Effect of Adenoidectomy and/or Tonsillectomy on Cardiac Functions in Children with Obstructive Sleep Apnea

Abstract

Background/Aims: We aimed to determine the effects of adenoidectomy and/or tonsillectomy (AT) on cardiac functions in children with adenoid and/or tonsillary hypertrophy and obstructive sleep apnea syndrome (OSAS) by using echocardiography with tissue Doppler imaging facility (TDI). Methods: Twenty-nine children with adenoid and/or tonsillary hypertrophy and OSAS and 26 children with primary snoring entered the study. Cardiac functions were assessed by echocardiography with TDI in both groups. Tests were repeated in the OSAS group 6 months after treatment with AT. Results: Echocardiography showed a decrease in estimated pulmonary artery systolic pressure from 31 ± 4.2 to 13.1 ± 2.3 (p < 0.001). In TDI, tricuspid E_m and E_m/A_m increased from 11.0 ± 2.7 to 13.5 ± 2.7 cm/s (p < 0.001), and 1.46 ± 0.52 to 1.82 ± 0.53 (p = 0.004), respectively, following AT, indicating improvement in right ventricular diastolic dysfunction. Similarly, mitral E_mand E_m/A_m increased from 12.3 ± 2.1 to 16.3 ± 2.7 cm/s, and from 1.65 ± 0.51 to 2.30 ± 0.54, respectively (p < 0.001). There was no significant difference between postoperative values and control group values. Conclusion: TDI is a technique able to detect diastolic dysfunction unnoticeable by conventional echocardiography. Following AT, we observed improvement in both left and right ventricular diastolic functions using TDI.

Urine levels of catecholamines in Greek children with obstructive sleep‐disordered breathing

“…1 Several pathophysiologic mechanisms related to cardiovascular morbidity have also been identified in children with obstructive sleep apnea. Elevated blood pressure, 2 changes in cardiac structure and function, [3][4][5] increased fasting insulin and lipid levels, 6,7 chronic inflammation 8 and endothelial dysfunction 9 most likely predispose children with obstructive sleep apnea to future cardiovascular disease. All the above secondary effects of sleep apnea are probably the result of increased work of breathing, more negative than usual intrathoracic pressure, arousals from sleep and gas exchange abnormalities which are the immediate consequences of intermittent upper airway obstruction during sleep.…”

The effect of adenotonsillectomy on right ventricle function and pulmonary artery pressure in children with adenotonsillar hypertrophy

“…Hypoxia may result in respiratory acidosis which in turn may lead to pulmonary artery vasoconstriction and increased RV dysfunction. Pulmonary vascular resistance was clearly increased to maintain cardiac output and resulted in a dialated RV, increased pulmonary pressure and the development of cor pulmonae [2,5]. Symptoms of PH may not be obvious until severe cardiac decompensation [10].…”

“…The relationship between ATH and other diseases such as cardiovascular and pulmonary disorders was reported in previous studies [1][2][3][4]. It is well known that ATH is one of the most common causes of upper respiratory tract obstruction, obstructive sleep apnea (OSA) and hypoxia in children [2]. Severe upper respiratory tract obstruction may have an effect on chronic alveolar hypoventilation, which consequently may lead to right ventricle (RV) dysfunction induced by hypoxemic pulmonary vasoconstriction.…”

“…Echocardiography is one of the most important noninvasive methods to diagnose for structural heart disease in children [6]. Previous conventional echocardiography studies have shown that upper respiratory tract obstruction causes pulmonary hypertension (PH) and right ventricle (RV) dysfunction [2,[7][8][9][10][11][12]. Although the standard test for the evaluation of pulmonary artery pressure is performed by highly invasive cardiac catheterization, Doppler echocardiography has been demonstrated to have a perfect correlation with cardiac catheterization [13,14].…”

Effect of tonsillectomy and/or adenoidectomy on pulmonary arterial pressure in adults

“…Mustafa et al .found that elevated PAP is present in 50 % of children undergoing tonsiloadenectomy [7]. Mehmet et al found a decrease in estimated pulmonary artery systolic pressure from 31±4.2 to 13.1 ± 2.3 after tonsillectomy and/ or adenoidectomy in adult [8].…”