Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea

Maloney, McKenzie; Ward, Sally L. Davidson; Su, Jennifer; Durazo‐Arvizu, Ramón; Breunig, Jacqueline M; Okpara, D.U.; Gillett, Emily

doi:10.5664/jcsm.9944

Cited by 12 publications

(12 citation statements)

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“…Despite the relationship between OSA and pulmonary hypertension, the literature regarding this in children is limited. A recent study by Maloney et al has identified CO 2 retention on the overnight PSG to be the significant risk factor for PH in children with severe OSA (AHI > 10/hr) [ 6 ]. Since our cohort included children with very severe OSA and gas exchange abnormalities, one would expect to see a higher incidence of PH.…”

Section: Discussionmentioning

confidence: 99%

“…Childhood obesity, craniofacial anomalies, and neuromuscular disorders significantly increase the risks of OSA [ 2 ]. OSA in children is linked to poor behavioral and emotional health, metabolic alterations, pulmonary and systemic hypertension, and overall decreased quality of life [ 3 , 4 , 5 , 6 , 7 ]. Therefore, appropriate diagnosis and management should be established early, to decrease such morbidities.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea

et al. 2022

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Available information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited. Our study evaluates the clinical features and polysomnographic (PSG) variables that predict post-operative outcomes in children with an obstructive apneal hypopnea index (AHI) of more than 25 events/hr. In this study from a single tertiary care center, we performed a retrospective chart review of patients with an AHI > 25/hr, who underwent tonsillectomy and adenoidectomy (T&A) between January 2016 and September 2021. In total, 50 children were included in the study: 26.0% (13/50) of children experienced post-operative respiratory events and four children needed intubation and ventilator support. Compared with children without respiratory events, children requiring post-operative respiratory interventions were younger (4.4 ± 5.2 vs. 8.0 ± 5.2 years; p = 0.04), had higher pre-operative AHI (73.6 ± 27.4 vs. 44.8 ± 24.9; p < 0.01), lower oxygen nadirs (70.0 ± 13.0% vs. 83.0 ± 7.0%; p < 0.01), and had lower body metabolic index Z-scores (−0.51 ± 2.1 vs. 0.66 ± 1.5; p < 0.04). Moderate to severe residual OSA was identified in 70% (24/34) of children with available post-operative PSG; younger children had better PSG outcomes. Our study shows that post-operative respiratory events are frequent in children with very severe OSA, particularly with an AHI > 40/h, younger children (<2 years of age), lower oxygen saturation (SpO2), and poor nutritional status, necessitating close monitoring.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea

et al. 2022

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“…Other components of the workup for OSA include TSH and free T4 levels to screen for hypothyroidism, and echocardiogram to look for pulmonary hypertension (particularly when severe OSA or sleep-related hypoventilation is present) [36]. Patients should also be screened for symptoms of gastroesophageal reflux disease (GERD) as it can worsen OSA [37].…”

Section: Treatment Of Sleep-related Breathing Disordersmentioning

confidence: 99%

Sleep Consequences of Prader-Willi Syndrome

Itani

Gillett

Perez

2023

Curr Neurol Neurosci Rep

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Purpose of Review This paper reviews how sleep is impacted in patients with Prader-Willi syndrome (PWS), focusing on sleep-related breathing disturbances and excessive daytime sleepiness (EDS). Recent Findings Hypothalamic dysfunction may underlie several aspects of the PWS phenotype. Central sleep apnea (CSA) can persist beyond infancy. Nocturnal hypoventilation is common and may occur without central or obstructive sleep apnea (OSA). Adenotonsillectomy, a mainstay of OSA treatment, may cause velopharyngeal insufficiency. Growth hormone (GH) is considered safe, but close surveillance for OSA remains important. Cardiac autonomic dysfunction occurs during slow wave sleep and may increase the risk of cardiovascular events. EDS and narcolepsy are also common. Modafinil and pitolisant are treatment options currently being studied. Summary Sleep disorders are prevalent in individuals with PWS. Sleep-related breathing disorders present as CSA in infancy and later in life as OSA and hypoventilation. GH therapy has improved the clinical outcomes of patients with PWS, but close surveillance and treatment for OSA is recommended. EDS can persist even after sleep-related breathing disorders are treated, and some individuals may even develop narcolepsy. Early recognition and treatment of sleep-related disorders may prevent morbidity and result in improved survival of patients with PWS.

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“…Previous research has described the prevalence of OSA in children with initially diagnosed PH ranging between 6% and 24%, 4,11,21 with the inverse prevalence of PH in children with initially diagnosed OSA demonstrating a wider range from 0% to 85%. 4,[22][23][24][25] When considering other forms of sleep-disordered breathing (SDB), one retrospective study of children with severe OSA showed an increased prevalence of sleep-related hypoventilation in children with PH. 25…”

Section: Introductionmentioning

confidence: 99%

“…4,[22][23][24][25] When considering other forms of sleep-disordered breathing (SDB), one retrospective study of children with severe OSA showed an increased prevalence of sleep-related hypoventilation in children with PH. 25…”

Section: Introductionmentioning

confidence: 99%

Occurrence of sleep‐disordered breathing in children with pulmonary hypertension

Ignatiuk,

Miles,

Gurbani

et al. 2023

Pediatric Pulmonology

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BackgroundObstructive sleep apnea (OSA) has been associated with pulmonary hypertension (PH) through a complex and bidirectional relationship. The prevalence of OSA and other forms of sleep‐disordered breathing (SDB) among children with PH is not well understood. A better understanding could help elucidate contributing factors for PH, guide diagnostic testing, and inform therapies. We therefore determined the proportion of SDB codiagnosis and OSA risk factors among a cohort of children with PH.MethodsRetrospective chart review was performed for children 0−21 years old with PH who underwent polysomnography (PSG) between 1 January 2010 and 31 August 2020. The primary outcome was OSA occurrence and risk based on demographics, diagnoses, and PH classification. The secondary outcome was occurrence and risk of other SDB diagnoses based on PH classification.ResultsAmong 89 children identified, diagnoses included OSA (N = 79, 89%), central sleep apnea (N = 11, 12%), sleep‐related hypoventilation (N = 6, 7%), and non‐apneic hypoxemia (N = 28, 31%). Trisomy 21 diagnosis (N = 38, 43%) was associated with increased OSA risk (RR: 1.24, 95% CI: [1.09−1.42]) and age >12 months at PSG was associated with decreased OSA risk (N = 52, 58%, RR: 0.60, 95% CI: [0.45−0.81]). There was no difference in SDB risk based on Group 1 (N = 56, 63%) or Group 3 (N = 33, 37%) PH and no difference in OSA severity based on demographics and diagnoses.ConclusionOSA was diagnosed among a majority of children with PH, and other SDB diagnoses were identified in a significant proportion of children. These findings support routine screening for SDB with PSG in children with PH.

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Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea

Cited by 12 publications

References 65 publications

Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea

Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea

Sleep Consequences of Prader-Willi Syndrome

Occurrence of sleep‐disordered breathing in children with pulmonary hypertension

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