Hypoxemia  – Causes, Consequences and Treatment

The term “sleep-related hypoxemia” refers to hypoxemia that manifests itself as a result of sleep-related breathing disorders or during sleep in general. While most of the symptoms are the same, it’s important to keep track of where the patient tends to fall asleep.

There is a vast number of sleeping disorders out there. After reading about their causes and contributing factors, it’s not fully unreasonable to start thinking that almost every habit humans have can directly lead to an inability to get proper rest. Because the restorative processes during sleep are in charge of maintaining our immune system, the prospect of not getting enough rest (when we otherwise could be) is worrying. It doesn’t end there, either. Most sleep disorders don’t have real cures, and the patient is instead given long-term therapy options to deal with the symptoms and maybe get some proper rest. Some prescription medication comes with side-effects that sound just as bad as the sleep disorder it’s supposed to cure – or it can cause other sleep disorders or more fatigue.

What could be scarier than all of those things? Well, what if we told you that there’s a breathing condition that can damage your liver, brain or other organs within minutes of symptoms appearing – possibly in your sleep? Hypoxemia and its sleep-related counterpart are some of the most threatening breathing-related conditions you can encounter, and it’s important to call 911 the moment you experience their symptoms. In this article, we will go over what makes hypoxemia so threatening, as well as how it can be diagnosed and treated.

An Overview of Hypoxemia

Hypoxemia is a breathing-related condition characterized by a low amount of oxygen in the blood. As soon as the percentage of oxygen drops to 90%, it is considered quite harmful to your body. Reaching 80% means you have a severe case of hypoxemia, where the symptoms are at their worst. 92-98% is what’s considered a “normal amount of oxygen in the blood.” If you have less than the necessary amount of oxygen in your blood, it means your body cannot distribute the correct amount to each bodily organ and various tissues. As a result, parts of your body stop functioning properly, which can lead to disastrous consequences after mere minutes – such as liver damage, brain damage or cardiovascular problems. Being able to recognize the symptoms of hypoxemia quickly is incredibly important, especially if you’re already aware of a chronic breathing problem in your life. Illnesses such as asthma or sleep disorders like obstructive sleep apnea are some of the most common causes of hypoxemia, so be alert if you’re facing conditions like these. Here’s the list of symptoms:

–          Noticeable changes in the person’s skin color, usually towards blue or cherry red

–          Intense coughing

–          Confusion and disorientation

–          Fast, shallow breathing, usually through the mouth

–          Increased heart rate

–          Intense sweating

–          Wheezing and similar breathing abnormalities

–          Slow heart rate

–          Mouth breathing and excessive drooling are a big telltale sign of hypoxemia in children

–          Problems forming coherent sentences and frequent pauses for breath while speaking

All of these are clear indicators of respiratory distress and hypoxemia and should be responded to as early as possible. Severe hypoxemia can easily lead to coma or even death, so there’s never any time to spare.

Diagnosing Hypoxemia

The earlier you can discover your susceptibility to hypoxemia (or identify its symptoms), the safer you are. Luckily, there are multiple reliable methods of diagnosing this condition, which lets treatment begin as soon as possible. We will go over each of these diagnostic methods, so you have a rough idea of what to expect when you make an appointment with your doctor. None of these methods are very painful, and the analysis typically doesn’t take too long. Here’s the list:

–          Listening to your heart and lungs is most likely going to be the first step the doctor takes. If they detect any abnormalities in how your lungs or heart operate, it is considered an indicator of breathing problems (and consequently, hypoxemia). Even if they don’t immediately hear it, almost every doctor will continue the diagnostic process because of how threatening hypoxemia is. There are no preliminary screenings here.

–          The second thing they often check is color changes on certain parts of your body, such as your lips, fingernails or skin in general. If they discover any bluish parts or cherry-red skin patches, it’s a clear sign that something is wrong with your oxygen levels.

–          An arterial blood gas test is one of, if not the most reliable method of identifying a lack of oxygen quickly. As with all blood tests, this is done using a needle, which is still pretty low on the discomfort scale (and if you have hypoxemia, it’s the last of your worries).

–          Pulse oximetry is a completely non-invasive method of checking your blood oxygen levels. It is performed using an oximeter, which is typically attached to your fingertip and used to inspect the peripheral oxygen saturation. While this method doesn’t directly analyze blood in your arteries, the results of pulse oximetry will match those of arterial blood gas tests done on the same patient in almost 100% of cases. For this reason, it’s used as a quick and reliable diagnostic method for hypoxemia.

