Echocardiographic screening in children with very severe obstructive sleep apnea

Teplitzky, Taylor B.; Pereira, Kevin D.; Isaiah, Amal

doi:10.1016/j.ijporl.2019.109626

Cited by 16 publications

(19 citation statements)

References 33 publications

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“…20 Our results are consistent with previous studies that abnormalities on preoperative echocardiograms are not directly associated with OSAS severity. 14,19 To our knowledge, this is the first study to evaluate preoperative CXR findings and OSAS severity, and we found no association. Unexpected abnormalities on echocardiogram and CXR CXR abnormal 0.09 0.3 (0.1-2.5) 0.5 (0.1-3.3) 0.6 (0.1-4.7) P = .11 † * Reference categories: 10 to 29.9 for OAHI ≥30, 10 to 39.9 for OAHI ≥40, 10 to 49.9 for OAHI ≥50, 10 to 59.9 for OAHI ≥60.…”

Section: Discussionmentioning

confidence: 56%

“…For instance, Teplitzky and colleagues analyzed echocardiogram results in pediatric patients with OAHI ≥30 and found no association between polysomnographic parameters and preoperative echocardiographic abnormalities. 14 The mean OAHI for patients in our severe OSA population was 30.3 (AE 23.8), and 61 of 358 (17%) patients had an OAHI ≥50. Due to the number of patients with substantially more severe OSAS than OAHI of 30, we were able to evaluate subgroups with higher OAHIs than previous studies.…”

Section: Discussionmentioning

confidence: 74%

“…19 In the aforementioned study by Teplitzky and colleagues, all 47 patients aged 1 to 17 years old with very severe OSAS (OAHI ≥30) had normal echocardiograms. 14 However, a literature review of 25 studies including 932 patients by Ingram and colleagues reported variable prevalence of pulmonary hypertension ranging from 0% to 85% in pediatric patients with OSAS; they also found that 6% to 24% of pediatric patients with pulmonary hypertension have OSAS. 20 The review did not exclude those with genetic syndromes or other comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…These findings suggest that in pediatric patients with severe OSAS, even very severe OSAS, these tests usually do not reveal new information as pediatric patients with severe OSAS by polysomnogram do not seem to experience the same cardiopulmonary complications seen in the adult population with severe OSAS. 11,14,18,19 This difference may be related to shorter intervals between pediatric OSAS onset and treatment compared to adults or different physiologic responses to severe OSAS based on age. Echocardiogram and CXR may be unnecessary and low-yield in pediatric patients in the absence of another clinical indication, such as severe obesity, systemic hypertension, congenital heart disease, chronic lung disease, or a genetic syndrome that is associated with these comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Some pediatric patients with a very high OAHI can be considered to have very severe OSAS, although that is not a well‐defined category. Isaiah and colleagues as well as Teplitzky and colleagues have previously evaluated outcomes in very severe pediatric OSAS as defined as OAHI ≥30 in patients ages 2 to 12 and 1 to 17 years old, respectively 13,14 …”

Section: Introductionmentioning

confidence: 99%

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Cardiopulmonary Testing before Pediatric Adenotonsillectomy for Severe and Very Severe Obstructive Sleep Apnea Syndrome

et al. 2021

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Objectives/Hypothesis: Adenotonsillectomy is first-line treatment for pediatric obstructive sleep apnea syndrome (OSAS) when not otherwise contraindicated. There is concern severe OSAS increases risk of comorbid cardiopulmonary abnormalities, such as ventricular hypertrophy or pulmonary hypertension, which preoperative testing could detect. Our objective is to determine if there is a severity of pediatric OSAS where previously undetected cardiopulmonary comorbidities are likely.Study Design: Retrospective chart review. Methods: We performed a retrospective review of 358 patients ≤21 years with severe OSAS who underwent adenotonsillectomy at a tertiary hospital June 1, 2016 to June 1, 2018. We extracted demographics, comorbidities, polysomnography, and preoperative tests. Wilcoxon rank-sum and logistic regression estimated associations of OSAS severity (based on obstructive apnea-hypopnea index [OAHI], hypoxia, hypercarbia) with preoperative echocardiograms and chest Xrays (CXRs).Results: Mean age was 5.9 (AE3.6) years and 52% were male. Mean OAHI and oxygen saturation nadir were 30.3 (AE23.8) and 80.7% (AE9.2), respectively. OAHI ≥60 was associated with having a preoperative echocardiogram (OR, 3.8; 95% CI, 1.7-8.5) or CXR (OR, 3.0; 95% CI, 1.4-6.8) compared to OAHI 10-59. There were no significant associations between OSAS severity and test abnormalities. The presence of previously diagnosed cardiopulmonary comorbidities was associated with abnormalities on echocardiogram (OR, 36; 95% CI, 4.1-320.1) and CXR (OR, 4.1; 95% CI, 1.2-14.4).Conclusions: Although pediatric patients with very severe OSAS (OAHI ≥60) underwent more pre-adenotonsillectomy cardiopulmonary tests, OSAS severity did not predict abnormal findings. Known cardiopulmonary comorbidities may be a better indication for cardiopulmonary testing than polysomnographic parameters, which could streamline pre-adenotonsillectomy evaluation and reduce cost.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 74%