Severe Nocturnal and Postexercise Hypoxia in Children and Adolescents with Sickle Cell Disease

被引:45
作者
Halphen, Isabelle [1 ]
Elie, Caroline [2 ,3 ]
Brousse, Valentine [4 ,5 ]
Le Bourgeois, Muriel [6 ]
Allali, Slimane [4 ,5 ]
Bonnet, Damien [2 ,7 ]
de Montalembert, Mariane [2 ,4 ,5 ]
机构
[1] Hop Necker Enfants Malad, AP HP, Pediat Emergency Dept, Paris, France
[2] Paris Descartes Univ, Paris, France
[3] Hop Necker Enfants Malad, AP HP, Dept Biostat, Paris, France
[4] Hop Necker Enfants Malad, AP HP, Dept Pediat, Paris, France
[5] Hop Necker Enfants Malad, AP HP, Sickle Cell Clin, Paris, France
[6] Hop Necker Enfants Malad, AP HP, Pediat Pneumol & Allergol Dept, Paris, France
[7] Paris Descartes Univ, Necker M3C, AP HP, Dept Pediat Cardiol, Paris, France
关键词
REGURGITANT JET VELOCITY; HEMOGLOBIN OXYGEN DESATURATION; 6-MINUTE WALK TEST; PULMONARY-HYPERTENSION; PULSE OXIMETRY; OXYHEMOGLOBIN DESATURATION; LUNG-FUNCTION; EXERCISE; SATURATION; HYPOXEMIA;
D O I
10.1371/journal.pone.0097462
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Hypoxia is a common feature in children with sickle cell disease (SCD) that is inconsistently associated with painful crises and acute chest syndrome. To assess the prevalence and risk factors of hypoxia, we recorded daytime, nocturnal, and postexercise pulse oximetry (SpO(2)) values in 39 SCD patients with a median age of 10.8 years. Median daytime SpO2 was 97% (range, 89%-100%), and 36% of patients had daytime hypoxia defined as SpO(2)< 96%. Median nocturnal SpO(2) was 94.7% (range, 87.7%-99.5%), 50% of patients had nocturnal hypoxia defined as SpO(2)<= 93%, and 11(37%) patients spent more than 10% of their total sleep time with SpO(2)< 90%. Median postexercise SpO(2) was 94% (range, 72%-100%) and 44.7% of patients had postexercise hypoxia defined as an SpO(2) decrease >= 3% after a 6-minute walk test. Among patients with normal daytime SpO(2), 35% had nocturnal and 42% postexercise hypoxia. Compared to 9 patients without daytime, nocturnal, or postexercise hypoxia, 25 patients with hypoxia under at least one of these three conditions had greater anemia severity (P = 0.01), lower HbF levels (P = 0.04), and higher aspartate aminotransferase levels (P = 0.03). Males predominated among patients with postexercise hypoxia (P = 0.004). Hypoxia correlated neither with painful crises nor with acute chest syndrome. Of 32 evaluable patients, 6 (18.8%) had a tricuspid regurgitation velocity >= 2.6 m/s, and this feature was associated with anemia (P = 0.044). Median percentage of the predicted distance covered during a 6-minute walk test was 86% [46-120]; the distance was negatively associated with LDH (P = 0.044) and with a past history of acute chest syndrome (P = 0.009). In conclusion, severe episodes of nocturnal and postexercise hypoxia are common in children with SCD, even those with normal daytime SpO(2).
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