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Zaffanello M, Ersu RH, Nosetti L, Beretta G, Agosti M, Piacentini G. Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:208. [PMID: 38397319 PMCID: PMC10887195 DOI: 10.3390/children11020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
This review investigates the relationship between pediatric obstructive sleep apnea, often associated with adenotonsillar hypertrophy, and cardiovascular health, particularly pulmonary hypertension. We conducted a comprehensive literature search using electronic databases, including Medline Pub-Med, Scopus, and the Web of Science. The study analyzed a total of 230 articles and screened 48 articles, with 20 included in the final analysis, involving 2429 children. The PRISMA flowchart visually illustrates the selection process, and the ROBINS-E and -I tools help ensure the reliability and validity of the evidence produced by these studies. These studies explored various aspects, including the severity of obstructive sleep apnea, cardiac anomalies, cardiac stress markers, risk factors for pulmonary hypertension, and the impact of adenoidectomy and tonsillectomy on cardiac function. The research found that adenotonsillar hypertrophy and obstructive sleep apnea are significant risk factors for cardiovascular complications, especially pulmonary hypertension, in children. Adenoidectomy and tonsillectomy may provide effective treatments. Following adenoidectomy in relation to obstructive sleep apnea, there appears to be a reduction in mean pulmonary artery pressure during echocardiographic examination. However, the efficacy of these procedures can vary based on the severity of obstructive sleep apnea and individual cardiac conditions. The study also identified concerns regarding data bias. The authors emphasize the need for well-designed clinical studies, including both healthy patients with adenotonsillar hypertrophy and vulnerable children with genetic disorders, to ensure that clinical decisions are based on solid scientific evidence.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics, and Gynecology University of Verona, 37134 Verona, Italy;
| | - Refika Hamutcu Ersu
- Division of Pediatric Respirology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (G.B.)
| | - Giulio Beretta
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (G.B.)
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics, and Gynecology University of Verona, 37134 Verona, Italy;
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Reynolds AM, Spaeth AM, Hale L, Williamson AA, LeBourgeois MK, Wong SD, Hartstein LE, Levenson JC, Kwon M, Hart CN, Greer A, Richardson CE, Gradisar M, Clementi MA, Simon SL, Reuter-Yuill LM, Picchietti DL, Wild S, Tarokh L, Sexton-Radek K, Malow BA, Lenker KP, Calhoun SL, Johnson DA, Lewin D, Carskadon MA. Pediatric sleep: current knowledge, gaps, and opportunities for the future. Sleep 2023; 46:zsad060. [PMID: 36881684 PMCID: PMC10334737 DOI: 10.1093/sleep/zsad060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/19/2023] [Indexed: 03/09/2023] Open
Abstract
This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.
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Affiliation(s)
| | - Andrea M Spaeth
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
| | - Lauren Hale
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Ariel A Williamson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monique K LeBourgeois
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Sachi D Wong
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Lauren E Hartstein
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Jessica C Levenson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Misol Kwon
- Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, PA, USA
| | - Chantelle N Hart
- The Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA
- The Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Ashley Greer
- The Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Cele E Richardson
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | | | - Michelle A Clementi
- Clinical Sciences, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stacey L Simon
- Clinical Sciences, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lilith M Reuter-Yuill
- Comprehensive Speech and Therapy Center, Western Michigan University, Kalamazoo, MI, USA
| | - Daniel L Picchietti
- University of Illinois School of Medicine, Carle Illinois College of Medicine, Carle Foundation Hospital, and University of Illinois School of Medicine, Urbana, IL, USA
| | - Salome Wild
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Leila Tarokh
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Beth A Malow
- Departments of Neurology and Pediatrics, Burry Chair in Cognitive Childhood Development, Vanderbilt University Medical Center, Nashville, TN, USA
- Sleep Disorders Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristina P Lenker
- Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daniel Lewin
- Department of Pulmonary and Sleep Medicine, Children’s National Hospital, Washington, DC, USA
| | - Mary A Carskadon
- Bradley Hospital Sleep Lab, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Omer KA, Mlauzi R, Basera W, McGuire J, Meyer H, Lawrenson J, Peer S, Singh Y, Zampoli M. Low incidence of pulmonary hypertension in children with suspected obstructive sleep apnea: A prospective observational study. Int J Pediatr Otorhinolaryngol 2023; 171:111648. [PMID: 37419069 DOI: 10.1016/j.ijporl.2023.111648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES Pulmonary hypertension (PH) secondary to obstructive sleep apnea (OSA) is an uncommon but serious perioperative risk factor in children undergoing surgery for adenotonsillar hypertrophy. Routine pre-operative echocardiography is commonly requested if severe OSA is suspected. We investigated the incidence of PH in children with suspected OSA and explored the association between PH and OSA severity. METHODS A prospective study of children aged 1-13 years with suspected OSA admitted for overnight oximetry (OO) and echocardiography at a pediatric referral hospital in Cape Town, South Africa from 2018 to 2019. OSA severity was defined by McGill Oximetry Score (MOS): MOS 1-2 (mild-moderate) and MOS 3-4 (severe). PH was defined as mean pulmonary arterial pressure (mPAP) ≥20 mmHg estimated on echocardiographic criteria. Children with congenital heart disease, underlying cardio-respiratory or genetic disorders, and severe obesity were excluded. RESULTS One hundred and seventy children median age 3.8 years (IQR 2.7-6.4) were enrolled and 103 (60%) were female. Twenty-two (14%) had a BMIz >1.0 and 99 (59%) had tonsillar enlargement grade 3/4. One hundred and twenty-two (71%) and 48 (28%) children had mild-moderate and severe OSA, respectively. Echocardiographic assessment for PH was successful in 160 (94%) children of which eight (5%) had PH with mPAP 20.8 mmHg (SD 0.9): six with mild-moderate OSA and two with severe OSA. No significant difference in mPAP and other echocardiographic indices was observed in children with mild-moderate (16.1 mmHg; SD 2.4) and severe OSA (15.7 mmHg; SD 2.1). Similarly, no clinical and OSA severity differences were observed in children with and without PH. CONCLUSION PH is uncommon in children with uncomplicated OSA and there is no association of PH with severity of OSA measured by OO. Routine echocardiographic screening for PH in children with clinical symptoms of OSA without co-morbidity is unwarranted.
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Affiliation(s)
- Khadar A Omer
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Raphael Mlauzi
- Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town. Burden of Disease Research Unit, South African Medical Research Council, South Africa
| | - Jessica McGuire
- Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - Heidi Meyer
- Division of Paediatric Anaesthesia, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa
| | - John Lawrenson
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town. Department of Paediatrics and Child Health, Stellenbosch University, South Africa
| | - Shazia Peer
- Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - Yanita Singh
- Paediatric Cardiology Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Marco Zampoli
- Department of Paediatrics and Child Health, University of Cape Town, South Africa.