–          Several breathing tests can help paint a clearer picture of the patient’s blood oxygen levels. Most of them involve blowing into some device (or a tube connected to the said device) and getting a reading. While not as prevalent as pulse oximetry or arterial blood gas tests, these methods find their niche thanks to their accessibility and overall reliability.

Once it’s established that you are dealing with hypoxemia, it’s time to begin treatment. It should go without saying, but follow every single instruction you’re given to the letter.

How Hypoxemia Treatment Works

Treatment is the make-or-break point in dealing with hypoxemia. The safest approach is to call 911 immediately and get taken to a hospital where health care providers will conduct oxygen therapy. Failure to administer this treatment as soon as possible can result in serious health complications for the patient. Even though all the relevant medication requires a prescription, exceptions are always made in case of severe emergencies. Hypoxemia is threatening enough to be considered an emergency. Almost every hospital has a protocol that allows for emergency oxygen therapy. Be aware that hypoxemia primarily occurs as a result of other health conditions, such as asthma, obstructive sleep apnea, heart failure, shock, myocardial infarction, etc. It’s equally as important to treat these underlying problems because ignoring them makes it much harder to get rid of hypoxemia.

Oxygen therapy may at first seem simple – the primary goal is to administer enough oxygen to hit the target saturation of 88-98%, depending on the patient’s age, medical history and other situational factors that may create special requirements. However, health care providers have to follow a list of guidelines that help them provide optimal therapy for any given patient. These guidelines may include one or more of the following steps:

–          Raising the patient’s back into a 45-degree position helps them breathe easier. The chest expands more naturally; the diaphragm moves more easily; the inhalation is much stronger and takes less effort. Patients with COPD (Chronic Obstructive Pulmonary Disease) may prefer to sit with their backs against a chair instead.

–          One of the best things to teach a patient is how to practice “controlled coughing” and various deep breathing exercises. These are all done to help clear the airway of any unwanted secretions and substances, which automatically increases the effectiveness of oxygen therapy. Patients who can’t quite muster up a strong cough can instead resort to “huffing,” where they make an intense exhalation. This technique often enables more reliable coughing later on.

–          Regular equipment inspections are mandatory. Make sure the airflow is set to the correct rate, and that any source of oxygen you’re using has enough to sustain the patient. Sometimes problems can arise if the hose connected to their facemask or nasal prongs gets twisted or bent in a way that slows down or stops the flow of oxygen.

–          Pain relief is of crucial importance. While the obvious reason is the comfort level of the patient and their responsiveness, there’s also another thing to consider. Pain increases our body’s metabolic demands, which also includes the demand for oxygen.

–          People with COPD or similar conditions tend to experience a lot of stress and anxiety. These two go hand-in-hand and are almost always overlooked or underestimated in terms of threat level. Make sure your patient receives stress relief through breathing retraining, relaxation techniques, counseling or even medication that alleviates stress and anxiety.

Sleep-Related Hypoxemia

The term “sleep-related hypoxemia” refers to hypoxemia that manifests itself as a result of sleep-related breathing disorders or during sleep in general. While most of the symptoms are the same, it’s important to keep track of where the patient tends to fall asleep. For example, sleeping during high-altitude travel or in areas full of smoke is a risky prospect, as it can lead to hypoxemia – sometimes in locations where you can’t quickly get medical help.

Diagnosis is performed in much the same way as with “normal” hypoxemia. The main unique thing here is that a formal sleep study is almost always conducted on top of everything else (such as arterial blood gas tests or pulse oximetry). If you’re dealing with sleep-related hypoxemia, make sure you maintain a sleep journal that can help any medical expert quickly deduce where the problems lie. Sleep-related hypoxemia is almost always treated through emergency oxygen therapy coupled with treatment options for underlying breathing problems, like obstructive sleep apnea, COPD and similar conditions. A diagnostic method called a “home sleep study” is used to monitor the patient’s blood oxygen levels while they’re asleep – typically through the use of an oximeter attached to their fingertip or a smart device that tracks biological functions, usually in the form of a watch. Consider this a part of sleep tracking. Home sleep studies are much less expensive and offer convenience to both the patient and their physician.


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