scholarly journals 1249 Reverse platypnoea-orthodeoxia syndrome: A rare cause of hypoxemia during in lab polysomnography

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A476-A476
Author(s):  
Mary T Sessums ◽  
Maria P Guzman ◽  
Brynn K Dredla
Keyword(s):  
Oxygen Saturation ◽  
Sleep Disordered Breathing ◽  
Clinical Presentation ◽  
Supplemental Oxygen ◽  
Sleep Medicine ◽  
Foramen Ovale ◽  
Transesophageal Echocardiogram ◽  
Class I Obesity ◽  
Catheter Closure ◽  
Cardiac Shunt

Abstract Introduction Sleep related hypoxemia carries a broad differential diagnosis. Right-to-left shunting is a known cause of hypoxemia that is not correctable with supplemental oxygen. A patent foramen ovale (PFO) is an intra-cardiac shunt that results in hypoxemia and in rare instances can lead to platypnea-orthodeoxia syndrome (POS). POS is characterized by dyspnea and hypoxemia in the upright position, which improves when supine. We present a case of nocturnal hypoxemia and PFO with a unique clinical presentation consistent with reverse POS discovered on PSG. Report of Case 57-year-old male with Class I obesity and a remote diagnosis of mild sleep-disordered breathing not treated with CPAP was referred to Sleep Medicine for excessive daytime sleepiness, snoring, and witnessed apneas. Polysomnography revealed basal oxygen saturation of ~88% during sleep. There was no evidence of apnea or hypopnea. Hypoxemia was not correctable with supplemental oxygen, suggestive of shunt physiology. Oxygen saturation was normal during upright exercise. Pulmonary hypertension was ruled out. Transesophageal echocardiogram revealed PFO with right-to-left shunt. Overall presentation was consistent with reverse POS secondary to PFO, which will be treated with percutaneous trans-catheter closure. Conclusion This is a rare case of reverse POS secondary to PFO, with shunt physiology initially suspected during Sleep Medicine evaluation based on PSG. Reverse POS is characterized by dyspnea and hypoxemia while supine, as opposed to upright as in classic POS. The precise pathophysiology of reverse POS is unclear. This case emphasizes the need to consider reverse POS in patients with supine hypoxemia refractory to oxygen therapy. Such findings on PSG should prompt further workup for causes of right-to-left shunt. This diagnosis should not be overlooked, as the underlying abnormality is often correctable. In this patient, we expect hypoxemia to resolve with percutaneous trans-catheter closure of PFO.

scholarly journals 0914 Sleep Disordered Breathing In Pediatric Patients Before And After Intrathecal Baclofen Therapy

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A347-A348
Author(s):  
M Sobremonte-King ◽  
M Chen ◽  
L M DelRosso
Keyword(s):  
Oxygen Saturation ◽  
Sleep Disordered Breathing ◽  
Retrospective Chart Review ◽  
Intrathecal Baclofen ◽  
Supplemental Oxygen ◽  
Respiratory Drive ◽  
Signed Rank ◽  
Before And After ◽  
Lower Oxygen ◽  
Disordered Breathing

Abstract Introduction Refractory spasticity in children is treated with intrathecal baclofen (ITB), which may worsen both central and obstructive breathing events. Sleep disordered breathing (SDB) is seldom investigated prior and/or subsequent to placement of ITB and there are currently no standardized protocols. This study aims to compare occurrence of SDB pre/post ITB placement. Methods Retrospective chart review revealed 104 patients started on ITB therapy from 2009-2019 and those who had pre and/or post ITB polysomnograms (PSG) were included. Medical history and PSG parameters were extracted. Comparison of paired results will occur using the Wilcoxon Signed Rank Sum Tests once collection is complete. Results Thirty-seven patients were identified having pre and/or post ITB PSGs. Results in mean ± SD show: age was 11 ± 4 years and 65% were male. Twenty-five pre ITB PSG had an oAHI of 4 ± 5 with 22/25 (88%) having SDB. There were 15/25 (60%) with mild OSA (oAHI >1 but < 5) and 7/25 (28%) with moderate-severe OSA (oAHI > 5/hr). CAI was 1 ± 2 and oxygen saturation nadir was 88 ± 9 %. Sixteen post ITB PSG had an oAHI of 8 ± 13 with 100% having SDB. There were 11/16 (69%) with mild OSA and 5/16 (31%) with moderate-severe OSA. CAI was 3 ± 7 and oxygen saturation nadir was 84 ± 8 %. Ten patients were initiated on non-invasive ventilation, one on supplemental oxygen and two had adenotonsillectomy. Conclusion Initial data shows high occurrence of SDB in patients pre and post ITB placement leading to medical or surgical intervention in 35%. Post ITB PSGs showed worsened oAHI and CAI and lower oxygen saturation nadir. Possible mechanisms include depression of central respiratory drive and decreased pulmonary reserves. This study may help stratify and address risks of ITB for those with refractory spasticity and SDB. Support None