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Johnson ZJ, Lestrud SO, Hauck A. Current understanding of the role of sleep-disordered breathing in pediatric pulmonary hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Nemati S, Aghajankhah M, Banan R, Haddadi S, Mehri M, Aghsaghloo V, Leili EK. The effects of adeno/tonsillectomy on cardiopulmonary function based on echocardiography indices in children with primary snoring and mild obstructive sleep apnea. Am J Otolaryngol 2022; 43:103317. [PMID: 35093617 DOI: 10.1016/j.amjoto.2021.103317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the effects of adenotonsillectomy on heart function based on echocardiography indices in children with primary snoring (PS) and mild obstructive sleep apnea due to adenotonsillar hypertrophy (ATH). METHODS 55 children (aged 7 to 11 years old) with PS and ATH who were a candidate for adenotonsillectomy from August 2018 to June 2019 evaluated. A history of Upper Respiratory Tract Obstruction was obtained, clinical examination was performed and the cases suspicious for moderate to severe degrees of Obstructive Sleep Apnea Syndrome were excluded. Echocardiography was performed one week before and 3-6 months after surgery. All data were analyzed by SPSS version 19 and P-value<0.05 was considered significant. RESULTS From 55 enrolled cases, 42 [30 boys (71.5%) and 12 girls (28.5%)] completed the study course. Tricuspid Annular Plane Systolic Excursion (TAPSE), Ejection Fraction (EF), Right Ventricular Peak Systolic Myocardial Velocity (RVSM), Right Ventricular Fractional Area Change (RVFAC) were increased significantly and Isovolumic Contraction Time (IVCT) index was decreased significantly after surgery (P-value<0.05). The difference of indices between the two sexes was not significant after surgery (P-value>0.05). CONCLUSION Adenotonsillectomy can improve cardiac function indices in patients with PS due to ATH especially in terms of right ventricle (RV) function and reduction in pulmonary artery pressure. So, although "subclinical", it is better to be considered PS not just as annoying noise for roommates before significant clinical cardiac problems happen.
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Affiliation(s)
- Shadman Nemati
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Rahmatollah Banan
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mostafa Mehri
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Vahid Aghsaghloo
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Ehsan Kazemnezhad Leili
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Sun YL, Yuan B, Kong F, Li XM. Effects of adenoidectomy or adenotonsillectomy on the cardiovascular system in children: a meta-analysis. Eur Arch Otorhinolaryngol 2021; 279:1147-1156. [PMID: 34269887 DOI: 10.1007/s00405-021-06986-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Adenoid or adenotonsillar hypertrophy (AATH) causes upper airway obstruction, leading to cardiovascular complications. This meta-analysis was conducted to evaluate the efficacy of adenoidectomy or adenotonsillectomy (AATE) on the cardiovascular system. METHODS Using the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases, we identified studies involving a comparison of preoperative and postoperative cardiovascular function in children with AATH. The Cochrane Collaboration's Review Manager 5.3 software was used for meta-analysis. RESULTS A total of 13 studies with 706 participants were included. The meta-analysis demonstrated a significant reduction in mean pulmonary artery pressure (mPAP) of patients after AATE compared with preoperative values. The left ventricular myocardial function index (LVMPI) and the right ventricular myocardial function index (RVMPI) showed a significant decrease after the operation. Moreover, AATE prominently increased left ventricular ejection time (LVET) and right ventricular ejection time (RVET) and reduced the left ventricular interventricular septum diameter (LVIVSD) and the right ventricular end-diastolic diameter (RVedD). There was no significant difference in mPAP, LVMPI, RVMPI, LVET, RVET, LVIVSD, and RVedD between postoperative patients and healthy children (P > 0.05). CONCLUSION AATE can improve cardiovascular function in pediatric patients with AATH. Specifically, it reduces mPAP and LVMPI/RVMPI in pediatric patients. Furthermore, AATE increases LVET and RVET and reduces LVIVSD and RVedD.
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Affiliation(s)
- Ya-Lei Sun
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing, 210000, Jiangsu, China
| | - Bin Yuan
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing, 210000, Jiangsu, China.
| | - Fei Kong
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing, 210000, Jiangsu, China
| | - Xin-Min Li
- Basic Medicine College, Henan University of Chinese Medicine, Zhengzhou, 450000, China
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The utility of preoperative echocardiography in pediatric obstructive sleep apnea. Sleep Breath 2021; 25:2171-2178. [PMID: 33606183 DOI: 10.1007/s11325-021-02303-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/28/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to determine the associations between cardiac function and postoperative adverse events in pediatric patients with obstructive sleep apnea (OSA). METHODS Patients between birth and 18 years of age diagnosed with OSA between January 1, 2015, and December 31, 2018, who underwent echocardiographic evaluation within 6 months of surgery at a tertiary care children's hospital were evaluated. Exclusion criteria included history of neuromuscular disorders, tracheostomy placement, or a predominance of central apneic events recorded during polysomnography (PSG). Patients were grouped by OSA severity. Chi-squared analysis and logistic regression were utilized to determine associations between demographic characteristics, OSA severity, preoperative echocardiographic abnormalities, and postoperative adverse events. RESULTS One hundred ten children met inclusion criteria for the study, including 22 with mild OSA, 22 with moderate OSA, and 66 with severe OSA. Race and the presence of congenital heart disease (CHD) were significantly associated with differences in OSA severity. Echocardiographic abnormalities were found in 45 patients, but exclusion of patients with CHD revealed no significant associations with differences in OSA severity. Postoperative adverse events were identified in 18 (16%) patients, and only O2 saturation nadir was found to be a significant predictor of these complications. CONCLUSION Preoperative echocardiogram abnormalities are not commonly found in children with OSA and presence of abnormalities does not predict postoperative adverse events. O2 saturation nadir measured on preoperative PSG is a significant predictor of postoperative adverse events and should be examined as a clinical indicator of OSA severity.
