Understanding Oxygen Saturation

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Oxygen saturation—sometimes referred to as O2 sats, or simply, sats—refers to the extent to which hemoglobin is saturated with oxygen. Hemoglobin is an element in your blood that binds with oxygen to carry it through the bloodstream to the organs, tissues, and cells of your body.

Normal oxygen saturation is usually between 96% and 98%. Any level below this is considered dangerous and warrants urgent oxygen supplementation and/or treatment for your lung condition.

How Blood Becomes Oxygenated

Each one of your red blood cells contains around 270 million molecules of hemoglobin. Oxygen binds to iron contained in hemoglobin after diffusing from the alveoli in your lungs.

Oxygen saturation is dependent upon:

  • Oxygen availability (what you breathe in)
  • Gas exchange in the lungs: The ability of oxygen to reach the alveoli and diffuse through the walls of the alveoli to reach the red blood cells
  • The concentration of hemoglobin in red blood cells
  • The affinity of hemoglobin for oxygen (i.e, how strongly hemoglobin attracts oxygen)

Most of the time, hemoglobin is optimally saturated with oxygen, but that may not be the case with some diseases that inhibit oxygen's binding ability.

Conditions Affecting Oxygen Saturation

Blood disorders, circulatory problems, and lung issues may negatively affect your blood oxygen saturation level, as they may prevent you from adequately absorbing or transporting oxygen.

Examples of conditions that can affect your O2 sat level include:

  • Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis
  • Asthma
  • Collapsed lung (pneumothorax)
  • Anemia
  • Heart disease
  • Pulmonary embolism
  • Congenital heart defects

Measuring Your Levels

Oxygen saturation is most commonly measured by two metrics:

  • Arterial blood gases: The value obtained from arterial blood gases or ABGs (SaO2) describes the oxygen saturation of arterial blood. It is obtained by drawing blood from an artery such as the radial artery in the wrist or the femoral artery in the groin. ABGs are measured in millimeters of mercury (mmHg) and can be a clue as to how efficiently your body is exchanging oxygen and carbon dioxide.
  • Pulse oximetry: The value obtained from peripheral capillary blood using pulse oximetry (SpO2) often closely reflects the levels that would be found in arterial blood. Pulse oximetry has the advantage of being a non-invasive test; it uses a probe attached to a finger or earlobe or other regions of the body that reads the wavelengths of light reflected from the blood. Not only are pulse oximeters standard for monitoring people in the hospital, but today's wearable technology empowers people to track their own saturation levels.
Oxygen Saturation Levels
Reading ABG Level O Sat Result
Below Normal < 80 mm Hg  < 95%
Normal 80 to 100 mm Hg 95% to 100%
Above Normal > 100 mm Hg > 100%

Decreased Oxygen Saturation

A drop in O2 sats is referred to as desaturation, or hypoxemia, and it can be caused by changes in a number of variables.

Among the possibilities:

  • A change in oxygen availability can be caused by a decreased concentration of oxygen in the inspired air such as at higher altitudes and when flying in an airplane.
  • Problems with gas exchange can relate to anything that reduces the ability of oxygen to travel from outside air down into your alveoli or the process of oxygen transfer from the alveoli into the capillaries of the blood, such as in asthma or COPD.
  • Decreased oxygen saturation may result from a lower concentration of hemoglobin, such as in iron deficiency anemia.
  • A decreased affinity of hemoglobin for oxygen may occur when there is something else present that binds more strongly to hemoglobin than does oxygen, such as in carbon monoxide poisoning.

If you're a smoker, you may find that you have a falsely high pulse oximetry reading due to the buildup of carbon monoxide in the blood from cigarettes. Because the oximeter can't distinguish between this type of gas and oxygen, it may provide an inaccurate result. An ABG test is a more reliable testing method in this case.

Complications of Low O2 Sats

When hypoxemia affects oxygen concentration in the body's tissues, the condition is described hypoxia—a marked change in the oxygen levels found in organs and muscles. The two terms are sometimes confused, but are distinct in that hypoxemia relates to decreased oxygen concentration in the blood only.

When cells do not get enough oxygen, they may adapt if the deficiency is small. However, with larger deficiencies, the result is cell damage followed by cell death.

Hypoxia is often caused by hypoxemia, but may also occur when:

  • There is anemia because there are too few red blood cells, so even fully oxygenated blood doesn't bring enough oxygen to tissues. This can occur with severe bleeding due to trauma or with sickle cell anemia.
  • There is inadequate blood flow, so even fully oxygenated blood does not reach the tissues. For example, a stroke occurs when there is inadequate blood flow to a region of the brain and a heart attack occurs due to inadequate blood flow to the heart muscles. Both result in cell and tissue death.
  • The tissues require even more oxygenated blood than can be delivered, such as in severe infections.

Treatment

There is no set level at which clinical effects of hypoxia occur; it may vary from person to person. But generally speaking, when oxygen saturation drops below 95%, levels are considered abnormal or below normal.

In these cases, supplemental oxygen therapy is usually needed, sometimes urgently. The brain is the most susceptible organ to hypoxia, and cognitive and visual function may be impaired when oxygen saturation levels are at 80% to 85%.

It is highly important to determine the cause of low oxygen saturation in order to correct the problem. In addition to providing supplemental oxygen, treating the underlying cause is a primary goal of treatment.

In cases of chronic conditions such as COPD and asthma, the root cause is usually an obstruction, resulting in inadequate air exchange in the lungs and alveoli. Treatment involves medication such as steroids or bronchodilators to open the airways and pulmonary rehabilitation, in addition to oxygen therapy.

In circulatory conditions like heart disease, inadequate blood flow can prevent optimal oxygen delivery. Medications that improve heart function, such as beta-blockers for heart failure or prescriptions to treat heart arrhythmias, can help improve oxygenation.

In blood conditions like anemia, blood supply to the tissues is reduced because of the blood's low ability to carry oxygen attached to hemoglobin. Sometimes a blood transfusion is necessary to augment the body's hemoglobin containing red blood cells and oxygen-carrying capacity.

A Word From Verywell

Oxygen saturation is a helpful metric in determining how efficiently your body can exchange oxygen for carbon dioxide, which can be helpful in assessing how certain therapies are performing when you have a specific condition, such as COPD. In those with chronic conditions affecting their lungs, blood, and circulation, regularly tracking your O2 sat levels via pulse oximetry can be useful.

However, if you don't have a health issue affecting your oxygen state, consistent monitoring of your O2 sat level is not something to worry about. Be aware that there is no reason to inhale oxygen if you do not have a medical problem that impairs your oxygen saturation level. While it is rare, oxygen toxicity can occur if you inhale oxygen for recreational purposes.

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Article Sources
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Additional Reading
  • Hafen BB, Sharma S. Oxygen Saturation. [Updated 2019 Jun 2]. In: StatPearls Treasure Island (FL): StatPearls Publishing. 2019 Jan.