Left Ventricular Hypertrophy and Abnormal Ventricular Geometry in Children and Adolescents with Obstructive Sleep Apnea

Amin, Raouf S.; Kimball, Thomas R.; Bean, Judy A.; Jeffries, Jenny L.; Willging, J. Paul; Cotton, Robin T.; Witt, Sandra A.; Glascock, Betty J.; Daniels, Steven R.

doi:10.1164/rccm.2105118

Cited by 407 publications

(261 citation statements)

References 36 publications

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“…This enlargement of the RV has also been observed in other studies, [13][14][15][16][17] although not with adjustment for the weight and height of each child.…”

Section: Discussionsupporting

confidence: 83%

“…16 The severity of obstructive respiratory events during sleep, expressed by the more elevated rates of apnea and hypopnea, suggest that they are directly correlated with LV abnormalities. 17 There is sufficient pathophysiologic evidence to allow for the suspicion that children with UA obstruction during sleep exhibit structural and functional cardiac abnormalities, notably of the right ventricle.…”

Section: Introductionmentioning

confidence: 99%

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Alterações ecocardiográficas em crianças com distúrbios respiratórios obstrutivos no sono

Weber¹,

Montovani²,

Matsubara³

et al. 2007

J. Pediatr. (Rio J.)

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Objectives: 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.

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“…This enlargement of the RV has also been observed in other studies, [13][14][15][16][17] although not with adjustment for the weight and height of each child.…”

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Alterações ecocardiográficas em crianças com distúrbios respiratórios obstrutivos no sono

Weber¹,

Montovani²,

Matsubara³

et al. 2007

J. Pediatr. (Rio J.)

View full text Add to dashboard Cite

show abstract

“…Immediate consequences of OSAS are sleep fragmentation, arousal, poor school/job performance, irritability, intermittent hypercapnia and hypoxemia, nocturnal hypertension and marked changes in autonomic control of the cardiovascular system. 88 The long-term consequences of OSAS include sustained daytime and nocturnal hypertension, 89,90 cor pulmonale, left ventricular hypertrophy 91 and increased cardiovascular and cerebrovascular morbidity and mortality. 92 Indeed, cross-sectional results from the Sleep Heart Health Study showed a strong association between OSAS, heart failure and stroke.…”

Section: Cardiovascular Risksmentioning

confidence: 99%

Bariatric surgery for pediatric extreme obesity: now or later?

2006

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Obesity is a multifactorial disease of epidemic and global proportions that poses the most significant threat to the health of our younger generations. Those who are the most extremely affected bear the largest burden of health problems. In the US, extreme obesity affects approximately 9 million adults and 2 million children, and is associated with both immediate health problems and later health risk, including premature mortality. Present medical and behavioral interventions for extreme obesity in adults and children rarely result in the significant, durable weight loss necessary to improve health outcomes, prompting a search for more aggressive measures. Weight loss (bariatric) surgery has been advocated as an intervention for those with extreme obesity. In adults, bariatric surgery results in prolonged weight control and improvement in serious obesity comorbidities, namely type 2 diabetes, dyslipidemias, hypertension and obstructive sleep apnea syndrome. A surge in weight loss operations for adolescents has been observed recently, with a threefold increase in case volumes nationwide from 2000 to 2003. Current evidence suggests that after bariatric surgery, adolescents lose significant weight and serious obesity-related medical conditions and psychosocial status are improved. Thus it is reasonable to propose that bariatric surgery performed in the adolescent period may be more effective treatment for childhood-onset extreme obesity than delaying surgery for extremely obese youth until adulthood. This position has been echoed by a number of groups and an independent systematic review. Finally, it is conceivable that bariatric surgery performed in adulthood for childhood onset extreme obesity may not be as effective for comorbidity treatment as surgery performed earlier during adolescence. The purpose of this review is to examine the evidence, which supports early rather than later use of bariatric surgery in the treatment of extreme obesity, and to present this information in light of the medical and surgical risks of bariatric surgery.

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“…O aumento de VD tem sido observado em outros estudos [13][14][15][16][17] , embora não ajustado para peso e altura de cada criança.…”

Section: Segundo Steiner and Straunerunclassified

“…A cirurgia de adenotonsilectomia também resultou em melhora dos parâmetros de fluxo pulmonar e de área de VD em crianças com hipertensão pulmonar, relacionada à obstrução das VAS 16 . A gravidade de eventos respiratórios obstrutivos no sono, expressa pelo índice de apnéia e hipopnéia mais elevado, sugere estar correlacionada diretamente com alterações em VE 17 .…”

Section: Introductionunclassified

Echocardiographic abnormalities in children with obstructive breathing disorders during sleep

Weber¹,

Montovani²,

Matsubara³

et al. 2007

J Pediatr (Rio J)

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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...

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Left Ventricular Hypertrophy and Abnormal Ventricular Geometry in Children and Adolescents with Obstructive Sleep Apnea

Cited by 407 publications

References 36 publications

Alterações ecocardiográficas em crianças com distúrbios respiratórios obstrutivos no sono

Alterações ecocardiográficas em crianças com distúrbios respiratórios obstrutivos no sono

Bariatric surgery for pediatric extreme obesity: now or later?

Echocardiographic abnormalities in children with obstructive breathing disorders during sleep

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