Sleep-Related Hypoxemia: Lack of Blood Oxygen

Learn about what causes sleep-related hypoxemia and how to treat it

By Sheryl Grassie

Sleep-related hypoxemia is a physical disorder that is characterized by inadequate oxygen in the blood. It has numerous causes and can result in serious health conditions. In this guide, we’ll help you understand what sleep-related hypoxemia is, how it impacts your health and tips for treating it.

Understanding Sleep-Related Hypoxemia

In a healthy state, and in a normal environment, our bodies take in the amount of oxygen needed for proper functioning. This oxygen enters through the lungs, is transported by the blood, and eventually makes its way into the tissues. When your body doesn’t get enough oxygen, it results in a condition called hypoxemia (low blood oxygen) or more severely hypoxia (low tissue oxygen). These two terms are sometimes used interchangeably, but they refer to somewhat different conditions. Sleep-related hypoxemia can progress into hypoxia when untreated. As well an acute episode of hypoxia, where someone is deprived of a significant amount of oxygen (like in the case of a near drowning) can cause a form of chronic hypoxemia.

Sleep-related hypoxemia happens due to underlying conditions and is exacerbated during sleep when the body is not in motion. These conditions are referred to as sleep-disordered breathing (SDB), hypoventilation syndromes, or sleep apnea. SDB’s are broken down further into three different types that all exhibit higher prevalence levels and come with increased health risks. Obstructive sleep apnea (OSA), Cheyne-Stokes respiration (CSR), and obesity hypoventilation syndrome (OHS) are the primary categories of SDB’s. All of these categories represent conditions that can cause insufficient oxygen intake while sleeping.

If there is insufficient oxygen to the body, then blood oxygen saturation levels drop and carbon dioxide levels rise. An increased carbon dioxide level can produce a host of unpleasant symptoms or in extreme cases brain damage or even death. To stay healthy we need a particular balance of these two elements (oxygen and carbon dioxide) which necessitates that our oxygen intake mechanisms be in good working order.

Symptoms of Sleep-Related Hypoxemia

What kind of symptoms might suggest sleep-related hypoxemia?

First, if you snore or are aware of having apneic episodes, these symptoms might be preliminary indicators. In children, mouth breathing and/or drooling can be indicative of hypoxemia. A secondary level of symptoms for both adults and children might include dizziness, confusion, sweating, faster or slower than normal heart rate, rapid breathing or shortness of breath. In a more advanced stage, you might experience hypoxemia symptoms as an inability to speak, extreme confusion or even unconsciousness or coma.

If you are concerned that you might have sleep-related hypoxemia or if you possibly have symptoms that align with the disorder, there are two common tests that can be performed at your doctor’s office or in a hospital emergency room.

  1. The first test, an arterial blood gas (ABG) test takes blood from an artery measuring the oxygen and carbon dioxide levels in the blood. It can also measure acidity or PH which may be an indicator of comorbid disorders. Test results for normal arterial blood oxygenation are measured in millimeters of mercury (mm Hg). Normal levels are from 75 to 100 mm Hg with anything under 60 mm Hg being outside the normal range.
  2. There is a second measure, a simple pulse oximeter that clips on your finger, which can assess blood oxygen saturation levels. Normal levels should be in the mid-to-upper 90th percentile with a reading below 90 percent deemed low. If levels are low, it would indicate the need for medical intervention.

Causes and Related Conditions

What causes sleep-related hypoxemia? What comorbid conditions should be monitored?

There is not a simple answer to the question, “What causes sleep-related hypoxemia?” It can be caused by a wide variety of disorders and conditions that all affect breathing. What these conditions have in common is that they directly or indirectly affect the body’s ability to take in oxygen. Both acute and chronic health conditions can create hypoventilation syndromes and affect oxygen intake while sleeping. Examples of breathing disorders or conditions that affect healthy breathing include bronchitis, asthma, lung cancer, obesity, Chronic Obstructive Pulmonary Disease (COPD), sleep apnea, heart or lung diseases, or trauma to the lungs.

