Top

Published in:

01-12-2021 | Sleep Apnea | ENT • Original Article

The utility of preoperative echocardiography in pediatric obstructive sleep apnea

Authors: Brian Pettitt-Schieber, Ching Siong Tey, Robert Hill, William Vaughn, Vivek Pakanati, Roberta Leu, Nikhila Raol

Published in: Sleep and Breathing | Issue 4/2021

Abstract

Purpose

The purpose of this study was to determine the associations between cardiac function and postoperative adverse events in pediatric patients with obstructive sleep apnea (OSA).

Methods

Patients between birth and 18 years of age diagnosed with OSA between January 1, 2015, and December 31, 2018, who underwent echocardiographic evaluation within 6 months of surgery at a tertiary care children’s hospital were evaluated. Exclusion criteria included history of neuromuscular disorders, tracheostomy placement, or a predominance of central apneic events recorded during polysomnography (PSG). Patients were grouped by OSA severity. Chi-squared analysis and logistic regression were utilized to determine associations between demographic characteristics, OSA severity, preoperative echocardiographic abnormalities, and postoperative adverse events.

Results

One hundred ten children met inclusion criteria for the study, including 22 with mild OSA, 22 with moderate OSA, and 66 with severe OSA. Race and the presence of congenital heart disease (CHD) were significantly associated with differences in OSA severity. Echocardiographic abnormalities were found in 45 patients, but exclusion of patients with CHD revealed no significant associations with differences in OSA severity. Postoperative adverse events were identified in 18 (16%) patients, and only O₂ saturation nadir was found to be a significant predictor of these complications.

Conclusion

Preoperative echocardiogram abnormalities are not commonly found in children with OSA and presence of abnormalities does not predict postoperative adverse events. O₂ saturation nadir measured on preoperative PSG is a significant predictor of postoperative adverse events and should be examined as a clinical indicator of OSA severity.

Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, Lloyd RM, Parikh SR, Shulman ST, Walner DL, Walsh SA, Nnacheta LC (2019) Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg 160(1_suppl):S1–s42. https://doi.org/10.1177/0194599818801757CrossRefPubMed

Brown OE, Manning SC, Ridenour B (1988) Cor pulmonale secondary to tonsillar and adenoidal hypertrophy: management considerations. Int J Pediatr Otorhinolaryngol 16(2):131–139. https://doi.org/10.1016/s0165-5876(98)90037-4CrossRefPubMed

Amin RS, Kimball TR, Kalra M, Jeffries JL, Carroll JL, Bean JA, Witt SA, Glascock BJ, Daniels SR (2005) Left ventricular function in children with sleep-disordered breathing. Am J Cardiol 95(6):801–804. https://doi.org/10.1016/j.amjcard.2004.11.044CrossRefPubMed

Amin RS, Kimball TR, Bean JA, Jeffries JL, Willging JP, Cotton RT, Witt SA, Glascock BJ, Daniels SR (2002) Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med 165(10):1395–1399. https://doi.org/10.1164/rccm.2105118CrossRefPubMed

Burns AT, Hansen SL, Turner ZS, Aden JK, Black AB, Hsu DP (2019) Prevalence of pulmonary hypertension in pediatric patients with obstructive sleep apnea and a cardiology evaluation: a retrospective analysis. J Clin Sleep Med 15(8):1081–1087. https://doi.org/10.5664/jcsm.7794CrossRefPubMedPubMedCentral

Revenaugh PC, Chmielewski LJ, Edwards T, Krishna J, Krakovitz P, Anne S (2011) Utility of preoperative cardiac evaluation in pediatric patients undergoing surgery for obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 137(12):1269–1275. https://doi.org/10.1001/archoto.2011.208CrossRefPubMed

Larrier DR, Huang ZJ, Zhang W, McHugh CH, Brock L, Reddy SC (2015) Is routine pre-operative cardiac evaluation necessary in obese children undergoing adenotonsillectomy for OSA? Am J Otolaryngol 36(6):744–747. https://doi.org/10.1016/j.amjoto.2015.05.007CrossRefPubMed

