The effect of adenotonsillectomy on pulmonary hypertension in pediatric obstructive sleep apnea

Abstract

Background In a majority of OSA children with adenotonsillar hypertrophy, very mild symptoms or no symptoms at all are related to the cardiopulmonary system, but symptomless chronic changes may slowly occur in these children. Therefore, it is wise to monitor these patients by an easy, noninvasive cost-effective method; this can easily be done by monitoring mean pulmonary artery pressure (mPAP) of these children with Doppler echocardiography. Doppler echocardiography has been demonstrated to have a perfect correlation with cardiac catheterization. This study aims to determine the pulmonary arterial systolic pressure (PASP) in OSA children with hypertrophied tonsils and adenoid and to clarify whether adenotonsillectomy has any effect on pulmonary arterial pressure of these children. Methods Study was conducted on 50 children of both sexes aged from 4 to 15 years. Children complain of loud snoring and obstructive sleep apnea due to hypertrophied tonsils and adenoids. Children fit for general anesthesia and adenotonsillectomy. In all subjects, Doppler echocardiography was done before and after adenotonsillectomy. Results Comparison between preoperative PASP and after 2 months showed that normal PASP were found in 25 (50.0%) and 50 (100.0%) for preoperative and after 2 months respectively. There was statistically significant difference between preoperative PASP and after 2 months. However, there was no correlation between preoperative PASP and age, sex, or duration of symptoms. Conclusion From this study, we conclude that adenotonsillar hypertrophy causes higher PASP in OSA children, PASP is worse in neglected OSA cases with long duration of symptoms, and adenotonsillectomy is an effective therapeutic measure in such patients.

Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review

“…Tables 1 and 2 show studies conducted over the past 20 years, each with a different research purpose and study methods. The available studies can be classified as observational studies (n.2) [16,17], retrospective studies (n.3) [18][19][20], cross-sectional studies (n.4) [21][22][23][24], comparative studies (n.2) [25,26], prospective studies (n.8) [27][28][29][30][31][32][33][34], and clinical trial (n.1) [35].…”

“…The authors of these studies used various methods to assess OSA and its effects on the cardiovascular system in children. The diagnosis of OSA was obtained by PSG [18][19][20][21]26,28,35], oximetry [34], and questionnaire OSA-18 [16,17,22,23,32]. Diagnosis of adenoid/tonsillar hypertrophy was obtained using Brodsky's Scale in three studies [22][23][24] and by taking X-rays in four studies [22,30,32,35].…”

“…The diagnosis of OSA was obtained by PSG [18][19][20][21]26,28,35], oximetry [34], and questionnaire OSA-18 [16,17,22,23,32]. Diagnosis of adenoid/tonsillar hypertrophy was obtained using Brodsky's Scale in three studies [22][23][24] and by taking X-rays in four studies [22,30,32,35]. ENT surgery was reported as adenoidectomy [16,17,[20][21][22]25,[27][28][29][30][31][32][33]35], tonsillectomy [29,32], and A&T [16,17,[20][21][22]25,[28][29][30][31][32][33]35].…”

“…Diagnosis of adenoid/tonsillar hypertrophy was obtained using Brodsky's Scale in three studies [22][23][24] and by taking X-rays in four studies [22,30,32,35]. ENT surgery was reported as adenoidectomy [16,17,[20][21][22]25,[27][28][29][30][31][32][33]35], tonsillectomy [29,32], and A&T [16,17,[20][21][22]25,[28][29][30][31][32][33]35]. A cardiac evaluation was performed by Doppler echocardiography [16,17,22,24,[27][28][29][30] and the analysis of various cardiac parameters [16,17,25,27,…”

“…ENT surgery was reported as adenoidectomy [16,17,[20][21][22]25,[27][28][29][30][31][32][33]35], tonsillectomy [29,32], and A&T [16,17,[20][21][22]25,[28][29][30][31][32][33]35]. A cardiac evaluation was performed by Doppler echocardiography [16,17,22,24,[27][28][29][30] and the analysis of various cardiac parameters [16,17,25,27,[29][30][31][32]. Some studies also involved monitoring biomarkers such as CRP [18] and NT-proBNP [18].…”