A Naturalistic Study of Carbon Monoxide, Heart Rate, Oxygen Saturation, and Perfusion Index in Hookah Lounge Patrons

BACKGROUND:

Waterpipe (also known as hookah) smokers are exposed to several toxicants, heavy metals, and carcinogens. This study assessed physiologic data from hookah bar participants in an urban area in Florida. We hypothesized that hookah lounge patrons would have a decreased




S



pO

2






and perfusion index, as well as an increased heart rate and exhaled carbon monoxide (CO) levels upon exiting the bars.



METHODS:
Exhaled CO levels, heart rate, pulse oximetry for carboxyhemoglobin, and perfusion index were obtained immediately before entering the hookah lounges and after exiting hookah lounges on a sample size of 200 patrons attending hookah lounges. Averages were then used for Wilcoxon signed-rank tests to assess differences across means.


RESULTS:

Combining data from both hookah smokers and concurrent smokers, the mean CO measurements went from 5.7 ppm prior to lounge entry to 66.5 ppm after the lounge visit (
P
< .001). Conversion to carboxyhemoglobin for all hookah smokers represents an increase from 1.5% to 10.6% (
P
< .001). Carboxyhemoglobin mean values as measured with pulse oximetry increased from 1.4% prior to the lounge visit to 7.2% after the lounge visit (
P
< .001). The mean heart rate for the subjects also increased from 90.3 beats/min to 94.2 beats/min (
P
< .001).




S



pO

2






levels decreased from 98.4% to 97.8% (
P
< .001). Similarly, the mean perfusion index decreased from 3.1% to 2.7% (
P
= .002).



CONCLUSIONS:
Hookah lounge smokers in the United States are exposed to high levels of CO that have the potential for detrimental health effects, as evidenced by rapid negative changes in physiological parameters. Respiratory therapists should be aware of potential cardiovascular changes in hookah lounge patrons who enter emergency rooms and health facilities due to recent exposures.