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Burns AT, Hansen SL, Turner ZS, Aden JK, Black AB, Hsu DP. Prevalence of Pulmonary Hypertension in Pediatric Patients With Obstructive Sleep Apnea and a Cardiology Evaluation: A Retrospective Analysis. J Clin Sleep Med 2020; 15:1081-1087. [PMID: 31482829 DOI: 10.5664/jcsm.7794] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Pulmonary hypertension (PH) has been reported as a serious complication of obstructive sleep apnea (OSA) in children; however, estimated prevalence rates vary widely (zero to 85%). The purpose of this study is to determine the prevalence of PH in children with OSA and identify factors that may predict an increased PH risk in children with OSA. METHODS A retrospective review of all pediatric beneficiaries (88,058) in the San Antonio Military Health System with a diagnosis of OSA and a clinical evaluation by a pediatric cardiologist. OSA severity and nadir oxygen saturation were recorded from overnight polysomnography. Reason for referral, comorbid disorders, echocardiogram results, and cardiac diagnoses were obtained from cardiology records. RESULTS OSA was identified in 2,020 pediatric patients (2.3%). A pediatric cardiology consultation was reported for 296 patients with OSA. After excluding 95 patients for incorrect OSA diagnoses, incomplete data, or OSA treatment before cardiology evaluation, 163 patients were included in the final analysis. A diagnosis of PH was found in 3 patients with OSA (1.8%). Two of these patients had obesity, and all three had comorbid cardiac disorders. CONCLUSIONS Prevalence of PH in pediatric patients with OSA is low and none of the patients with PH had severe OSA. Current guidelines recommend PH screening in patients with severe OSA, yet OSA severity may not accurately predict risk. Factors evaluated in this study did not demonstrate an increased PH risk; additional research is necessary to improve screening in pediatric patients with OSA. CITATION Burns AT, Hansen SL, Turner ZS, Aden JK, Black AB, Hsu DP. Prevalence of pulmonary hypertension in pediatric patients with obstructive sleep apnea and a cardiology evaluation: a retrospective analysis. J Clin Sleep Med. 2019;15(8):1081-1087.
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Affiliation(s)
- Antoinette T Burns
- Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Shana L Hansen
- Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Zachary S Turner
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - James K Aden
- San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Alexander B Black
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Daniel P Hsu
- Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
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Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation. Braz J Otorhinolaryngol 2020; 88:589-593. [PMID: 33067133 PMCID: PMC9422691 DOI: 10.1016/j.bjorl.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/10/2020] [Accepted: 08/22/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. Objective The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. Methods This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. Results Significantly higher left ventricular myocardial performance index (0.52 ± 0.06 vs. 0.41 ± 0.04, p < 0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p < 0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p < 0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p = 0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p = 0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p < 0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p = 0.224). Conclusion Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.
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Ferreira Nader CMF, Capanema FD, Franco LP, Meira ZMA, Galvão CP, Ramos VM, Tinano MM, Torres LL, Guimarães RB, Becker HMG. Pulmonary arterial pressure and nasal obstruction in mouth-breathing children: Similarities between adenotonsillar hypertrophy and allergic rhinitis. Int Forum Allergy Rhinol 2020; 11:128-135. [PMID: 32713167 DOI: 10.1002/alr.22651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Upper airway obstruction may cause pulmonary hypertension in childhood. In this study we aimed to identify a possible correlation of systolic pulmonary arterial pressure (SPAP), using Doppler echocardiography, with nasal patency (NP), as measured by rhinomanometry, in mouth-breathing (MB) children with allergic rhinitis (AR) and adenotonsillar hypertrophy (ATH). METHODS In this cross-sectional study we evaluated 183 patients, from 2 to 12 years of age, at an MB referral clinic in Brazil, from December 2013 to 2017. We allocated patients to 4 etiology groups: group 1, 60 MBs with ATH; group 2, 47 MBs with AR; group 3, 43 MBs with both ATH and AR; and group 4, 33 nasal breathing control subjects. The ratio of total nasal inspiratory flow (assessed by active anterior rhinomanometry) and expected inspiratory flow adjusted for height determined the percent NP (%NP). RESULTS The median %NP was higher in controls than in the MB groups (controls, 114% [79-147%]; ATH: 65% [5-116%]; AR: 57% [23-144%]; ATH and AR: 64% [3-120%]; p < 0.001). Median SPAP was higher in the MB groups than in controls (SPAP: ATH, 26.0 [20.0-35.0] mmHg; AR, 26.0 [22.0-32.0] mmHg; ATH and AR, 26.30 [20.0-34.0] mmHg; control, 22.0 [16.0-30.0] mmHg; p < 0.001). SPAP showed a negative association with %NP (Spearman's rho = -0.24; p < 0.001). CONCLUSION Reduced nasal airflow in MB children showed a correlation with higher levels of systolic pulmonary arterial pressure. The AR and ATH groups were similar in nasal obstruction severity and systolic pulmonary arterial pressure level distribution.
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Affiliation(s)
| | - Flávio Diniz Capanema
- Department of Pediatrics, Faculty of Health and Human Ecology, Vespasiano, MG, Brazil
| | - Letícia Paiva Franco
- Department of Otolaryngology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Zilda Maria Alves Meira
- Department of Pediatric Cardiology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Cláudia Pena Galvão
- Department of Otolaryngology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Mariana Maciel Tinano
- Department of Odontology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lucas Lima Torres
- School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Helena Maria Gonçalves Becker
- Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Department of Otolaryngology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Adamu A, Jibril Y, Hasheem M, Abdullahi H, Salisu A, Nwaorgu OB. Comparison of flexible nasopharyngoscopy with plain radiograph in the assessment of children with adenoid hypertrophy. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:6-10. [PMID: 35814967 PMCID: PMC9267043 DOI: 10.4103/jwas.jwas_37_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/27/2022] [Indexed: 12/14/2022]
Abstract
Background: Obstructive adenoid hypertrophy is one of the commonest disorder seen in paediatric otorhinolaryngology clinics. It has a wide range of complications that can lead to cardiopulmonary and developmental problems; hence, early diagnosis and treatment are paramount in preventing the complications. Several modalities for the assessment of adenoid hypertrophy have been described in the literature, of which plain radiograph and flexible nasopharyngoscopy are the most popular. In this study, traditional method of evaluating adenoid hypertrophy (plain radiograph) has been compared with newer flexible nasopharyngoscopy. Materials and Methods: This is a cross-sectional study of randomly selected children with clinical diagnosis of obstructive adenoid disease. All eligible participants underwent clinical examinations, flexible nasopharyngoscopy and postnasal space X-ray. The findings were compared using the chi-square test and Pearson’s correlation test. Results: The age of the participants ranged between 2 and 10 years with mean of 4.5 ± 2.5 years. There were 79 (56.4%) males and 61 (43.6%) females. The adenoid hypertrophy observed using flexible nasopharyngoscopy among the participants ranged between 20 and 90% with mean of 67.4 ± 15.4%. The adenoid enlargement measured using adenoidal–nasopharyngeal ratio on plain radiograph ranged between 0.40 and 0.96 with mean of 0.7 ± 0.09. The Pearson’s correlation test revealed strong correlation between flexible nasopharyngoscopy and plain radiograph (r = 0.858, P = .000), and there was statistically significant association between the two methods (χ2 = 148.8, P = .000). Conclusion: There was a strong correlation between flexible nasopharyngoscopy and plain radiograph of the postnasal space in the assessment of obstructive adenoid disease in children.
