Longitudinal Cardiovascular Outcomes of Sleep Disordered Breathing in Children: A Meta-Analysis and Systematic Review

Ehsan, Zarmina; Ishman, Stacey L.; Kimball, Thomas R.; Zhang, Nanhua; Zou, Yuanshu; Amin, Raouf S.

doi:10.1093/sleep/zsx015

Cited by 57 publications

(37 citation statements)

References 66 publications

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“…On the other hand, there was no significant change in interventricular septum thickness, left ventricular parameters, or left atrial diameter. 16 In addition, Loffredo et al published a study in 2015 of children with OSA and compared to children with primary snoring and healthy controls while evaluating endothelial dysfunction based on oxidative stress. The OSA patients’ oxidative stress improved after adenotonsillectomy, demonstrating a possible reduced cardiovascular risk in OSA children.…”

Section: Resultsmentioning

confidence: 99%

The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews

Reckley

Fernandez-Salvador

Camacho

2018

NSS

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ObjectiveTonsillectomy with adenoidectomy is a combination surgery that has been used to treat pediatric obstructive sleep apnea (OSA). For adults, tonsillectomy has also been reported as a primary treatment modality when the tissue is hypertrophied. The objective of this study is to provide an overview of published systematic reviews and meta-analyses of tonsillectomy with or without adenoidectomy as used in the treatment of OSA in children and adults.Data sourcesNine databases, including PubMed/MEDLINE.Review methodsDatabases were searched from their inception through July 9, 2017. The PRISMA statement was followed.ResultsMore than 20 recent systematic reviews and meta-analyses were identified regarding tonsillectomy as a treatment modality for OSA. There were four articles that addressed tonsillectomy’s overall success, efficacy, and complications in otherwise healthy pediatric patients. Three studies evaluated tonsillectomy in obese children, and two specifically examined children with Down syndrome. Only one systematic review and meta-analysis discussed tonsillectomy as a treatment for OSA in the adult population.ConclusionTonsillectomy as an isolated treatment modality is rarely performed in pediatric patients with OSA; however, tonsillectomy is commonly performed in combination with adenoidectomy and the combination has demonstrated efficacy as the primary treatment option for most children. In the limited adult data, tonsillectomy alone for OSA has a surprising success rate; yet, more research is required to determine long-term improvement and need for further treatment.

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Section: Resultsmentioning

confidence: 99%

The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews

Reckley

Fernandez-Salvador

Camacho

2018

NSS

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“…It has been theorized that OSA has a causal relationship with HTN because of association with increased arterial stiffness and sympathetic tone 25–27 . Furthermore, several studies in pediatric patients have demonstrated that adequate treatment of OSA (eg, via nighttime CPAP/BiPAP or curative tonsillectomy and adenoidectomy) can lead to improvements in BP 3,4 as well as other cardiovascular complications in adults (eg, right‐heart parameters, risk of myocardial infarction, or stroke) 1,2 . In addition, appropriate treatment of HTN/EBP can lead to the improvement of OSA severity 28 .…”

Section: Discussionmentioning

confidence: 99%

The relationship of hypertension with obesity and obstructive sleep apnea in adolescents

Khan

Mathur

Barraza

et al. 2020

Pediatric Pulmonology

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Objectives To assess the independent relationships of obesity and obstructive sleep apnea (OSA) with hypertension/elevated blood pressure (EBP) in adolescent patients. Study Design A retrospective cohort analysis was performed on 501 patients (age 13‐21 years) with three separate blood pressure measurements within 6 months of polysomnography. EBP was defined as average systolic blood pressure (SBP) ≤120 mm Hg; obesity as body mass index Z‐score ≤1.65; and OSA as obstructive apnea‐hypopnea index <1. Pearson correlations and multivariable analyses were performed to assess the independent effects of the apnea‐hypopnea index and body mass index Z‐score on SBP. Results Of 501 patients (mean age 16 ± 2 years), 246 (49%) were male. OSA was present in 329 (66%) patients, obesity in 337 (67%), and EBP in 262 (52%). EBP was present in 70% of obese adolescents and 60% of adolescents with OSA. Univariable correlation showed a significant relationship between SBP, body mass index Z‐score, and apnea‐hypopnea index. Multivariable linear regression analysis showed blood pressure was significantly associated with body mass index Z‐score (β = .46; P < .01), age (β = .25; P < .01), and height Z‐score (β = .14; P < .01), but not apnea‐hypopnea index (β = .01; P = .72). Conclusions The relationship between OSA and EBP in adolescents is most closely associated with the degree of obesity. Further studies are needed to assess the effect of the treatment of obesity and OSA on blood pressure in adolescents.

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“…Obstructive sleep apnea (OSA) is the result of upper airway obstruction (UAO) during sleep 1,2 . Children with OSA are at increased risk for growth failure, 3,4 neurocognitive impairment including hyperactivity and learning difficulties, 4‐6 and cardiovascular changes including impaired ventricular function and hypertension 7‐9 . Thus, early diagnosis and treatment of OSA in children are needed to mitigate the effects of these resultant comorbidities 6,10 .…”

Section: Introductionmentioning

confidence: 99%

High flow nasal cannula treatment for obstructive sleep apnea in infants and young children

Ignatiuk

Schaer

McGinley

2020

Pediatric Pulmonology

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Background Continuous positive airway pressure (CPAP) is the nonsurgical treatment of choice for children with obstructive sleep apnea (OSA). However, CPAP limitations include difficulty with adherence and midface hypoplasia risk. We, therefore, sought to assess the effect of warm humidified air delivered via open nasal cannula (HFNC) on OSA in children in the sleep laboratory and at home. Methods A retrospective review was performed among children recommended treatment of OSA with HFNC. Reasons for HFNC recommendation included poor surgical candidacy, residual OSA following surgery, and CPAP intolerance. Children underwent both diagnostic and HFNC titration sleep studies and were prescribed HFNC for home use. Standard sleep architecture, arousals, and apnea‐hypopnea indices (AHI) were assessed with the evaluation of reported adherence and complications over 12 months of treatment. Results Twenty‐two children (average 12.8 months, 95% confidence interval [95% CI: 7.0, 18.6]) with OSA (obstructive AHI [OAHI] range: 4.8‐89.2 events/h) underwent HFNC titration with significant reduction in OAHI (28.9 events/h [17.6, 40.2] vs 2.6 [1.1, 4.0]; P < .001) (mean [95% CI]). Nineteen patients received home HFNC treatment. By 12 months, four patients were lost to follow‐up and OSA resolved in three patients (16%). Of 12 remaining patients, 7 (58%) continued therapy while 5 (42%) discontinued due to intolerance. The most common treatment complication was cannula dislodgement. Additional complications included skin irritation, dry mucus membranes, restlessness, oxygen desaturation, and increased central apneas. Conclusion HFNC offers a treatment alternative to CPAP in infants and young children with OSA and was well tolerated at home in our study.

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Longitudinal Cardiovascular Outcomes of Sleep Disordered Breathing in Children: A Meta-Analysis and Systematic Review

Cited by 57 publications

References 66 publications

The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews

The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews

The relationship of hypertension with obesity and obstructive sleep apnea in adolescents

High flow nasal cannula treatment for obstructive sleep apnea in infants and young children

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