Hypoxic load a useful marker to detect sleep disorders in children

Primarily used in adults, hypoxic load may also be a suitable measure for assessing the severity of sleep apnea in children. It appears to act as a predictor of sleepiness in children with milder sleep disorders, according to a study published in the Journal of Sleep Research.Hypoxic load (also known as hypoxic burden) is an increasingly common marker for assessing the severity of sleep apnea in adults. It provides a better understanding of the intensity and duration of hypoxic events by indicating the time spent below the oxygen saturation threshold during sleep.Studies show that its prognosis is superior to that of the apnea-hypopnea index (AHI), particularly regarding cardiovascular risks.Given the scarcity of data on the use of hypoxic load in the pediatric population, French researchers recruited 380 children aged three to 18 years with recurrent snoring in whom obstructive sleep apnea (OSA) was suspected.PolysomnographyAll children underwent polysomnography. Hypoxic load was then calculated by summing the area under the curve of events corresponding to a desaturation >3%. Unsurprisingly, a strong correlation was observed between hypoxic load, AHI and oxygen saturation. A high hypoxic load corresponded to a more severe sleep disorder.The children were then classified into three groups based on the severity of their sleep disturbances: primary snoring (n=225), mild sleep apnea (n=56) or moderate to severe sleep apnea (n=99)The hypoxic load was significantly higher in obese children, particularly those with moderate to severe OSA. In this cohort, it reached 5.19% min/h [1.37; 10.97] in non-obese children compared to 9.89% min/h [4.76; 17.70] in obese children.As for the impact of amygdala hypertrophy on the hypoxic load, it was stronger in children with primary snoring.A tool for predicting sleepinessEven with a low hypoxic load, some children with primary snoring scored particularly high on the Epworth Sleepiness Scale. The hypoxic load score revealed an association that could predict which children with primary snoring were likely to experience high levels of sleepiness.In these children, each 1.5% min/h increase in hypoxic load increased the risk of excessive daytime sleepiness by 39% (OR=1.39; 95% CI, 1.01-1.89). This association could not be established in the cohort of children with mild, moderate or severe sleep apnea.“Given that sleep-disordered breathing and daytime sleepiness predict children’s reading ability, and that sleepiness has a strong negative impact on academic performance, these findings warrant further investigation,” the researchers said.Most importantly, this link with sleepiness was not apparent when relying solely on the apnea-hypopnea index, reinforcing the use of hypoxic load to obtain a more representative picture of sleep disorders in children.This article has been translated from its original French and first appeared on our sister site Profession Santé.

Hypoxic load a useful marker to detect sleep disorders in children

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