Overnight oximetry in African children with human immunodeficiency virus
- N Dlamini1,
- B Eley2,
- R van Toorn3,
- K Pohl1,
- T Kilborn2,
- T Padayachee1,
- J Collinson4,
- F Kirkham5,
- J Wilmshurst2
- 1Evelina Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
- 2Paediatrics and Radiology, Red Cross War Memorial Hospital, Cape Town, South Africa
- 3Paediatrics, Tygerberg Hospital, Cape Town, South Africa
- 4University of Oxford, Oxford, UK
- 5Neurosciences, University College London Institute of Child Health, London, UK
Aims Obstructive sleep apnoea (OSA) has been described in 2 small studies of adults with human immunodeficiency virus (HIV) and appears to be associated with higher body mass index1 and adenotonsillar hypertrophy.2 However, there are few data in children and the possibility of an association with cerebrovascular disease has not been addressed. The aim of this prospective study, funded by the Heinz fellowship, was to examine the prevalence of OSA in African children with HIV and any association with middle cerebral artery velocity (MCAV) measured using transcranial Doppler (TCD) ultrasound.
Methods We undertook TCD and overnight pulse oximetry using the Masimo motion-resistant portable oximeter in 12 unselected African children (8 male; median age 4; range 2.5-10 years) with HIV. We analysed the data using Download 2001, which includes delta1 ,2, a measure of OSA if >0.4,3 as well as mean and minimum haemoglobin oxygen saturation (SpO2), the percentage of the total sleep study spent with SpO2<95% and the number of desaturations per hour.
Results Median (range) for mean and minimum overnight SpO2 were 98.5 (94.6-99.6)% and 81 (33-94)% respectively, while the percentage of the total study with SpO2<95% was 99.3 (76.9-99.9). The median number of dips in SpO2 >4% per hour was 1.34 (0.29-4.54) and the median delta12 index was 0.36 (0.29-0.83). Five children (42%) had delta12>0.4, consistent with a diagnosis of OSA. Delta12 and the number of desaturations per hour were correlated with CD4% (r=0.83, p=0.012 and r=0.71, p=0.049 respectively). Minimum SpO2 was correlated with haemoglobin (r=0.93, p=0.001) and respiratory rate (r=−0.71, p=0.01). None of the oximetry indices were correlated with body mass index. Right MCA correlated with mean overnight SpO2 (r=−0.74, p=0.01).
Discussion Our data suggest that OSA is common in African children with HIV, especially those with a high CD4%, while hypoxia may be associated with cerebrovascular disease.