Critical flicker fusion frequency results during oxygen decompression in standard HBOT session — observational study
Abstract
Most hyperbaric medicine reports concentrate on the patient and his morbidities. In addition to
the well-known indications for hyperbaric oxygen therapy (HBOT), we cannot discount possible side effects.
Among medical staff regularly exposed to hyperbaric conditions the best described so far is decompression
sickness. A non-invasive and easily available way to assess cognitive functioning involves the use of the critical
flicker fusion frequency (CFFF) test. In the current study, the flicker test was performed several times
on 21 subjects, both under normobaric and hyperbaric conditions. The test was conducted using the device
that flickering was programmed according to the method of limits. While in the hyperbaric chamber,
15 of the participants breathed oxygen to reduce the risk of decompression sickness. Flicker and fusion
frequencies differed from each other in both normo- and hyperbaric conditions (p < 0.01). CFFF results
were dependent on oxygen breathing during decompression.
Keywords: flicker testcritical flicker fusion frequencyCFFFflickerfusionoxygenhyperbaric oxygen therapy
References
- Balestra C, Lafère P, Germonpré P. Persistence of critical flicker fusion frequency impairment after a 33 mfw SCUBA dive: evidence of prolonged nitrogen narcosis? Eur J Appl Physiol. 2012; 112(12): 4063–4068.
- Bell J, Thombs PA, Davison WJ, et al. Decompression tables for inside chamber attendants working at altitude. Undersea Hyperb Med. 2014; 41(6): 505–513.
- Bliznyuk A, Grossman Y. Role of NMDA Receptor in High-Pressure Neurological Syndrome and Hyperbaric Oxygen Toxicity. Biomolecules. 2023; 13(12).
- Bobon DP, Lecoq A, von Frenckell R, et al. Critical flicker fusion frequency in psychopathology and psychopharmacology. Review of the literature. Acta Psychiatr Belg. 1982; 82(1): 7–112.
- Carmel D, Lavie N, Rees G. Conscious awareness of flicker in humans involves frontal and parietal cortex. Curr Biol. 2006; 16(9): 907–911.
- Considine EG, Florian JP, Klemp AO. Endurance Exercise Performance Is Reduced after 6-h Dives at 1.35 ATA When Breathing 100% Oxygen Compared with Air. Med Sci Sports Exerc. 2024; 56(2): 257–265.
- Curran S, Wattis J. Critical flicker fusion threshold: a potentially useful measure for the early detection of Alzheimer's disease. Human Psychopharmacology: Clinical and Experimental. 2000; 15(2): 103–112, doi: 10.1002/(sici)1099-1077(200003)15:2<103::aid-hup149>3.0.co;2-7.
- Dillon D. Differences Between Ascending and Descending Flicker-Fusion Thresholds Among Groups of Hospitalized Psychiatric Patients and a Group of Normal Control Persons. The Journal of Psychology. 1959; 48(2): 255–262.
- Ghozlan A, Widlöcher D. Ascending-descending threshold difference and internal subjective judgment in CFF measurements of depressed patients before and after clinical improvement. Percept Mot Skills. 1993; 77(2): 435–439.
- Jain K. Textbook of Hyperbaric Medicine. 2017.
- Jones MW, Brett K, Han N, Cooper JS, Wyatt HA. Hyperbaric Physics. StatPearls [Internet]. 2022.
- Haarlem CS, O'Connell RG, Mitchell KJ, et al. The speed of sight: Individual variation in critical flicker fusion thresholds. PLoS One. 2024; 19(4): e0298007.
- Karakaya H, Aksu S, Egi SM, et al. Effects of Hyperbaric Nitrogen Narcosis on Cognitive Performance in Recreational air SCUBA Divers: An Auditory Event-related Brain Potentials Study. Ann Work Expo Health. 2021; 65(5): 505–515.
- Kirkland PJ, Mathew D, Modi P, Cooper JS. Nitrogen Narcosis In Diving. StatPearls [Internet] 2023.
- Kluis L, Diaz-Artiles A. Revisiting decompression sickness risk and mobility in the context of the SmartSuit, a hybrid planetary spacesuit. NPJ Microgravity. 2021; 7(1): 46.
- Kot J, Lenkiewicz E, Lizak E, et al. Spinal cord decompression sickness in an inside attendant after a standard hyperbaric oxygen treatment session. Diving Hyperb Med. 2021; 51(1): 103–106.
- Kot J, Winklewski PJ, Sicko Z, et al. Effect of oxygen on neuronal excitability measured by critical flicker fusion frequency is dose dependent. J Clin Exp Neuropsychol. 2015; 37(3): 276–284.
- Mankowska ND, Grzywinska M, Winklewski PJ, et al. Neuropsychological and Neurophysiological Mechanisms behind Flickering Light Stimulus Processing. Biology (Basel). 2022; 11(12).
- Mankowska ND, Marcinkowska AB, Waskow M, et al. Critical Flicker Fusion Frequency: A Narrative Review. Medicina (Kaunas). 2021; 57(10).
- Marcinkowska AB, Mankowska ND, Kot J, et al. Impact of Hyperbaric Oxygen Therapy on Cognitive Functions: a Systematic Review. Neuropsychol Rev. 2022; 32(1): 99–126.
- Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017; 47(1): 24–32.
- Muth T, Schipke JD, Brebeck AK, et al. Assessing Critical Flicker Fusion Frequency: Which Confounders? A Narrative Review. Medicina (Kaunas). 2023; 59(4).
- Sharma RI, Marcinkowska AB, Mankowska ND, et al. Cognitive Functions in Scuba, Technical and Saturation Diving. Biology (Basel). 2023; 12(2).
- Solomon SG, Martin PR, White AJR, et al. Modulation sensitivity of ganglion cells in peripheral retina of macaque. Vision Res. 2002; 42(27): 2893–2898.
- Sramek M, Honek J, Tomek A, et al. Risk stratification of neurological decompression sickness in divers. Bratisl Lek Listy. 2022; 123(2): 77–82.
- Tyler CW. Analysis of visual modulation sensitivity. II. Peripheral retina and the role of photoreceptor dimensions. J Opt Soc Am A. 1985; 2(3): 393–398.
- van Ooij PJAM, Sterk PJ, van Hulst RA. Oxygen, the lung and the diver: friends and foes? Eur Respir Rev. 2016; 25(142): 496–505.
- Vrijdag XCe, van Waart H, Sleigh JW, et al. Investigating critical flicker fusion frequency for monitoring gas narcosis in divers. Diving Hyperb Med. 2020; 50(4): 377–385.
- Witucki P, Duchnick J, Neuman T, et al. Incidence of DCS and oxygen toxicity in chamber attendants: a 28-year experience. Undersea Hyperb Med. 2013; 40(4): 345–350.
- Zhu H, Traore K, Santo A, et al. Oxygen and Oxygen Toxicity: The Birth of Concepts. React Oxyg Species (Apex). 2016; 1(1): 1–8.