Sleep-Disordered Breathing is Associated With Increased Mortality in Hospitalized Infants With Congenital Heart Disease

Combs, Daniel; Skrepnek, Grant H.; Seckeler, Michael D.; Barber, Brent J.; Morgan, Wayne J.; Parthasarathy, Sairam

doi:10.5664/jcsm.7334

Cited by 13 publications

(7 citation statements)

References 32 publications

(33 reference statements)

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“…Indeed, it has been shown that morbidity of patients with congenital heart defects is higher if they also have SDB. 10 Our patient with a complex genetic condition including congenital heart defects, developmental delay, KFS, and SDB highlights the variability in pathophysiology. It remains possible that that a pleiotropic genetic defect acting earlier in development may contribute to CSA/SBD and congenital heart defects.…”

Section: Discussionmentioning

confidence: 86%

Central sleep apnea and Chiari 1 malformation in a pediatric patient with Klippel-Feil syndrome

Martirosyan

Malhotra

2020

Journal of Clinical Sleep Medicine

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Klippel-Feil sequence (KFS) is a rare congenital condition that presents with congenital cervical spine fusion, reduced cervical spine flexion, and low posterior hairline. Chiari malformation type 1 and sleep-disordered breathing (SDB) are frequent comorbidities of KFS. The pathologic basis of the connection between Chiari malformation type 1 and SDB in the setting of KFS is not clearly understood. Here we report a pediatric patient with KFS, SDB, and drooling who also had Chiari malformation type 1. Posterior fossa decompression of this patient significantly improved most symptoms including sleep disturbances. Repeat polysomnogram 8 weeks after posterior fossa decompression revealed worsening central sleep apnea despite the patient being clinically asymptomatic. Taken together, this case highlights the point that, although it is critical to recognize the association of SDB in the setting of KFS, decompression alone may not be sufficient to completely alleviate SDB and certain neurologic symptoms.

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Section: Discussionmentioning

confidence: 86%

Central sleep apnea and Chiari 1 malformation in a pediatric patient with Klippel-Feil syndrome

Martirosyan

Malhotra

2020

Journal of Clinical Sleep Medicine

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“…CSA in infants with congenital heart disease is associated with a fourfold increase in mortality 13 . However, the study describing these findings did not report prevalence of HF or its association with CSA.…”

Section: Introductionmentioning

confidence: 91%

Heart failure is not a determinant of central sleep apnea in the pediatric population

Wheeler

Tutrow

Ebenroth

et al. 2021

Pediatric Pulmonology

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Background/Objectives Adults with heart failure (HF) have high prevalence of central sleep apnea (CSA). While this has been repeatedly investigated in adults, there is a deficiency of similar research in pediatric populations. The goal of this study was to compare prevalence of CSA in children with and without HF and correlate central apneic events with heart function. Methods Retrospective analysis of data from children with and without HF was conducted. Eligible children were less than 18 years old with echocardiogram and polysomnogram within 6 months of each other. Children were separated into groups with and without HF based on left ventricular ejection fraction (LVEF). Defining CSA as central apnea‐hypopnea index (CAHI) more than 1/hour, the cohort was also classified into children with and without CSA for comparative study. Results A total of 120 children (+HF: 19, −HF: 101) were included. The +HF group was younger, with higher prevalence of trisomy 21, muscular dystrophy, oromotor incoordination, and structural heart disease. The +HF group had lower apnea‐hypopnea index (median: 3/hour vs. 8.6/hour) and lower central apnea index (CAI) (median: 0.2/hour vs. 0.55/hour). Prevalence of CSA was similar in both groups (p = .195). LogCAHI was inversely correlated to age (Pearson correlation coefficient: −0.245, p = .022). Children with CSA were younger and had higher prevalence of prematurity (40% vs. 5.3%). There was no significant difference in LVEF between children with and without CSA. After excluding children with prematurity, relationship between CAHI and age was no longer sustained. Conclusions In contrast to adults, there is no difference in prevalence of CSA in children with and without HF. Unlike in adults, LVEF does not correlate with CAI in children. Overall, it appears that central apneic events may be more a function of age and prematurity rather than of heart function.

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“…However, only central apnea (4% of the infants) and not OSA was associated with increased mortality, while OSA and central apnea were associated with longer hospital stay and increased total charges when compared with infants without SDB. 68 …”

Section: Diagnostic Evaluation Of Sdb and Osa Syndromementioning

confidence: 99%

Sleep‐Disordered Breathing and Cardiovascular Disease in Children and Adolescents

Smith¹,

Isaiah²,

Melendres³

et al. 2021

JAHA

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Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular disease in adults. It is associated with incident systemic hypertension, arrhythmia, stroke, coronary artery disease, and heart failure. OSA is common in children and adolescents, but there has been less focus on OSA as a primary risk factor for cardiovascular disease in children and adolescents. This scientific statement summarizes what is known regarding the impact of sleep‐disordered breathing and, in particular, OSA on the cardiovascular health of children and adolescents. This statement highlights what is known regarding the impact of OSA on the risk for hypertension, arrhythmia, abnormal ventricular morphology, impaired ventricular contractility, and elevated right heart pressure among children and adolescents. This scientific statement also summarizes current best practices for the diagnosis and evaluation of cardiovascular disease–related complications of OSA in children and adolescents with sleep apnea and highlights potential future research in the area of sleep‐disordered breathing and cardiovascular health during childhood and adolescence.

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Sleep-Disordered Breathing is Associated With Increased Mortality in Hospitalized Infants With Congenital Heart Disease

Abstract: SDB, particularly central sleep apnea, was independently associated with worse outcomes in hospitalized infants with CHD. Further research on whether treatment of SDB in infants with CHD can abrogate adverse patient outcomes is needed.

Cited by 13 publications

References 32 publications

Central sleep apnea and Chiari 1 malformation in a pediatric patient with Klippel-Feil syndrome

Central sleep apnea and Chiari 1 malformation in a pediatric patient with Klippel-Feil syndrome

Heart failure is not a determinant of central sleep apnea in the pediatric population

Sleep‐Disordered Breathing and Cardiovascular Disease in Children and Adolescents

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