Echocardiographic abnormalities in children with obstructive breathing disorders during sleep

Abstract

ResumoObjetivos: Avaliar a morfologia e função cardíaca através do ecocardiograma em crianças com obstrução respiratória no sono. Métodos:Foram estudadas 40 crianças de ambos os sexos, com idade entre 3 e 11 anos, sendo que 30 apresentavam obstrução respiratória no sono (grupo I) e 10 crianças eram controles saudáveis (grupo II). Os dois grupos eram semelhantes quanto a gênero, idade, peso e altura. As 40 crianças realizaram ecocardiograma, visando às quatro câmaras em sístole e diástole, com atenção especial ao ventrículo direito. Os dados obtidos foram comparados através do teste t de Student (p < 0,05).Resultados: Observou-se, no grupo I, aumento do diâmetro e da área do ventrículo direito em sístole e diástole. A variação entre sístole e diástole da área do ventrículo direito era menor. Em ventrículo esquerdo, foi observada diminuição do diâmetro diastólico, uma menor fração de ejeção e um encurtamento menor. Conclusões:As alterações morfológicas e funcionais cardíacas encontradas em ventrículo direito e ventrículo esquerdo sugerem que obstrução respiratória no sono em crianças pode levar a repercussões cardiovasculares. Estas alterações podem expor as crianças a um maior risco anestésico e cirúrgico.J Pediatr (Rio J). 2007;83(6):518-522: Apnéia do sono obstrutiva, criança, ecocardiografia. AbstractObjectives: To assess cardiac morphology and function by means of echocardiograms of children with obstructed breathing while asleep. Methods:The study enrolled 40 children of both sexes, aged from 3 to 11 years; 30 of them had obstructed breathing during sleep (group I) and 10 children were healthy controls (group II). The two groups were similar in terms of sex, age, weight and height. The 40 children underwent echocardiogram, viewing all four chambers during systole and diastole, paying special attention to the right ventricle (RV). These data were compared by means of Student's t test (p < 0.05). Results:In group I, increased diameter and area of the right ventricle were observed during both systole and diastole. There was less variation in RV area between systole and diastole. Reduced left ventricle (LV) diastolic diameter was also observed, together with reduced ejection fraction and reduced contraction. Conclusions:The morphological and functional cardiac abnormalities observed in the RV and LV suggest that, in children, obstructed breathing during sleep can lead to cardiovascular repercussions. These abnormalities may expose these children to increased anesthetic and surgical risks.J Pediatr (Rio J). 2007;83(6):518-522: Obstructive sleep apnea, child, echocardiography. IntroduçãoO quadro clínico de obstrução das vias aéreas superiores (VAS) no sono varia de intensidade, desde roncos noturnos à síndrome da apnéia hipopnéia obstrutiva do sono (SAHOS) 1 .A SAHOS é caracterizada por episódios repetidos de obstrução das VAS, associados à hipóxia e hipercapnia intermitente 1,2 . Sua prevalência nas crianças varia de 0,7 a 3% nos diferentes estudos epidemiológicos [3][4][5] . O seu pico de incidên-cia é observado...

Prevalência de sintomas de distúrbios respiratórios do sono em escolares brasileiros

“…In addition to the data described here, a recent study that was published in this same Jornal de Pediatria indicates that there is an important association between SDB and cardiovascular repercussions. 36 Our findings are important to alert the medical community and the general public to the highly prevalent symptoms related to sleep, which can be investigated and for which treatment exists. The relationship between SDB and poor performance at school detected in this study merits the attention of future studies, due to the impact that this finding could have on the community as a whole.…”

Longitudinal Cardiovascular Outcomes of Sleep Disordered Breathing in Children: A Meta-Analysis and Systematic Review

“…Cross-sectional studies suggest that SDB is associated with elevated BP in children and linked to higher left ventricular mass and left ventricular diastolic dysfunction. 17,22,73 The E/A ratio is a measure of diastolic function. Although baseline values for mitral E/A ratios were normal (>1), there was a significant increase in Em/Am ratio with treatment without a significant change in E/A ratio.…”

Indication and the Efficacy of Adenoidectomy in Infancy

“…Unfortunately we are unable to classify the severity of UA obstruction in these children in order to correlate the degree of echocardiographic findings with the number of obstructive respiratory events or of oxyhemoglobin desaturation episodes. Silke Anna et al, Saied that neither polysomnography nor cardiorespiratory monitoring are carried out as routine for adenotonsillectomy indicated due to UA obstruction in order to quantify sleeping obstructive respiratory events and confirm the diagnosis of OSA [21].…”