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Kayapinar O, Kaya A, Ozde C, Cebeci D, Unlu I. Evaluating the effect of nasal septoplasty on atrial electromechanical features. Am J Otolaryngol 2019; 40:179-182. [PMID: 30621931 DOI: 10.1016/j.amjoto.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent studies have demonstrated that right ventricular (RV) dysfunction and increased pulmonary artery pressure may be frequent in patients with upper airway obstruction. In this study, we evaluated atrial conduction delays in patients with upper airway obstruction secondary to nasal septum deviation (NSD). METHODS A total of 32 patients with upper airway obstruction secondary to NSD undergoing a septoplasty procedure were enrolled in this study. Preoperative electrocardiography and transthoracic echocardiography were performed in all patients who underwent surgery. The mean pulmonary artery pressure (mPAP) and atrial conduction time (ACT) were recorded before and 6 months after the surgical procedures. RESULTS The PAP was significantly lower postoperatively than preoperatively (20.75 ± 4.83 vs. 24.68 ± 5.26; P < 0.001). The postoperative Electromechanical Delay of Mitral septal wall (EMD-MS) value was significantly lower than that preoperatively (46.20 ± 8.5 vs. 40.5 ± 9.9; P < 0.001). The postoperative Electromechanical Delay of Mitral lateral wall (EMD-ML) value decreased significantly compared to the preoperative period (46.3 ± 7.4 vs. 40.6 ± 9.3; P < 0.001). The postoperative Electromechanical Delay of Tricuspit lateral wall (EMD-TL) value was significantly lower than that preoperatively (43.8 ± 7.0 vs. 38.1 ± 9.1; P < 0.001). There was no significant change in pre- or postoperative measurements of inter- and intra-atrial conduction delays. CONCLUSIONS We demonstrated that upper airway obstruction secondary to NSD causes a significant increase in mPAP and a significant delay in ACT, which improved after nasal septoplasty. According to these results, we conclude that upper airway obstruction may be an important risk factor for pulmonary arterial hypertension, RV dysfunction, and atrial arrhythmias, especially in unoperated cases.
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Affiliation(s)
- Osman Kayapinar
- Cardiology, Duzce University Medical School, 81100 Duzce, Turkey.
| | - Adnan Kaya
- Cardiology, Duzce University Medical School, 81100 Duzce, Turkey
| | - Cem Ozde
- Cardiology, Duzce University Medical School, 81100 Duzce, Turkey
| | - Derya Cebeci
- Otolaryngeaolgy, Duzce University Medical School, 81100 Duzce, Turkey
| | - Ilhan Unlu
- Otolaryngeaolgy, Duzce University Medical School, 81100 Duzce, Turkey
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Kang SJ, Kwon YW. Right Atrial Deformation Mechanics in Children with Adenotonsillar Hypertrophy. J Cardiovasc Imaging 2019; 26:201-213. [PMID: 30607387 PMCID: PMC6310760 DOI: 10.4250/jcvi.2018.26.e26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/05/2018] [Accepted: 11/05/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Children with significant adenotonsillar hypertrophy (ATH) may show right ventricular (RV) dysfunction. We aimed to evaluate RV dysfunction in such children before adenotonsillectomy by evaluating peak longitudinal right atrial (RA) strain (PLRAS) in systole. PLRAS, electrocardiogram (ECG) and conventional echocardiographic parameters were compared to distinguish children with significant ATH with sleep-related breathing disorder (ATH-SRBD) from controls. METHODS Fifty-six children (23 controls and 33 children with ATH-SRBD without symptoms of heart failure) were retrospectively studied. Preoperative echocardiograms and ECGs of children with ATH-SRBD who underwent adenotonsillectomy were compared to those of controls. Available postoperative ECGs and echocardiograms were also analyzed. RESULTS Preoperatively, prolonged maximum P-wave duration (Pmax) and P-wave dispersion (PWD), decreased PLRAS, and increased tricuspid annulus E/E′ were found in children with ATH-SRBD compared to those of controls. From the receiver operating characteristic curves, PLRAS was not inferior compared to tricuspid annulus E/E′, Pmax, and PWD in differentiating children with ATH-SRBD from controls; however, the discriminative abilities of all four parameters were poor. In children who underwent adenotonsillectomy, echocardiograms 1.2 ± 0.4 years after adenotonsillectomy showed no difference in postoperative PLRAS and tricuspid annulus E/E′ when compared with those of the preoperative period. CONCLUSIONS Impaired RA deformation was reflected as decreased PLRAS in children with ATH-SRBD before adenotonsillectomy. Decreased PLRAS in these children may indicate subtle RV dysfunction and increased proarrhythmic risk. However, usefulness of PLRAS as an individual parameter in differentiating preoperative children with ATH-SRBD from controls was limited, similar to those of tricuspid annulus E/E′, Pmax, and PWD.
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Affiliation(s)
- Soo Jung Kang
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yoo Won Kwon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Kim SH. Echocardiographic Evaluation of Right-sided Heart in Pediatric Patients with Adenotonsillar Hypertrophy. J Cardiovasc Imaging 2018; 26:214-216. [PMID: 30607388 PMCID: PMC6310753 DOI: 10.4250/jcvi.2018.26.e30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/15/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sung Hye Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
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15
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Kim DY, Ko KO, Lim JW, Yoon JM, Song YH, Cheon EJ. The improvement of right ventricular function after adenotonsillectomy in children with obstructive sleep apnea. KOREAN JOURNAL OF PEDIATRICS 2018; 61:392-396. [PMID: 30360034 PMCID: PMC6313087 DOI: 10.3345/kjp.2018.06436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/06/2018] [Indexed: 11/27/2022]
Abstract
Purpose Adenotonsillar hypertrophy (ATH) that causes upper airway obstruction might lead to chronic hypoxemic pulmonary vasoconstriction and right ventricular (RV) dysfunction. We aimed to evaluate whether adenotonsillectomy (T&A) in children suffering from obstructive sleep apnea (OSA) due to severe ATH could improve RV function. Methods Thirty-seven children (boy:girl=21:16; mean age, 9.52±2.20 years), who underwent T&A forsleep apnea due to ATH, were included. We analyzedthe mean pulmonary artery pressure (mPAP), the presence and the maximal velocity of tricuspid regurgitation (TR), the tricuspid annular plane systolic excursion (TAPSE), and the right ventricular myocardial performance index (RVMPI) with tissue Doppler echocardiography (TDE) by transthoracic echocardiography pre- and post-T&A. The follow-up period was 1.78±0.27 years. Results Only the RVMPI using TDE improved after T&A (42.18±2.03 vs. 40±1.86, P=0.001). The absolute value of TAPSE increased (21.45±0.90 mm vs. 22.30±1.10 mm, P=0.001) but there was no change in the z score of TAPSE pre- and post-T&A (1.19±0.34 vs. 1.24±0.30, P=0.194). The mPAP was within normal range in children with ATH, and there was no significant difference between pre- and post-T&A (19.6±3.40 vs. 18.7±2.68, P=0.052). There was no difference in the presence and the maximal velocity of TR (P=0.058). Conclusion RVMPI using TDE could be an early parameter of RV function in children with OSA due to ATH.
