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

Background: Exposure to high levels of carbon monoxide (CO) is a result of hookah smoking.  CO has over 200 times the affinity for hemoglobin thereby disabling oxygen uptake. Increased carbon monoxide and low levels of oxygen have deleterious physiological effects on the body and lead to unnecessary emergency room visits.

Methods: Assessments of exhaled CO,  CO pulse oximetry readings, heart rate, oxygen saturation (SpO2), and perfusion index (P.I.) were conducted among two hundred hookah smokers (n=200) before and after participating in hookah smoking.  Survey data was collected on the amount of time in minutes patrons spent inside the hookah bar, number of tobacco bowls smoked, number of charcoals used, number of cigarettes smoked and previous hookah smoking.

 Results:  A paired samples t-test was conducted using SPSS software to discern differences before and after the hookah bar . Significant increases were observed in exhaled CO, pulse CO-oximetry readings, and heart rate measured in beats per minute (bpm) with concurrent decreases in SpO2 and P.I. Mean increases of 60.8 ppm, 5.9% COHb, 3.8 bpm were recorded for changes in exhaled CO, pulse CO-oximetry, and heart rate, respectively. Mean decreases of oxygen saturation and perfusion index were noted as 0.5 mg/l and 0.4% (all p-values < .05).

Conclusion: Hookah smoking produces high levels of carbon monoxide, leading to concern of carbon monoxide toxicity, tachycardia and impaired oxygen delivery.  Health education and a need for policy implications and environmental regulation in hookah bars are needed to curb this public health threat.