Certain lifestyle factors like smoking or the use of narcotics, medications like codeine and morphine, or environmental factors like mold and pollen, can all cause breathing challenges and impede oxygen intake. Further, environmental considerations like high altitude, smoke from forest fires, or cyanide poisoning, can contribute to sleep-related hypoxemia.

Treatment Options

If you have been diagnosed with sleep-related hypoxemia, you will want to discuss treatment options with your doctor. The goal will be to find a treatment intervention or develop a treatment plan that works to increases your blood oxygen level. This may include direct oxygen, various medications, physical devices, or lifestyle changes. It may include a specific combination of interventions dependent on your individual circumstances. An acute attack of hypoxemia, one that drives you to the emergency room, will likely be treated at the hospital with supplemental oxygen through the nose. This alone can restore levels to normal, but follow-up may be required to determine the cause and better clarify a treatment plan. Extreme cases may require the use of a hyperbaric chamber.

Other, less urgent visits to a doctor, will allow for a more comprehensive assessment of symptoms and treatments that are directly correlated with the cause. A bronchial infection might be treated with antibiotics. If asthma is at play an inhaler might be prescribed, steroids or other anti-inflammatory drugs might be indicated. Mechanical interventions, such as corrective breathing devices, might be suggested to keep air passages open at night and allow for better intake of oxygen. Your physician might recommend a combination of pharmaceuticals and supplemental oxygen to combat the hypoxemia. Or, they might recommend changes in lifestyle like losing weight, quitting smoking, or incorporating a better diet and better sleep hygiene. From medications to weight loss, from nasal strips to a continuous positive airway pressure device (CPAP), there are numerous ways to assist with and monitor a sleep-related hypoxemic condition.

Lifestyle and Prevention

More and more the medical community is looking at lifestyle as a causative factor, and thus a curative factor when examining disease. Diet and exercise can both contribute to good health and to ill health. Excess weight, for example, is considered a result of lifestyle preferences and could be reversed or eliminated by different choices.

What we eat affects our health. In the case of hypoxemia there are indicators that adequate levels of iron in the blood support proper blood oxygen saturation. Eating foods that are rich in iron, like meat and fish, beans and nuts, spinach and broccoli, can help prevent hypoxemia. Your doctor can guide you to dietary improvements that directly relate to your condition.

Further, there is evidence that regular mild exercise like walking, stretching, and yoga positively impacts blood oxygen levels and can mitigate the effects of hypoxemia. Exercise can support lung health, improve sleep patterns, and eliminate the need for certain medications that potentially compromise lung function.

There is a myriad of lifestyle enhancements that can be undertaken to improve health and support prevention of sleep-related hypoxemia. In addition to diet and exercise, there is mindfulness-based stress reduction, meditation, gardening, increasing sleep, owning a pet, volunteering, taking supplements, and having a hobby just to name a few. The point is, to assess what you can do to keep healthy and keep the underlying causes of hypoxemia at bay. 

Secondary Effects

Having sleep-related hypoxemia can additionally interrupt sleep patterns and compromise overall health. Adequate sleep is now considered by the medical community to be one of the primary factors in overall good health and wellbeing along with diet and exercise. Studies show that lack of sleep, and lack of deep sleep caused by sleep apnea, breathing disorders and related conditions, can affect hormones, metabolism, weight gain and mood. These all affect general health and contribute to underlying conditions that can cause sleep-related breathing disorders. Having hypoxemia can limit the very activities that would help prevent it. Making conscious lifestyle choices is crucial for individuals with this disorder.

Conclusion

Sleep-related hypoxemia is defined as low blood oxygen due to sleep-disordered breathing. Symptoms can include rapid heart rate, trouble breathing, dizziness, confusion, sweating, inability to talk, loss of consciousness, and coma. Breathing disorders that restrict oxygen intake are caused by underlying disorders and conditions that affect lung function.

These can be acute viruses like bronchitis, chronic lung-related conditions like asthma or COPD, medications like codeine and morphine, lifestyle choices like smoking, and environmental issues like pollen and mold. Treatment always includes direct and indirect ways of improving oxygen intake. Interventions are medical like oxygen and medication, mechanical like a CPAP, and lifestyle-related like diet and exercise. Overall, the literature suggests an increase in the prevalence of sleep-related hypoxemia and the need for more awareness and research.


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