Kalra M, Kimball TR, Daniels SR, LeMasters G, Willging PJ, Rutter M, Witt SA, Glascock BJ, Amin RS (2005) Structural cardiac changes as a predictor of respiratory complications after adenotonsillectomy for obstructive breathing during sleep in children. Sleep Med 6(3):241–245. https://doi.org/10.1016/j.sleep.2004.10.004CrossRefPubMed

McCormick ME, Sheyn A, Haupert M, Thomas R, Folbe AJ (2011) Predicting complications after adenotonsillectomy in children 3 years old and younger. Int J Pediatr Otorhinolaryngol 75(11):1391–1394. https://doi.org/10.1016/j.ijporl.2011.07.035CrossRefPubMed

10.

Teplitzky TB, Pereira KD, Isaiah A (2019) Echocardiographic screening in children with very severe obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 126:109626. https://doi.org/10.1016/j.ijporl.2019.109626CrossRefPubMed

11.

Ismail K, Roberts K, Manning P, Manley C, Hill NS (2015) OSA and pulmonary hypertension: time for a new look. Chest 147(3):847–861. https://doi.org/10.1378/chest.14-0614CrossRefPubMed

12.

Roland PS, Rosenfeld RM, Brooks LJ, Friedman NR, Jones J, Kim TW, Kuhar S, Mitchell RB, Seidman MD, Sheldon SH, Jones S, Robertson P (2011) Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg 145(1 Suppl):S1–S15. https://doi.org/10.1177/0194599811409837CrossRefPubMed

13.

Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):e714–e755. https://doi.org/10.1542/peds.2012-1672CrossRefPubMed

14.

Basha S, Bialowas C, Ende K, Szeremeta W (2005) Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. Laryngoscope 115(6):1101–1103. https://doi.org/10.1097/01.Mlg.0000163762.13870.83CrossRefPubMed

15.

Mitchell RB, Kelly J (2006) Behavior, neurocognition and quality-of-life in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 70(3):395–406. https://doi.org/10.1016/j.ijporl.2005.10.020CrossRefPubMed

16.

Li AM, Au CT, Sung RY, Ho C, Ng PC, Fok TF, Wing YK (2008) Ambulatory blood pressure in children with obstructive sleep apnoea: a community based study. Thorax 63(9):803–809. https://doi.org/10.1136/thx.2007.091132CrossRefPubMed

17.

Sun SS, Grave GD, Siervogel RM, Pickoff AA, Arslanian SS, Daniels SR (2007) Systolic blood pressure in childhood predicts hypertension and metabolic syndrome later in life. Pediatrics 119(2):237–246. https://doi.org/10.1542/peds.2006-2543CrossRefPubMed

18.

Brooks DM, Kelly A, Sorkin JD, Koren D, Chng SY, Gallagher PR, Amin R, Dougherty S, Guo R, Marcus CL, Brooks LJ (2020) The relationship between sleep-disordered breathing, blood pressure, and urinary cortisol and catecholamines in children. J Clin Sleep Med 16(6):907–916. https://doi.org/10.5664/jcsm.8360CrossRefPubMedPubMedCentral

19.

Weber SA, Pierri Carvalho R, Ridley G, Williams K, El Dib R (2014) A systematic review and meta-analysis of cohort studies of echocardiographic findings in OSA children after adenotonsilectomy. Int J Pediatr Otorhinolaryngol 78(10):1571–1578. https://doi.org/10.1016/j.ijporl.2014.07.021CrossRefPubMed

20.

Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thebaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL (2015) Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation 132(21):2037–2099. https://doi.org/10.1161/cir.0000000000000329CrossRefPubMed

21.

Çetin M, Bozan N (2017) The effects of adenotonsillar hypertrophy corrective surgery on left ventricular functions and pulmonary artery pressure in children. Int J Pediatr Otorhinolaryngol 101:41–46. https://doi.org/10.1016/j.ijporl.2017.07.027CrossRefPubMed

22.

Attia G, Ahmad MA, Saleh AB, Elsharkawy A (2010) Impact of obstructive sleep apnea on global myocardial performance in children assessed by tissue Doppler imaging. Pediatr Cardiol 31(7):1025–1036. https://doi.org/10.1007/s00246-010-9755-0CrossRefPubMed

23.

