Sudden Drops in Blood Oxygen Levels After Surgery

Sudden drop in blood oxygen levels..?

Hello Doctor, I have a question again.
Originally, I had severe obstructive sleep apnea, but after a major surgery, I have seen significant improvement in my "fatigue" and the "snoring" has noticeably decreased.
However, two months post-surgery, I still experience persistent headaches and pressure and soreness in the upper part of both eyes, accompanied by intense daytime sleepiness.
This condition can last all day, usually worsening about half an hour after waking up (including after naps), and it recurs throughout the day.
This is different from the gradual resolution of symptoms after waking up from sleep deprivation.
In the past two days, I have been using a portable pulse oximeter at home, and the oxygen saturation readings have improved significantly, but there have been one or two instances where it suddenly dropped to 82% (prior to surgery, the drops were gradual and occurred frequently).
Doctor, could this indicate that there may already be damage to the brain? I have undergone multiple ENT examinations, and there have been no significant issues found.
Since follow-up appointments are scheduled far in advance, and I cannot remove my braces for an MRI, and the outpatient EEG has shown no problems, I am unsure which direction to take to quickly identify the issue.

Niming, 50~59 year old female. Ask Date: 2015/11/07

Dr. Gao Chunde reply Neurology

If daytime sleepiness and fatigue are not caused by sleep apnea, other underlying conditions should be considered.
Blood oxygen levels are typically measured using a fingertip pulse oximeter; however, if the extremities are cold or circulation is poor, or if the sensor is misaligned, the readings may be inaccurate.
Once peripheral circulation improves or the sensor is correctly positioned, the readings should increase.
If the oxygen saturation truly drops to 82%, symptoms such as dizziness and mild shortness of breath would be expected.
Therefore, regarding your symptoms of upper eyelid heaviness and daytime sleepiness, it may be worthwhile to consult a neurologist to investigate whether past sleep apnea has led to issues with blood pressure, lipid levels, or blood glucose, potentially resulting in insufficient cerebral blood flow or poor circulation.
Based on the findings from the examinations, appropriate treatment can be initiated to improve your condition.

Reply Date: 2015/11/07

More Info

Sudden drops in blood oxygen levels can be concerning, especially after surgery for obstructive sleep apnea (OSA). In your case, it seems that while there has been significant improvement in some symptoms post-surgery, the presence of persistent headaches, eye discomfort, and excessive daytime sleepiness raises important questions about your overall health and potential complications.

Firstly, it’s essential to understand that blood oxygen saturation (SpO2) levels are typically measured using a pulse oximeter, which provides a quick assessment of how well oxygen is being transported in the blood. Normal SpO2 levels range from 95% to 100%. A drop to 82% is considered critically low and can lead to symptoms such as dizziness, confusion, and in severe cases, loss of consciousness. This sudden drop could indicate several underlying issues.

One possibility is that the sudden drops in oxygen levels could be related to residual effects of sleep apnea or other respiratory issues that may not have been fully resolved by the surgery. Even with improvements in symptoms like snoring and fatigue, it’s possible that there are still episodes of hypoventilation or airway obstruction occurring, particularly during sleep. This could explain the sudden drops in oxygen saturation you are experiencing.

Another consideration is the potential for neurological issues. While the absence of findings on EEG and the inability to perform an MRI due to dental braces complicate the diagnostic process, it’s crucial to consider that chronic low oxygen levels can lead to brain hypoxia, which may manifest as headaches, cognitive changes, and fatigue. However, it’s important to note that not all cases of low oxygen saturation result in brain damage, especially if the episodes are brief and infrequent.

Given your symptoms and the sudden drops in oxygen levels, it would be prudent to consult a neurologist or a sleep specialist who can further evaluate your condition. They may recommend additional testing, such as a sleep study (polysomnography) to monitor your breathing patterns during sleep and assess for any residual sleep apnea or other sleep-related breathing disorders. This could provide valuable insights into whether your oxygen saturation drops are related to sleep disturbances.

In the meantime, it’s important to monitor your symptoms closely. If you experience persistent headaches, significant fatigue, or any new neurological symptoms, seek immediate medical attention. Additionally, maintaining a healthy lifestyle, including regular exercise, a balanced diet, and proper hydration, can support your overall health and potentially improve your oxygen levels.

In summary, while sudden drops in blood oxygen levels can indicate potential complications, it’s essential to approach this issue holistically. Collaborating with healthcare professionals to explore further diagnostic options and treatment strategies will be key in addressing your ongoing symptoms and ensuring your well-being.

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