with PB was reported by Parkins et al., with findings similar to ours. These authors analyzed the breathing pattern in 34 children with a mean age of 3.1 months exposed to oxygen at 15% (equivalent to a barometric pressure of 582 mm Hg), and found that apneas associated with PB increased 3.5 times with the simulated altitude, whereas the increment of isolated apneas was only of 0.15.
\nRecently, a study similar to ours at an altitude of 8,600 ft was published. The results agree in relation to SpO2, but CAI and PB were higher in our results. The authors report an important number of obstructive apneas that was not found by us.
\nThe absence of correlation between PB and SpO2 represented by the SSR suggests that low SpO2 is attributable to the decreased inspiratory SpO2 characteristic of high altitudes, and not to the increase in PB. In consequence, the clinical decision to provide supplementary oxygen should be based on the SpO2 data and not with the intention of changing the PB or CAI parameters. The obstructive sleep apnea index and the mixed apnea index were 0 in all the infants taking part in this study. Values approaching 0 for these parameters have been previously reported at sea level, by Schl\u00fcter in Germany and by Kato in Belgium. The SpO2 difference between the 5th to 25th percentiles were the same as that observed between the 25th and 95th percentiles, showing a relevant difference in the physiological behavior of this parameter during sleep in about 25% of the babies. The reason why this happens, and whether there are any consequences, should be evaluated in further investigations. It could be hypothesized that some babies have a higher level of pulmonary vascular reactivity in response to the hypobaric hypoxia.
\nConsidering the haemoglobin dissociation curve, the data obtained for SpO2 in this study can be useful as an approximation to what happens in a range of \u00b1 1000 ft around 8200 ft of altitude, where large populations live, including cities like M\u00e9xico DF with 21 million inhabitants, Bogot\u00e1 (Colombia) with 8 million, Addis Ababa (Ethiopia) with 2.7 million, Sana\u2019a (Yemen) with 2.5 million, Quito (Ecuador) with 2.3 million, Arequipa (Peru) and Toluca (M\u00e9xico) with 0.8 million, and Cochabamba (Bolivia), Quetzaltenango (Guatemala) and Asmara (Eritrea) with 0.6 million.<\/p>\n
\nThe SpO2, RP, and IAC were all lower than the values at sea level, and the RP and the IAC are lower. When apneas associated with RP were discounted, the IAC was similar to sea level.<\/p>\n