Differences in pulse oximetry saturation from sea level to high altitude among subjects with and without respiratory disease. A population-based, cross-sectional study
- 1Fundación Neumológica Colombiana, Bogotá, Colombia
- 2Universidad de La Sabana, Chia, Colombia
- 3Department of Radiology. Fundación Cardioinfantil, Bogotá, Colombia
Abstract
IntroductionOxygen saturation (SpO2) is used to detect hypoxemia and guide oxygen therapy, but its interpretation varies with altitude, age, and lung disease. Although >500 million people live at ≥1,500 m, population-based data comparing SpO2 across altitudes in adults with and without chronic respiratory disease are scarce. We aimed to compare SpO2 between these groups from sea level to 3,030 m, identify factors associated with SpO2, and describe SpO2 by altitude and age in adults without respiratory disease. We hypothesized that SpO2 would be lower in participants with respiratory disease, with differences increasing with altitude.MethodsPREPOCOL II is a population-based, cross-sectional study with a probabilistic, two-stage, clustered sampling design to estimate the prevalence and risk factors for respiratory disease among adults ≥40 years in Colombian cities at different altitudes (18-3030 m). All participants completed a standardized questionnaire, spirometry, and SpO2 measurement. Participants with respiratory disease (RDP), including chronic obstructive pulmonary disease, asthma, chronic bronchitis, obstructive sleep apnea, and interstitial lung disease, were compared with controls using Mann-Whitney and Kruskal-Wallis tests, multivariable linear regression, and comparisons of altitude coefficients between groups.ResultsA total of 1146 RDP and 4613 controls were included. RDP were older, and had lower BMI and lung function. SpO2 was lower in RDP than in controls at all altitudes and decreased in both groups as altitude and age increased (p<0.001). In multivariable models, altitude showed the strongest association with SpO2 (standardized β −0.69 in controls and −0.71 in RDP), followed by age and BMI (and FEV1 in RDP). The decrease in SpO2 per unit of altitude was larger in RDP (B −1.15 vs. −0.80; difference p<0.001), and the between-group difference became evident at ~1,500 m (median 97.0% vs. 95.5%).ConclusionAmong lifelong residents living at altitudes from sea level to 3,030 m, SpO2 was lower in RDP than in controls. SpO2 decreased with altitude and age in both groups, with altitude being the variable most strongly associated with SpO2. SpO2 values should be interpreted in relation to specific altitude and age. In RDP, the lower SpO2 was most evident at altitudes of ~1,500 m and above.
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BibTeX
@article{gonzalezgarcia2026differences,
title = {{Differences in pulse oximetry saturation from sea level to high altitude among subjects with and without respiratory disease. A population-based, cross-sectional study}},
author = {Mauricio Gonzalez-Garcia and Mauricio Gonzalez-Garcia and Carlos A. Torres-Duque and Carlos A. Torres-Duque and Carlos Aguirre-Franco and Carlos Aguirre-Franco and Abraham Alí-Munive and Abraham Alí-Munive and Nadia Juliana Proaños and Nadia Juliana Proaños and Carolina Perez and Alejandro Casas-Herrera and Alejandro Casas-Herrera},
journal = {Frontiers in Physiology},
year = {2026},
month = oct,
doi = {10.3389/fphys.2026.1956566},
url = {https://doi.org/10.3389/fphys.2026.1956566},
note = {CC BY},
}
RIS
TY - JOUR
TI - Differences in pulse oximetry saturation from sea level to high altitude among subjects with and without respiratory disease. A population-based, cross-sectional study
AU - Mauricio Gonzalez-Garcia
AU - Mauricio Gonzalez-Garcia
AU - Carlos A. Torres-Duque
AU - Carlos A. Torres-Duque
AU - Carlos Aguirre-Franco
AU - Carlos Aguirre-Franco
AU - Abraham Alí-Munive
AU - Abraham Alí-Munive
AU - Nadia Juliana Proaños
AU - Nadia Juliana Proaños
AU - Carolina Perez
AU - Alejandro Casas-Herrera
AU - Alejandro Casas-Herrera
PY - 2026
DA - 2026/10/26
JO - Frontiers in Physiology
DO - 10.3389/fphys.2026.1956566
UR - https://doi.org/10.3389/fphys.2026.1956566
AB - IntroductionOxygen saturation (SpO2) is used to detect hypoxemia and guide oxygen therapy, but its interpretation varies with altitude, age, and lung disease. Although >500 million people live at ≥1,500 m, population-based data comparing SpO2 across altitudes in adults with and without chronic respiratory disease are scarce. We aimed to compare SpO2 between these groups from sea level to 3,030 m, identify factors associated with SpO2, and describe SpO2 by altitude and age in adults without respiratory disease. We hypothesized that SpO2 would be lower in participants with respiratory disease, with differences increasing with altitude.MethodsPREPOCOL II is a population-based, cross-sectional study with a probabilistic, two-stage, clustered sampling design to estimate the prevalence and risk factors for respiratory disease among adults ≥40 years in Colombian cities at different altitudes (18-3030 m). All participants completed a standardized questionnaire, spirometry, and SpO2 measurement. Participants with respiratory disease (RDP), including chronic obstructive pulmonary disease, asthma, chronic bronchitis, obstructive sleep apnea, and interstitial lung disease, were compared with controls using Mann-Whitney and Kruskal-Wallis tests, multivariable linear regression, and comparisons of altitude coefficients between groups.ResultsA total of 1146 RDP and 4613 controls were included. RDP were older, and had lower BMI and lung function. SpO2 was lower in RDP than in controls at all altitudes and decreased in both groups as altitude and age increased (p<0.001). In multivariable models, altitude showed the strongest association with SpO2 (standardized β −0.69 in controls and −0.71 in RDP), followed by age and BMI (and FEV1 in RDP). The decrease in SpO2 per unit of altitude was larger in RDP (B −1.15 vs. −0.80; difference p<0.001), and the between-group difference became evident at ~1,500 m (median 97.0% vs. 95.5%).ConclusionAmong lifelong residents living at altitudes from sea level to 3,030 m, SpO2 was lower in RDP than in controls. SpO2 decreased with altitude and age in both groups, with altitude being the variable most strongly associated with SpO2. SpO2 values should be interpreted in relation to specific altitude and age. In RDP, the lower SpO2 was most evident at altitudes of ~1,500 m and above.
SN - 1664-042X
ER -