scholarly journals Amelioration of sleep-disordered breathing with supplemental oxygen in older adults

2020 ◽  
Vol 129 (6) ◽  
pp. 1441-1450
Author(s):  
Ruchi Rastogi ◽  
M. S. Badr ◽  
A. Ahmed ◽  
S. Chowdhuri
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Sleep Disordered Breathing ◽  
Supplemental Oxygen ◽  
Vulnerable Population ◽  
Central Apnea ◽  
Elderly Adults ◽  
Chemoreflex Sensitivity ◽  
Central Apneas ◽  
First Time

This study demonstrates for the first time in elderly adults without heart disease that intervention with supplemental oxygen in the clinical range will ameliorate central apneas and hypopneas by decreasing the propensity to central apnea through decreased chemoreflex sensitivity, even in the absence of a reduction in the plant gain. Thus, the study provides physiological evidence for use of supplemental oxygen as therapy for mild-to-moderate SDB in this vulnerable population.

Does persistent (patent) foramen ovale closure reduce the risk of recurrent decompression sickness in scuba divers?

2021 ◽  
Vol 51 (1) ◽  
pp. 63-67
Author(s):  
Björn Edvinsson ◽  
◽  
Ulf Thilén ◽  
Niels Erik Nielsen ◽  
Christina Christersson ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Foramen Ovale ◽  
Residual Shunt ◽  
Interatrial Communication ◽  
Scuba Divers ◽  
Increased Risk ◽  
History Of ◽  
Catheter Closure ◽  
Pfo Closure

Introduction: Interatrial communication is associated with an increased risk of decompression sickness (DCS) in scuba diving. It has been proposed that there would be a decreased risk of DCS after closure of the interatrial communication, i.e., persistent (patent) foramen ovale (PFO). However, the clinical evidence supporting this is limited. Methods: Medical records were reviewed to identify Swedish scuba divers with a history of DCS and catheter closure of an interatrial communication. Thereafter, phone interviews were conducted with questions regarding diving and DCS. All Swedish divers who had had catheter-based PFO-closure because of DCS were followed up, assessing post-closure diving habits and recurrent DCS. Results: Nine divers, all with a PFO, were included. Eight were diving post-closure. These divers had performed 6,835 dives (median 410, range 140–2,200) before closure, and 4,708 dives (median 413, range 11–2,000) after closure. Seven cases with mild and 10 with serious DCS symptoms were reported before the PFO closure. One diver with a small residual shunt suffered serious DCS post-closure; however, that dive was performed with a provocative diving profile. Conclusion: Divers with PFO and DCS continue to dive after PFO closure and this seems to be fairly safe. Our study suggests a conservative diving profile when there is a residual shunt after PFO closure, to prevent recurrent DCS events.

scholarly journals Automatic Oxygen Delivery System for Premature Babies

2010 ◽  
Vol 4 (2) ◽  
Author(s):  
Thao P. Do ◽  
Lindsey J. Eubank ◽  
Devin S. Coulter ◽  
John M. Freihaut ◽  
Carlos E. Guevara ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Oxygen Concentration ◽  
Delivery System ◽  
Pulse Oximeter ◽  
Oxygen Delivery ◽  
Supplemental Oxygen ◽  
Saturation Level ◽  
Blood Oxygen ◽  
Blood Oxygen Saturation ◽  
Oxygen Saturation Level

