PURPOSE: Low nocturnal saturations in sickle cell patients has been associated with increase pain crisis and first cerebrovascular accident. Reports from pediatric sickle cell disease (SSD) suggests that low daytime oxygen saturations may predict nocturnal desaturations. However, there is no data on this relationship in adult sickle cell population. This study evaluated the relationship of daytime pulse-oximetry and nocturnal desaturations in adult SSD.
METHODS: Retrospective analysis of 43 consecutive adult patients referred from sickle cell clinic. Nocturnal desaturation was defined as spending >5 mins below 89% during sleep. Daytime saturations were considered normal if over 95%. Patient’s baseline characteristics and co-morbid conditions were documented. Findings were compared with a control group of 20 patients.
RESULTS: Of the 43 consecutive patients identified complete data was available on 27 patients. The mean age of the group was 40 years (22-65). Of the 27 patients, 17 (63%) had daytime saturations >95% and 10 (37%) had low daytime saturations 95% or less. 6/10 (60%) of patients with daytime saturation 95% or less had nocturnal desaturation compared to 7/17 (41%) in the higher saturations group. Baseline characteristics were similar between groups. When compared with control group comprising of non sickle cell with no underlying cardiopulmonary disease and daytime saturations >95%, the sickle cell group with >95% daytime saturations demonstrated significant oxygen desaturations 7/17 (41%) desaturated compared to 0/20 of control group(p<0.0072). In this limited study nocturnal desaturations were not associated with increased pain crisis or increased hospital admissions.
CONCLUSIONS: Our study is the first to evaluate the relationship of day/ night oxygen saturations in adult sickle cell patients. We observed that having high daytime oxygen saturations does not rule out nocturnal desaturations in adult sickle cell patients.
CLINICAL IMPLICATIONS: Normal daytime saturations in adult SSD should not be a deterrent for physicians in evaluating for nocturnal desaturations.
DISCLOSURE: The following authors have nothing to disclose: Hiren Mehta, Renuka Kadali, Hadi Chohan, Jimmy Efird, Peter Boettger, Darla Liles, Charles Knupp, Sunil Sharma
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