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Affiliation(s)
- Dong Yeop Kim
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung Ok Ko
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jae Woo Lim
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hwa Song
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Eun Jeong Cheon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
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Does Nasal Surgery Affect Right Ventricular Myocardial Functions at the Tissue Level in Patients with Nasal Septum Deviation? J Clin Med 2018; 7:jcm7080186. [PMID: 30060456 PMCID: PMC6112028 DOI: 10.3390/jcm7080186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 01/20/2023] Open
Abstract
Objective: One of the most common causes of upper airway obstruction in adults is nasal septum deviation (NSD). The chronic hypoxia caused by this obstruction gradually leads to increased pulmonary vascular resistance, pulmonary hypertension (PHT), and right ventricular (RV) failure. The purpose of this study was to determine changes in RV myocardial functions at the tissue level before, and after surgery in patients with NSD. Subjects and Methods: Fifty-eight patients with symptoms of nasal obstruction and snoring were included in this observational study. Preoperative and postoperative third-month peripheral arterial oxygen saturation (SpO2), and RV systolic and diastolic functions measured by pulmonary artery systolic pressure (PASP), tissue Doppler parameters, and speckle tracking echocardiography (STE) were studied in these patients. Results: We observed a very significant decrease in PASP in the postoperative period (32.54 ± 5.24 mmHg vs. 24.22 ± 4.55 mmHg, p = 0.001). Postoperative SpO2 values, measured at room temperature also increased significantly (93.5 ± 0.82% vs. 95.6 ± 0.79%, p = 0.001). There was a significant improvement after surgery in RV systolic functions, represented by global longitudinal strain (GLS) (21.12 ± 2.07 vs. 22.49 ± 1.89, p = 0.013) and systolic global longitudinal strain rate (GLSRs) (1.30 ± 0.12 vs. 1.38 ± 0.13, p = 0.015). No significant differences in terms of RV diastolic function parameters were detected, including the RV early diastolic global longitudinal strain rate (GLSRe) (1.56 ± 0.21 vs. 1.55 ± 0.26, p = 0.86) and RV late diastolic global longitudinal strain rate (GLSRa) (0.88 ± 0.19; 0.89 ± 0.18, p = 0.76). Conclusion: This study was performed with an advanced technique capable of tissue level examination. The findings demonstrated significant improvement in both chronic hypoxia and RV systolic myocardial functions, measured at the tissue level after nasal surgery.
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Kimbell JS, Basu S, Garcia GJM, Frank-Ito DO, Lazarow F, Su E, Protsenko D, Chen Z, Rhee JS, Wong BJ. Upper airway reconstruction using long-range optical coherence tomography: Effects of airway curvature on airflow resistance. Lasers Surg Med 2018; 51:150-160. [PMID: 30051633 DOI: 10.1002/lsm.23005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Adenotonsillectomy (AT) is commonly used to treat upper airway obstruction in children, but selection of patients who will benefit most from AT is challenging. The need for diagnostic evaluation tools without sedation, radiation, or high costs has motivated the development of long-range optical coherence tomography (LR-OCT), providing real-time cross-sectional airway imaging during endoscopy. Since the endoscope channel location is not tracked in conventional LR-OCT, airway curvature must be estimated and may affect predicted airway resistance. The study objective was to assess effects of three realistic airway curvatures on predicted airway resistance using computational fluid dynamics (CFD) in LR-OCT reconstructions of the upper airways of pediatric patients, before and after AT. METHODS Eight subjects (five males, three females, aged 4-9 years) were imaged using LR-OCT before and after AT during sedated endoscopy. Three-dimensional (3D) airway reconstructions included three airway curvatures. Steady-state, inspiratory airflow simulations were conducted under laminar conditions, along with turbulent simulations for one subject using the k-ω turbulence model. Airway resistance (pressure drop/flow) was compared using two-tailed Wilcoxon signed rank tests. RESULTS Regardless of the airway curvatures, CFD findings corroborate a surgical end-goal with computed post-operative airway resistance significantly less than pre-operative (P < 0.01). The individual resistances did not vary significantly for different airway curvatures (P > 0.25). Resistances computed using turbulent simulations differed from laminar results by less than ∼5%. CONCLUSIONS The results suggest that reconstruction of the upper airways from LR-OCT imaging data may not need to account for airway curvature to be predictive of surgical effects on airway resistance. Lasers Surg. Med. 51:150-160, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Julia S Kimbell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Saikat Basu
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Guilherme J M Garcia
- Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin.,Medical College of Wisconsin, Biotechnology and Bioengineering Center, Milwaukee, Wisconsin
| | - Dennis O Frank-Ito
- Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina
| | - Frances Lazarow
- Beckman Laser Institute, University of California, Irvine, California
| | - Erica Su
- Beckman Laser Institute, University of California, Irvine, California
| | - Dimitry Protsenko
- Beckman Laser Institute, University of California, Irvine, California
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine, California
| | - John S Rhee
- Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian J Wong
- Beckman Laser Institute, University of California, Irvine, California.,Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
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18
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Does Septoplasty Improve Heart Functions of Patients With Septum Deviation in Terms of Echocardiography Findings? J Craniofac Surg 2018; 28:1803-1805. [PMID: 28857985 DOI: 10.1097/scs.0000000000003814] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The authors aimed to determine pulmonary artery pressure and right heart functions in patients with nasal septum deviation (NSD) with echocardiography (EchoCG) and compare the postoperative changes of EchoCG parameters with preoperative findings. METHODS Seventy-six patients who underwent septoplasty composed the study group. Average age of patients was 23.50 ranging between 18 and 48 years of age. There were 53 males (69.7%) and 23 females (30.3%). Mean pulmonary artery pressure, tricuspid annular-plane systolic excursion, right ventricular diameter, and e/a ratio were measured by EchoCG preoperatively and same parameters were reobtained 3 months after surgery. RESULTS Mean pulmonary artery pressure reduced from 23.88 ± 6.36 to 19.80 ±3.95 mm Hg and tricuspid annular-plane systolic excursion increased from 22.36 ±3.85 to 23.57±3.00 3 months after surgery. It represented statistically significant improvement at right heart functions postoperatively (P < 0.001). Although they were not statistically significant, there was also some improvement in right ventricular diameter and e/a ratio values postoperatively. CONCLUSION Nasal septum deviation was associated with higher PAP values, which were improved after surgery. Although at a lower extent, a negative effect of NSD on right heart functions was also suspected. Thus, treatment of NSD without delay was proposed, not only to treat the nasal symptoms but possible future cardiovascular complications as well.
