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Ictal hypoxemia: A systematic review and meta-analysis
Elisa Bruno1, Giulia Maira2, Andrea Biondi1
1Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, UK.
Ictal hypoxemia (IH) is common in refractory epilepsy, particularly in adults and during tonic-clonic seizures. Its severity is linked to SpO2 desaturation levels, highlighting a significant clinical concern.
Area of Science:
- Neurology
- Critical Care Medicine
- Epileptology
Background:
- Ictal hypoxemia (IH) is a critical event during seizures.
- Understanding IH incidence and contributing factors is vital for patient management.
Purpose of the Study:
- To determine the incidence of ictal hypoxemia (IH).
- To identify clinical and study-related factors influencing IH incidence.
Main Methods:
- Systematic review and random-effects meta-analysis of 21 studies.
- Included 917 participants with concurrent EEG and SpO2 monitoring during seizures.
- Meta-regression analyzed factors affecting study heterogeneity.
Main Results:
- Pooled incidence of IH was 35 per 100 seizures (95% CI 27-44).
- Higher IH incidence observed in adults (41/100 seizures) and tonic-clonic seizures (47/100 seizures).
- SpO2 desaturation severity was the only significant factor correlated with IH incidence (p=0.00).
Conclusions:
- IH is frequent in refractory epilepsy, especially in adults and with tonic-clonic seizures.
- IH severity is independent of age and seizure type.
- IH is a significant clinical concern due to its association with cardiorespiratory compromise and SUDEP.
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