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Intermittent hypoxia in childhood: the harmful consequences versus potential benefits of therapeutic uses
Tatiana V Serebrovskaya1, Lei Xi2
1Bogomoletz Institute of Physiology , Kiev , Ukraine.
Insights
Intermittent hypoxia (IH) in infants can negatively impact development, but controlled IH therapy shows promise for treating various childhood conditions. This review analyzes the dual nature of IH in pediatrics.
Area of Science:
- Neonatal physiology
- Pediatric pulmonology
- Developmental neuroscience
Background:
- Intermittent hypoxia (IH) is common in preterm and term infants, often linked to sleep-disordered breathing.
- Adverse neurodevelopmental and behavioral effects are reported in children with IH, but causality is unclear.
- Conversely, controlled IH conditioning is used therapeutically for conditions like asthma and cerebral palsy.
Purpose of the Study:
- To provide an impartial analysis of current evidence on the dual effects of IH in pediatric patients.
- To clarify the complex relationship between IH, sleep fragmentation, and neurocognitive outcomes.
- To explore the potential therapeutic applications of IH while mitigating risks.
Main Methods:
- Review of existing scientific literature on intermittent hypoxia in pediatric populations.
- Analysis of studies reporting adverse effects of IH on development and cognition.
- Examination of research on the therapeutic use of controlled IH conditioning.
Main Results:
- Evidence suggests IH can negatively impact child development, behavior, and cognition.
- Therapeutic applications of moderate IH conditioning show benefits in various pediatric diseases.
- The exact causative link between IH and neurocognitive deficits remains uncertain.
Conclusions:
- Intermittent hypoxia presents a complex dichotomy in pediatric health, with potential for harm and therapeutic benefit.
- Further research is needed to understand the mechanisms and optimize the use of IH.
- A comprehensive understanding is crucial for preventing adverse outcomes and maximizing therapeutic potential in children.
Abstract:
Intermittent hypoxia (IH) often occurs in early infancy in both preterm and term infants and especially at 36-44 weeks postmenstrual age. These episodes of IH could result from sleep-disordered breathing or may be temporally unrelated to apnea or bradycardia events. There are numerous reports indicating adverse effects of IH on development, behavior, academic achievement, and cognition in children with sleep apnea syndrome. It remains uncertain about the exact causative relationship between the neurocognitive and behavioral morbidities and IH and/or its associated sleep fragmentation. On the other hand, well-controlled and moderate IH conditioning/training has been used in sick children for treating their various forms of bronchial asthma, allergic dermatoses, autoimmune thyroiditis, cerebral palsy, and obesity. This review article provides an updated and impartial analysis on the currently available evidence in supporting either side of the seemingly contradictory scenarios. We wish to stimulate a comprehensive understanding of such a complex physiological phenomenon as intermittent hypoxia, which may be accompanied by other confounding factors (e.g., hypercapnia, polycythemia), in order to prevent or reduce its harmful consequences, while maximizing its potential utility as an effective therapeutic tool in pediatric patients.
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