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19
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Çetin M, Bozan N. The effects of adenotonsillar hypertrophy corrective surgery on left ventricular functions and pulmonary artery pressure in children. Int J Pediatr Otorhinolaryngol 2017; 101:41-46. [PMID: 28964308 DOI: 10.1016/j.ijporl.2017.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Comparison of left ventricular functions in preoperative and postoperative periods of children with adenotonsillar hypertrophy (ATH) who have findings of upper airway obstruction (UAO), using echocardiographic parameters. METHODS Thirty children who were diagnosed with UAO due to ATH, and who have undergone adenoidectomy/adenotonsillectomy and 30 healthy children, between 2 and 11 years of age, were included in the study. Patient group was evaluated by the pulsed wave tissue Doppler echocardiography, as well as with conventional echocardiography, before and 6 months after the operation. RESULTS Of 30 children in study group, 18 (60%) had adenotonsillectomy and 12 (40%) had adenoidectomy. The differences between groups regarding myocardial performance index (MPI) was not statistically significant (p = 0.847). There was not any statistically significant difference between groups in terms of mitral isovolemic acceleration (MIVA) (2.28 ± 0.67, 2.24 ± 0.55, 2.23 ± 0.49; p = 0.943, respectively). Interventricular septum diameter (IVSD) was significantly higher in preoperative group than postoperative and control groups (3.68 ± 0.52, 3.50 ± 0.40, 3.38 ± 0.60; p = 0.028, respectively). Pulmonary acceleration time (PAcT) was found to be significantly lower in preoperative group compared to postoperative and control groups (107.64 ± 16.60, 119.52 ± 15.95, 120.47 ± 16.19; p = 0.004, respectively). Mean pulmonary arterial pressure (mPAP) was significantly higher in preoperative group than postoperative and control groups (30.58 ± 8.11, 25.23 ± 9.07, 25.00 ± 6.52; p = 0.002, respectively). In postoperative group mPAP was found to be similar to the control group. CONCLUSIONS Clinical or subclinical left ventricle (LV) dysfunction in children with ATH who have findings of UAO was not determined while mean pulmonary arterial pressure was significantly higher compared with the control cases. Besides early adenotonsillectomy is a beneficial treatment option for these patients.
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Affiliation(s)
- Mecnun Çetin
- Department of Pediatric Cardiology, Yuzuncu Yil University, Van, Turkey.
| | - Nazım Bozan
- Department of Otolaryngology, Yuzuncu Yil University, Van, Turkey
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Ingram DG, Singh AV, Ehsan Z, Birnbaum BF. Obstructive Sleep Apnea and Pulmonary Hypertension in Children. Paediatr Respir Rev 2017; 23:33-39. [PMID: 28185814 DOI: 10.1016/j.prrv.2017.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 11/03/2016] [Accepted: 01/04/2017] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) is a common pediatric breathing disorder, affecting 1-5% of all children. Pulmonary hypertension (PH), a severe complication of OSA, is associated with significant morbidity and mortality. Despite this important relationship between OSA and PH, there is sparse literature addressing this subject in children. This review will examine the putative relationship between OSA and PH, synthesize the available literature in children, and suggest a reasonable approach, despite limited data, for clinicians. We conclude that available evidence suggests many children with OSA have evidence of PH (estimates ranging from 0% to 85%) and vice versa (estimates ranging from 6% to 24%). Furthermore, previous studies demonstrate that treatment of the OSA, either with surgery or non-invasive ventilation, ameliorates pulmonary artery pressures to the extent of cure in a substantial number of cases. Future studies are required to better delineate the true co-occurrence of these diseases and help predict which patients are at greater risk for this serious complication. Clinicians who maintain a healthy vigilance for this important interaction of disease states will likely recognize opportunities to intervene and improve prognoses in these patients.
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Affiliation(s)
- David G Ingram
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO.
| | - Alvin V Singh
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO
| | - Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO
| | - Brian F Birnbaum
- Division of Cardiology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO
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Changes at Mean Platelet Volume and Platelet Distribution Width Levels After Septoplasty and Its Correlation With Epworth Sleepness Scale. J Craniofac Surg 2017; 28:71-73. [PMID: 27893555 DOI: 10.1097/scs.0000000000003207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Nasal septum deviation may affect cardiopulmonary system. Those effects can be determined via blood tests and Epworth sleepness scale (ESS). In this study, it was aimed to measure mean platelet volume (MPV) and platelet distribution width (PDW) in patients with nasal septum deviation and to assess changes at their levels after septoplasty. Furthermore, it was purposed to document the correlation between ESS score and MPV, PDW levels. METHODS Eighty-one patients who underwent septoplasty and 50 healthy controls composed the study group. Epworth sleepness scale was performed to all patients preoperatively and patients were divided into 2 groups in terms of ESS scores. Mean platelet volume and PDW levels were measured preoperatively and it was repeated postoperatively. RESULTS In Group A (ESS <10), MPV reduced from 8.48 ± 0.38 fl to 8.47 ± 0.36 fl (P >0.05), PDW reduced from 14.56 ± 1.27% to 14.43 ± 1.03% after surgery (P >0.05). On the other hand, in Group B (ESS ≥10), MPV reduced from 9.54 ± 0.68 fl to 8.87 ± 0.44 fl (P <0.001), PDW reduced from 17.15 ± 1.75% to 15.35 ± 1.29% postoperatively (P <0.001). CONCLUSIONS Statistically significant improvements at MPV and PDW levels after surgery were noticed only at patients with excessive daytime sleepness whose ESS score was 10 or above. According to this, it would be preferable to operate these patients earlier to protect them from systemic effects.
