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Is the below normal vertical position value of Sp02 a sign of concern?

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Pulmonologist
Practicing since : 2003
Answered : 593 Questions
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Hello Doctor:

Just a question regarding SpO2 numbers. If someone has a standing up(vertical position) SpO2 value below the normal range say...95% (normal being 96%-99%) and a lying down-horizontal value between 91%-94%....my question(s) is A. Is the below normal vertical position value of Sp02 a sign of concern? B. is the further drop in SpO2 when someone is lying in the horizontal position(say sleeping) a further sign of concern?

Thank you,
XXXXXXX
Posted Mon, 5 Nov 2012 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 3 hours later
Hi,
Thanks for posting the query on XXXXXXX
After going through your query, I would like to comment the following:

1. You have mentioned that there is "Hyperventilation during day and during sleep with apnea at times". This makes the probability of Obstructive sleep apnea a possibility. Thus Over night polysomnography / sleep study is required for diagnosis of Obstructive sleep apnea and CPAP therapy may be initiated if required.

2. Regarding the fall in oxygen saturation in supine position - If it is transient and returns to normal within a couple of minutes then no need to worry. However if it is static and remains the same, then it needs to be investigated. Is there associated obesity, presence of obstructive sleep apnea or some cardiac or pulmonary disease? are the questions that need to be answered. Investigations required may be chest xray pa view, ecg, 2d echo,sleep study, ABG (preferably early morning) & Clinical evaluation including Body mass index measurement.

3. Thus a clinical evaluation by a Pulmonologist may be required.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
Follow-up: Is the below normal vertical position value of Sp02 a sign of concern? 1 hour later
Dr. Mishra:

Thank you so much for your response. Furthermore to your questions...I have done two stress echos recently (about 4 months ago) which were normal. I have seen a Pulmonologist/Respirologist for possible asthma. He did the first part of the test where you inhale a bronchodilator to see any changes in breathing. This part was normal. He suggested to do another test where the airways are purposely constricted by some agent. I have not done this test yet because it scares me a bit. I was on asthma medication from 1997-2001 for some type of allergic bronchitis?? There is some obesity around my waste but its not too bad. Unfortunately I have not lived a very active life style since around the age of 27. When i tried to get back to exercising i found there was some type of "exercise intolerance" evident(ie.muscles tiring easily...possible problem with lactic acid metabolism?...possible other issues?)

The drop in SpO2 in the surpine position flactuates mostly between 91%-94%. Perhaps average 93%. Even at vertical position it can flactuate downwards a bit from mostly around 95%. I am not a doctor but i do have an inquiring mind...i think this is strange...Can chronic hyperventilation cause flactuations in SpO2...and reductions in the surpine position? I've been told that hyperventilation should stop during the night because breathing is metabolically controlled? so why is continuing during sleep in a "massive" fashion? The extent of the problem got worse after some type of viral infection back in March/12. From that moment it felt like something changed in my lungs/breathing intensified. I was on Biaxin (1000mg) for seven days. I know it may be difficult for you to answer..but could this drug affect the breathing centre is some people? (ie. cause hyperventilation to intensify is someone already hyperventilated through life?)

I have had one sleep study about a year ago...they did not tell me that something was found.

I suppose the questions are if sleep apnea is causing all this? Is Hyperventilation causing all this? or is something else causing hyperventilation and sleep apnea?

Threre is stress in my life as i am trying to resolve a divorce after a 16 years generally unhappy marriage.

Thank you,
XXXXXXX ,
Toronto,Canada
 
 
Answered by Dr. Gyanshankar Mishra 36 minutes later
Hi,
Thanks for posting the follow up query.
After going through your follow up query, I would like to comment the following:

1. I suggest you calculate your exact body mass index which is mple and can be calculated at various internet websites for free (It is based on your height and weight.)

2. There is a possibility of obesity hypoventilation syndrome / obstructive sleep apnea. Since you symptoms are present currently, i suggest you to take a repeat sleep study now. Also other than obesity upper airway anatomy can influence this.

3. Investigations as outlined by me previously will definitely throw some light on the cause of supine desaturation. Since your stress echo was normal, apparently any major cardiac disorder is ruled out.

4. Biaxin is an antibiotic and is unlikely to cause such symptoms.

5. Also a 6 minute walk test should be done by you and oxygen saturation fall if any should be documented.

6. Also do remember that a fall in saturation of more than 3 % is significant and should be investigated.

7. If you are not comfortable with bronchoprovocation tests then you may avoid them as they are going to reveal the presence or absence of airway hyper responsiveness. However do continue your inhalers.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
Follow-up: Is the below normal vertical position value of Sp02 a sign of concern? 10 hours later
Hello Dr. Mishra:

Thank you for your response. I ended in the emergency last night.
I dont know and they dont know what is happening.

As I was about to lay down to go to sleep...i got chest tightness...the SpO2 dropped down significantly and my heart beat went as high as 160bpm. It scared me as you can probably imagine...so an ambulance was called. They took it seriously a possible heart issue.

During the ambulance ride the paramedics saw the drops in SpO2 again and commented that threre is something physiologically going on...this is not things like anxiety/panic attack.

I agreed with them...to make a long story short...upon admission to hospital emergency....everything seemed to be stable again...all emergency test (EKG, blood tests were normal). So they released me. This is the mystery that haunts me and i am trying to solve so desperately.

I will look at you suggested previously. Also now i am thinking is this a possible electrosensitivity issue that affects the electical system of the heart at times (ie. sensitive to WiFi, Cell Towers; cordless phones). There are documented such cases.

I am looking for a doctor(s) to see and believe what I see at times and what the paramedics saw and commented on. It is very very frustrating. It almost feels like someone is playing a "cruel jock" on me.

Any other comments/views/suggestions will be greatly valued and appreciated.
Why is the SpO2 dropping? Why did my heart go from 90Bpm to 160bpm as
i was going to sleep? Why doctors here do not see what the paramedics saw and what i see going on?

Thank you, XXXXXXX
 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,
Thanks for posting the follow up query.
After going through your follow up query, I would like to comment the following:

1. You seem to be suffering from supine desaturation. Increased heart beat is a normal physiological response to decreased spo2 (hypoxemia).

2. ABG (sleep study, HRCT scan thorax may be of additional help.

4. You need to get evaluated in deatil as outlined in my previous post.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
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