PEDIATRICS Vol. 115 No. 2 February 2005, pp. e204-e209 (doi:10.1542/peds.2004-1256)
ELECTRONIC ARTICLE |
Nocturnal Arterial Oxygen Saturation and Academic Performance in a Community Sample of Children




* Department of Neonatology, University Hospital of Tuebingen, Tuebingen, Germany
Departments of Pediatric Pulmonology and Neonatology
Epidemiology, Social Medicine, and Health System Research, Hannover Medical School, Hannover, Germany
Objective. Hypoxemia, often assessed via pulse oximetry, is associated with neurocognitive deficits in children. The best way to qualify hypoxemia, or which level of hypoxemia already affects cognition, is unknown.
Methods. We assessed the association of pulse oximetry-derived variables that qualify hypoxemia with impaired academic performance in mathematics in a population-based cross-section of 995 primary school children who underwent overnight home recordings of motion-resistant new-generation pulse oximeter saturation (SpO2). Impaired academic performance in mathematics was based on the last school report and defined as grade 4 to 6 on a 6-point scale (ie, approximately the lowest quintile grades).
Results. Of 10 variables under study, only the nadir of the SpO2 values was significantly associated with impaired performance. Categories of this variable representing mild (ie, 91%93% SpO2; odds ratio: 1.65; 95% confidence interval: 1.062.56) and moderate hypoxemia (ie,
90% SpO2; odds ratio: 2.28; 95% confidence interval: 1.304.01) both were associated with impaired performance in mathematics.
Conclusions. We suggest using the nadir of the SpO2 values in an overnight study to qualify hypoxemia in future studies. This variable may predict neurocognitive deficits in school children. Mild hypoxemia, as yet widely considered benign, may already affect cognition in childhood.
Key Words: sleep-disordered breathing hypoxemia pulse oximetry oxygen saturation learning disorders
Abbreviations: SpO2, oxygen saturation by pulse oximeter D4 event, desaturation by
4% DC event, desaturation cluster SATmin, nadir SpO2 D92 event, desaturation to
92% D90 event, desaturation to
90% OR, odds ratio
Accepted Oct 14, 2004.
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