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Reversible Severe Pulmonary Hypertension after Adenotonsillectomy: A Case Report of a Child Treated at Bugando Medical Centre, Northwestern Tanzania. Case Rep Pediatr 2016; 2016:2897320. [PMID: 27635273 PMCID: PMC5011215 DOI: 10.1155/2016/2897320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022] Open
Abstract
Upper airway obstruction (UAO) due to adenotonsillar hypertrophy represents one of the rare causes of pulmonary hypertension in children. We report a case of adenotonsillar hypertrophy, managed at pediatric and otorhinolaryngology departments in Bugando Medical Centre (BMC), northwestern Tanzania, with complete remission of symptoms of pulmonary hypertension following adenotonsillectomy. A 17-month-old boy presented with difficulty breathing, dry cough, and noisy breathing since 1 year. He had facial and lower limb oedema with a pan systolic murmur at the tricuspid area, fine crepitations, and tender hepatomegaly. A grade II tonsillar hypertrophy and hypertrophied adenoids were seen on nasal and throat evaluation. A 2D-echocardiography showed grossly distended right atrium and ventricle, dilated pulmonary artery, and grade III tricuspid regurgitation. His final diagnosis was severe pulmonary hypertension with right-sided heart failure due to adenotonsillar hypertrophy. He had complete remission of cardiopulmonary symptoms after adenotonsillectomy and had normal control echocardiography six and twelve months after surgery. Children with symptoms of upper airway obstruction and cardiopulmonary involvement could benefit from routine screening for pulmonary hypertension. Adenotonsillectomy should be considered for possible complete remission of both UAO and cardiopulmonary symptoms.
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Acar OÇ, Üner A, Garça MF, Ece İ, Epçaçan S, Turan M, Kalkan F. The Effect of Tonsillectomy and Adenoidectomy on Right Ventricle Function and Pulmonary Artery Pressure by Using Doppler Echocardiography in Children. Clin Exp Otorhinolaryngol 2016; 9:163-7. [PMID: 27090272 PMCID: PMC4881318 DOI: 10.21053/ceo.2015.00087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/16/2015] [Accepted: 07/08/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives The purpose of the present study is to emphasize the efficacy of the myocardial performance index and tricuspid annular plane systolic excursion (TAPSE) in the determination of impaired cardiac functions and recovery period following the treatment in children with adenoid and/or tonsillar hypertrophy. Methods Fifty-three healthy children after routine laboratory, imaging and clinical examinations, with adenoid and/or tonsillar hypertrophy were evaluated before and 3 months after adenotonsillectomy for cardiac functions using M mode and Doppler echocardiography. Results The mean age of cases was 6.4±3.0 years, 34 (65%) were male, and 19 (35%) were female. Pulmonary hypertension was observed to be mild in 3 patients and moderate in 1 patient preoperatively. When the preoperative and postoperative echocardiographic measurements of the patients were compared, the tricuspid valve E wave velocity, the E/A ratio (E, early diastolic flow rate; A, late diastolic flow rate), and the TAPSE values were determined to be significantly higher postoperatively (P<0.05). The tricuspid valve deceleration time, the isovolumetric relaxation time and the systolic pulmonary artery pressure were found to be significantly lower compared to the preoperative values (P<0.05). Conclusion Adenoidectomy and/or tonsillectomy may prevent cardiac dysfunctions that can develop in the later periods due to adenoid and/or tonsil hypertrophy in children, before the appearance of the clinical findings of cardiac failure.
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Affiliation(s)
- Onur Çağlar Acar
- Division of Pediatric Cardiology, Department of Pediatrics, Yüzüncü Yıl University Medical Faculty, Van, Turkey
| | - Abdurrahman Üner
- Division of Pediatric Cardiology, Department of Pediatrics, Yüzüncü Yıl University Medical Faculty, Van, Turkey
| | - Mehmet Fatih Garça
- Department of Otorhinolaryngology, Yüzüncü Yıl University Medical Faculty, Van, Turkey
| | - İbrahim Ece
- Division of Pediatric Cardiology, Department of Pediatrics, Yüzüncü Yıl University Medical Faculty, Van, Turkey
| | - Serdar Epçaçan
- Division of Pediatric Cardiology, Department of Pediatrics, Yüzüncü Yıl University Medical Faculty, Van, Turkey
| | - Mahfuz Turan
- Department of Otorhinolaryngology, Yüzüncü Yıl University Medical Faculty, Van, Turkey
| | - Ferhat Kalkan
- Department of Otolaryngology, Training and Research Hospital, Van, Turkey
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Ozkececi G, Akci O, Bucak A, Ulu S, Yalım Z, Aycicek A, Onrat E, Avsar A. The effect of septoplasty on pulmonary artery pressure and right ventricular function in nasal septum deviation. Eur Arch Otorhinolaryngol 2016; 273:3747-3752. [PMID: 27075685 DOI: 10.1007/s00405-016-4042-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/07/2016] [Indexed: 11/27/2022]
Abstract
Nasal septum deviation (NSD) can cause obstruction of the upper airway, which may lead to increased pulmonary artery pressure (PAP) and right ventricle dysfunction. The aim of the present study was to evaluate the effect of septoplasty on right ventricular function and mean PAP of patients with marked NSD. 25 patients with marked NSD (mean age = 31.8 ± 12.3 years) and 27 healthy volunteers (mean age = 34.5 ± 10.8 years) were enrolled. Echocardiography was performed for all subjects and right ventricular function and mean PAP were evaluated before and 3 months after septoplasty. Tricuspid annular plane systolic excursion (TAPSE) and tricuspid annulus early diastolic myocardial velocity (E') were significantly lower in patients with NSD than control subjects, while right ventricle myocardial performance index (RVMPI) and mean PAP were significantly higher (respectively, p = 0.006, 0.037, 0.049, 0.046). When preoperative and postoperative findings were compared, the mean PAP decreased whereas TAPSE increased significantly (respectively, p = 0.007, 0.03). The results of the present study demonstrated that mean PAP increased and right ventricular function worsened in patients with NSD. However, mean PAP decreased and right ventricular function tended to recover after septoplasty.
