Abstract WMP114: The Role of Hypoxemia and Hypercapnia as Risk Factors for Childhood Stroke
Bibliographic record
Abstract
Background: Risk factors for childhood stroke differ significantly from those in adults. Obstructive Sleep Apnea (OSA) is an independent risk factor for adult stroke. Children with Sickle Cell Disease (SCD) have a higher prevalence of OSA than the general pediatric population, and nocturnal hypoxemia in these patients is independently predictive of future CNS events. Hypoxemia and hypercapnia secondary to OSA result in a pro-inflammatory and prothrombotic cascade associated with metabolic dysregulation and endothelial dysfunction. Hypothesis: We hypothesized that OSA, hypoxemia and/or hypercapnia are associated with an increased stroke risk in a pediatric population. Methods: Clinical and radiologic data of consented children seen in the stroke program from 1992-2014 with clinically indicated sleep study/polysomnography (PSG) were retrospectively reviewed and analyzed. Results: Thirty-one children (31/947; 14 male, mean age at PSG 8.4 years) were identified. Twenty-three children had arterial ischemic stroke (AIS) (mean age 7.6 years, SEM 0.99 years) and eight were non-stroke arteriopathy patients (mean age 10.5 years, SEM 1.16 years). Children diagnosed with AIS had significantly higher prevalence of OSA than children with no stroke (69% vs. 25%, p=0.0429) regardless of the timing of sleep study (11/15, 73.3% OSA post-stroke diagnosis and 5/8, 62.5% OSA pre-stroke diagnosis). AIS patients had significantly lower minimum SaO2 values overnight (83.19% vs. 94.56%, p=0.0072), and higher overnight mean end tidal (et) and transcutaneous (tc) CO2 levels (et CO2 42.78 vs. 41.75 mmHg, p=0.4940; tc CO2 42.08 vs. 39.67 mmHg, p=0.3544). Primary risk factors of AIS in children with clinically indicated PSG included 3 moyamoya (33% with OSA), 8 cardiac (63% with OSA), 5 SCD (83% with OSA), and 7 other (86% with OSA). Cardiac patients had the lowest nocturnal SaO2 and highest CO2 levels when compared to moyamoya, SCD and others. Conclusions: In our study, children with AIS were more likely to have OSA and nocturnal hypoxemia, highlighting these as potential risk factors for stroke in childhood. Future prospective studies are required to explore the relationship between stroke, hypoxemia and hypercapnia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".