When an infant is born prematurely, there are a number of health risks. Among these are underdeveloped lungs, which can lead to abnormal gas exchange of oxygen or hypoxemia. Hypoxemia is treated through oxygen therapy, which involves the delivery of supplemental oxygen to the patient but there are risks associated with this method. Risks include retinopathy, which can cause eye damage when oxygen concentration is too high, and brain damage, when the concentration is too low [1]. Supplemental oxygen concentration must be controlled rigorously. Currently healthcare staff monitors infants’ blood oxygen saturation level using a pulse oximeter. They manually adjust the oxygen concentration using an air-oxygen blender. Inconsistent manual adjustments can produce excessive fluctuations and cause the actual oxygen saturation level to deviate from the target value. Precision and accuracy are compromised. This project develops an automatic oxygen delivery system that regulates the supplemental oxygen concentration to obtain a target blood oxygen saturation level. A microprocessor uses a LABVIEW® program to analyze pulse oximeter and analyzer readings and control electronic valves in a redesigned air-oxygen blender. A user panel receives a target saturation level, displays patient data, and signals alarms when necessary. The prototype construction and testing began February 2010.

scholarly journals Evaluation of Knowledge of Oxygen Therapy and Reading of Flowmeter among the Health Workers in the Pediatric Unit of the Hospital Universitario San Ignacio, Bogotá, Colombia

2018 ◽  
Vol 59 (3) ◽  
pp. 1-8
Author(s):  
Elly Morros González ◽  
Diana Estrada Cano ◽  
Marcela Murillo Galvis ◽  
Jos Carlos Montes Correa ◽  
Nelcy Rodríguez Malagón ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Oxygen Saturation ◽  
Oxygen Therapy ◽  
Health Workers ◽  
Supplemental Oxygen ◽  
Cross Sectional Study ◽  
Peripheral Oxygen Saturation ◽  
Cross Sectional ◽  
Fraction Of Inspired Oxygen ◽  
Supplemental Oxygen Therapy

Introduction: Supplemental oxygen is considered a pharmaceutical drug; therefore, it can produce adverse effects. Lack of consensus regarding the reading of oxygen flowmeters and the peripheral oxygen saturation (SpO2) goals can influence clinical and paraclinical decisions and hospital stay length. Objective: To assess knowledge on oxygen therapy, adverse effects, SpO2 goals and reading of oxygen flowmeters among personnel in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia. Methodology: Cross-sectional study derived from convenience sampling through a self-applied survey between December 2016 and January 2017. The poll evaluated topics on supplemental oxygen therapy fundamentals and adverse effects, SpO2 goals and flowmeter readings through flowmeters photographs indicating a specific fraction of inspired oxygen (FiO2). Results: The response rate was 77% from 259 subjects. 22% considered that the oxygen saturation either increases or remains the same during sleep periods in children. 78% of participants knew at least one complication associated to prolonged oxygen therapy and 67% due to supplemental oxygen concentration greater than required. In neonatal population, 10% considered oxygen saturation goals equal to or greater than 96%. In the flowmeter’s reading evaluation, incorrect answers ranged from 9 to 19%. Conclusion: It is imperative to reinforce updated concepts on oxygen therapy, with emphasis in SpO2 goals, adverse effects and appropriate flowmeter’s readings through periodic educational campaigns.

scholarly journals Platypnea-orthodeoxia syndrome after open prostatectomy and cystolithotomy: Coincidence or unknown pathophysiology?

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090459
Author(s):  
Ismael P Flores ◽  
Alexandre T Maciel
Keyword(s):  
Case Report ◽  
Patent Foramen Ovale ◽  
Inferior Vena ◽  
Vena Cava ◽  
Sitting Position ◽  
Foramen Ovale ◽  
Open Prostatectomy ◽  
Anatomical Changes ◽  
Upper Abdominal ◽  
Cardiac Shunt

A few cases of platypnea-orthodeoxia syndrome have been described in the literature, some of them after thoracic or upper abdominal surgeries. In most cases, hypoxemia in the upright or sitting position, which is the main clinical symptom for this uncommon diagnosis, is usually related to a dynamic right to left cardiac shunt induced by anatomical changes in the relative position between the inferior vena cava and the atria in the presence of a patent foramen ovale. In this case report, we describe a situation in which platypnea-orthodeoxia syndrome developed acutely before surgery but that became severely exacerbated after an open urologic surgery without a clear acute anatomical change that could be responsible for triggering the syndrome. This case might suggest that the pathophysiology of acute platypnea-orthodeoxia syndrome is not completely elucidated and that other possible triggers for acute clinical manifestation in addition to acute anatomical thoracic changes must be explored.

Sign in / Sign up

Export Citation Format

Share Document