Chan JY, Li AM, Au CT, Lo AF, Ng SK, Abdullah VJ, Ho C, Yu CM, Fok TF, Wing YK (2009) Cardiac remodelling and dysfunction in children with obstructive sleep apnoea: a community based study. Thorax 64(3):233–239. https://doi.org/10.1136/thx.2007.094904CrossRefPubMed

24.

Cincin A, Sakalli E, Bakirci EM, Dizman R (2014) Relationship between obstructive sleep apnea-specific symptoms and cardiac function before and after adenotonsillectomy in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 78(8):1281–1287. https://doi.org/10.1016/j.ijporl.2014.05.011CrossRefPubMed

25.

Duman D, Naiboglu B, Esen HS, Toros SZ, Demirtunc R (2008) Impaired right ventricular function in adenotonsillar hypertrophy. Int J Cardiovasc Imaging 24(3):261–267. https://doi.org/10.1007/s10554-007-9265-1CrossRefPubMed

26.

Amin R, Somers VK, McConnell K, Willging P, Myer C, Sherman M, McPhail G, Morgenthal A, Fenchel M, Bean J, Kimball T, Daniels S (2008) Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep disordered breathing. Hypertension 51(1):84–91. https://doi.org/10.1161/hypertensionaha.107.099762CrossRefPubMed

27.

Elalfy MS, Youssef OI, Deghedy MMR, Abdel Naby MM (2018) Left ventricular structural and functional changes in children with beta-thalassemia and sickle cell disease: relationship to sleep-disordered breathing. J Pediatr Hematol Oncol 40(3):171–177. https://doi.org/10.1097/mph.0000000000001096CrossRefPubMed

28.

Villa MP, Ianniello F, Tocci G, Evangelisti M, Miano S, Ferrucci A, Ciavarella GM, Volpe M (2012) Early cardiac abnormalities and increased C-reactive protein levels in a cohort of children with sleep disordered breathing. Sleep Breath 16(1):101–110. https://doi.org/10.1007/s11325-010-0462-0CrossRefPubMed

29.

Wilson K, Lakheeram I, Morielli A, Brouillette R, Brown K (2002) Can assessment for obstructive sleep apnea help predict postadenotonsillectomy respiratory complications? Anesthesiology 96(2):313–322. https://doi.org/10.1097/00000542-200202000-00015CrossRefPubMed

30.

Neidenbach RC, Lummert E, Vigl M, Zachoval R, Fischereder M, Engelhardt A, Pujol C, Oberhoffer R, Nagdyman N, Ewert P, Hauser M, Kaemmerer H (2018) Non-cardiac comorbidities in adults with inherited and congenital heart disease: report from a single center experience of more than 800 consecutive patients. Cardiovasc Diagn Ther 8(4):423–431. https://doi.org/10.21037/cdt.2018.03.11CrossRefPubMedPubMedCentral

Title: The utility of preoperative echocardiography in pediatric obstructive sleep apnea
Authors: Brian Pettitt-Schieber
Ching Siong Tey
Robert Hill
William Vaughn
Vivek Pakanati
Roberta Leu
Nikhila Raol
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Sleep Apnea
Tonsillectomy
Echocardiography
Care
Pulmonary Hypertension
Polysomnography
Echocardiography
Pulmonary Hypertension
Pulmonary Hypertension
Pulmonary Hypertension
Published in: Sleep and Breathing / Issue 4/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02303-5

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The utility of preoperative echocardiography in pediatric obstructive sleep apnea

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2021

Does nocturnal use of a complete denture interfere with the degree of obstructive sleep apnea? A systematic review and meta-analysis

Should we incorporate obstructive sleep apnea in CHA2DS2-VASc score?

Obstructive sleep apnea syndrome and Alzheimer’s disease pathology: may continuous positive airway pressure treatment delay cognitive deterioration?

Analysis of the characteristics of sleep in patients with patent foramen ovale complicated with obstructive sleep apnea

Socioeconomic disparities in obstructive sleep apnea: a systematic review of empirical research

Transvenous phrenic nerve stimulation improves central sleep apnea, sleep quality, and quality of life regardless of prior positive airway pressure treatment

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page