Central Venous Oxygen Saturation, Abnormal Gas Exchange, and Rate of Fall of Arterial Oxyhemoglobin Saturation During Obstructive Apnea

  • E. C. Fletcher
Conference paper

Abstract

The minimum (nadir) arterial oxyhemoglobin saturation (SaO2) during obstructive sleep apnea (OSA) is a function of apnea duration and rate of fall of arterial oxyhemoglobin saturation (dSaO2/dt) (Fig. 1). The longer the apnea, or the steeper the dSaO2/dt for a given duration of apnea, the lower the nadir SaO2 will be. Several factors have been shown to affect apnea duration: hypercarbia [1], level of oxygenation [1–4], and stage of sleep [5]. Other studies have demonstrated that dSaO2/dt is affected by thoracic gas volume [6, 7] as well as SaO2 [8, 9] at apnea onset.

Keywords

Obesity Catheter Dioxide Respiration Radionuclide 

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References

  1. 1.
    Hudgel DW, Hendricks C, Dadley A (1988) Alteration in obstructive apnea pattern induced by changes in oxygen and carbon-dioxide-inspired concentrations. Am Rev Respir Dis 138: 16–19PubMedCrossRefGoogle Scholar
  2. 2.
    Alford NJ, Fletcher EC, Nickeson D (1986) Acute oxygen in patients with sleep apnea and COPD. Chest 89: 30–38PubMedCrossRefGoogle Scholar
  3. 3.
    Martin RJ Sanders MH, Gray BA, Pennock BE (1982) Acute and long-term ventilatory effects of hyperoxia in the adult sleep apnea syndrome. Am Rev Respir Dis 125: 175–180PubMedGoogle Scholar
  4. 4.
    Smith PL, Haponik EF, Bleeker ER (1984) The effects of oxygen in patients with sleep apnea. Am Rev Respir Dis 130: 958–963PubMedGoogle Scholar
  5. 5.
    Findley LJ, Wilhoit SC, Suratt PM (1985) Apnea duration and hypoxemia during REM sleep in patients with obstructive sleep apnea. Chest 87: 432–435PubMedCrossRefGoogle Scholar
  6. 6.
    Findley LJ, Ries AL, Tisi GM, Wagner PD (1983) Hypoxemia during apnea in normal subjects: mechanisms and impact of lung volume. J Appl Physiol 55: 1777–1783PubMedGoogle Scholar
  7. 7.
    Shepard JW (1985) Gas exchange and hemodynamics during sleep. Symposium on sleep apnea disorders. Med Clin North Am 69: 1243–1264PubMedGoogle Scholar
  8. 8.
    Bradley TD, Martinez D, Rutherford R, Lue F, Grossman R, Moldofsky H, Zamel N, Phillipson EA (1985) Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea. J Appl Physiol 59: 1364–1368PubMedGoogle Scholar
  9. 9.
    Strohl KP, Altose MD (1984) Oxygen saturation during breath-holding and during apneas in sleep. Chest 85: 181–186PubMedCrossRefGoogle Scholar
  10. 10.
    Cherniack NS, Longobardo GS (1970) Oxygen and carbon dioxide gas stores of the body. Physiol Rev 50: 196–243PubMedGoogle Scholar
  11. 11.
    Guyton AC (1976) The systemic circulation. In: Guyton AC (ed) Textbook of medical physiology, 5th edn Saunders, Philadelphia, pp 237–249Google Scholar
  12. 12.
    Fletcher EC, Kass R, Thornby JI, Rosborough J, Miller T (1989) Central venous O2 saturation and rate of arterial desaturation during obstructive apnea. J Appl Physiol 66 (3): 1477–1485PubMedCrossRefGoogle Scholar
  13. 13.
    Kelman GR, Nunn JF, Prys-Roberts C, Greenbaum R (1967) The influence of cardiac output on arterial oxygenation: a theoretical study. Br J Anaesth 39: 450–457PubMedCrossRefGoogle Scholar
  14. 14.
    Mithoefer JC, Ramirez C, Cook W (1978) The effect of mixed venous oxygenation on arterial blood in chronic obstructive pulmonary disease. Am Rev Respir Dis 117: 259–264PubMedGoogle Scholar
  15. 15.
    Bradley TD, Rutherford R, Grossman RF et al. (1985) Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis 131: 835–839PubMedGoogle Scholar
  16. 16.
    Fletcher EC, Schaaf JW, Miller J, Fletcher JG (1987) Long-term cardiopulmonary sequelae in patients with sleep apnea and chronic lung disease. Am Rev Respir Dis 135: 525–533PubMedGoogle Scholar
  17. 17.
    Weitzenblum E, Krieger J, Apprill M, Vallee E, Ehrhart M, Ratomaharo J, Oswald M, Kurtz D (1988) Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am Rev Respir Dis 138: 345–349PubMedGoogle Scholar
  18. 18.
    Fletcher E, Miller T, Luckett RA, Goodnight SJ, Rosborough JI, Muniz S, Munafo DA (1989) Altered gas exchange and the rate of fall of arterial oxygen saturation (dSaO2/dt) in obstructive sleep apnea. Am Rev Respir Dis 139 (4): A180Google Scholar
  19. 19.
    Fletcher EC, Costarangos C, Miller T (1989) The rate of fall of arterial oxyhemoglobin saturation in obstructive sleep apnea. Chest 96: 717–722PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • E. C. Fletcher
    • 1
  1. 1.Department of Medicine, Section of Pulmonary Disease and Critical CareHouston Veterans Administration Medical Center, Baylor College of MedicineHoustonUSA

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