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Affiliation(s)
- Gulay Ozkececi
- Department of Cardiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, 03200, Turkey.
| | - Onder Akci
- Department of Cardiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, 03200, Turkey
| | - Abdulkadir Bucak
- Department of Otorhinolaryngology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, 03200, Turkey
| | - Sahin Ulu
- Department of Otorhinolaryngology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, 03200, Turkey
| | - Zafer Yalım
- Department of Cardiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, 03200, Turkey
| | - Abdullah Aycicek
- Department of Otorhinolaryngology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, 03200, Turkey
| | - Ersel Onrat
- Department of Cardiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, 03200, Turkey
| | - Alaettin Avsar
- Department of Cardiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, 03200, Turkey
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Blechner M, Williamson AA. Consequences of Obstructive Sleep Apnea in Children. Curr Probl Pediatr Adolesc Health Care 2016; 46:19-26. [PMID: 26631839 DOI: 10.1016/j.cppeds.2015.10.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/07/2015] [Indexed: 01/19/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) has various negative health and behavioral consequences in the pediatric population. As shown in adults, there are metabolic derangements such as obesity, insulin sensitivity, dyslipidemia, and metabolic syndrome, as well as cardiovascular derangements like hypertension, chronic inflammation, endothelial dysfunction, ventricular size/function abnormalities, and even elevated pulmonary arterial pressures, that can be seen in children with OSAS. The first two sections will discuss the metabolic and cardiovascular consequences on OSAS in children. The last section summarizes selected studies and reviews on the behavioral, neurocognitive and academic consequences of OSAS in children.
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Affiliation(s)
- Michael Blechner
- Division of Pulmonary Medicine, The Children׳s Hospital of Philadelphia, Philadelphia, PA.
| | - Ariel A Williamson
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE; Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children׳s Hospital of Philadelphia, Philadelphia, PA
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Abstract
Adenoid hypertrophy (AH) is a common disorder in children, resulting in chronic nasal congestion. This chronic congestion should be evaluated carefully because it can lead to chronic upper airway obstruction. Many authors have suggested that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of cardiopulmonary diseases. Mean platelet volume (MPV) is a marker of platelet function and is positively associated with indicators of platelet activity. Mean platelet volume is an indicator of larger and more reactive platelets and has been shown to be increased in patients with vascular disease, including peripheral, pulmonary, and coronary artery disease. Recently, MPV levels have also been shown to be increased in patients with severe obstructive sleep apnea, and marked nasal septal deviation. Moreover, increased MPV has also been shown to have a prognostic role in cardiovascular disease. We investigated whether MPV is higher in patients with AH and whether higher MPV levels can be reduced by adenoidectomy. To the best of our knowledge, this is the first study to investigate MPV in patients with AH. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with AH and adenoidectomy is an effective therapeutic measure in such patients. Increased platelet activation may be related to an increase of cardiopulmonary risk in patients with AH.
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Lee JH, Yoon JM, Lim JW, Ko KO, Choi SJ, Kim JY, Cheon EJ. Effect of adenotonsillar hypertrophy on right ventricle function in children. KOREAN JOURNAL OF PEDIATRICS 2014; 57:484-8. [PMID: 25550703 PMCID: PMC4279009 DOI: 10.3345/kjp.2014.57.11.484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/26/2014] [Accepted: 07/05/2014] [Indexed: 11/27/2022]
Abstract
Purpose Chronic upper airway obstruction causes hypoxemic pulmonary vasoconstriction, which may lead to right ventricle (RV) dysfunction. Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Therefore, we aimed to evaluate RV function in children with ATH. Methods Twenty-one children (male/female, 15/6; mean age, 92.3¡¾39.0 months; age range, 4-15 years) with ATH and 21 healthy age- and gender-matched controls were included in this study. Tricuspid annular plane systolic excursion and RV myocardial performance index were measured by transthoracic echocardiography. Further, the plasma level of N-terminal of probrain natriuretic peptide (NT-proBNP), an indicator of RV function, was determined. Results The snoring-tiredness during daytime-observed apnea-high blood pressure (STOP) questionnaire was completed by the patients' parents, and loud snoring was noted in the ATH group. The plasma NT-proBNP level was significantly higher in the ATH group than that in the controls (66.44±37.63 pg/mL vs. 27.85±8.89 pg/mL, P=0.001). The echocardiographic parameters were not significantly different between the groups. Conclusion We were unable to confirm the significance of echocardiographic evidence of RV dysfunction in the management of children with ATH. However, the plasma NT-proBNP level was significantly higher in the ATH group than that in the control, suggesting that chronic airway obstruction in children may carry a risk for cardiac dysfunction. Therefore, more patients should be examined using transthoracic echocardiography. In addition, pediatricians and otolaryngologists should consider cardiologic aspects during the management of children with severe ATH.
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Affiliation(s)
- Jin Hwan Lee
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jae Woo Lim
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung Og Ko
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Seong Jun Choi
- Department of Otolaryngology, Konyang University College of Medicine, Daejeon, Korea
| | - Jong-Yeup Kim
- Department of Otolaryngology, Konyang University College of Medicine, Daejeon, Korea
| | - Eun Jung Cheon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
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Çetin M, Yılmaz M, Özen S, Bozan N, Coşkun Ş. Assessment of pulmonary artery pressure and right ventricular function in children with adenotonsillar hypertrophy using different parameters. Int J Pediatr Otorhinolaryngol 2014; 78:1837-42. [PMID: 25183378 DOI: 10.1016/j.ijporl.2014.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Our aim was comparison of preoperative and postoperative right ventricular functions of children with adenotonsillar hypertrophy (ATH) who have findings of upper airway obstruction, using new echocardiographic parameters. METHODS Forty-one children who have admitted to our hospital with symptoms suggestive of upper airway obstruction, whose history and physical examination findings suggest upper airway obstruction and who have undergone adenoidectomy/adenotonsillectomy and 40 healthy children, all of whom between 2 and 12 years of age, were included in the study. Patient group was evaluated by pulsed wave tissue Doppler echocardiography as well as with conventional echocardiography before the operation and 6 months after the operation. RESULTS Of 41 children in study group, 26 (63.4%) had adenotonsillectomy and 15 (36.6%) had adenoidectomy. Tricuspid annular plane systolic excursion (TAPSE) was significantly lower in preoperative group compared to control group (18.46±1.67, 19.77±1.62; p=0.000, respectively). Myocardial performance index (MPI) was significantly higher in preoperative group than postoperative and control group (0.40±0.07, 0.36±0.06, 0.35±0.07; p=0.032, respectively). Tricuspid isovolumic acceleration (TIVA) was significantly lower in preoperative group than preoperative and control group (2.97±0.8, 3.43±0.7, 3.43±0.9; p=0.020, respectively). Disappearance of this difference was found between postoperative and control groups (p=0.984). Pulmonary acceleration time (PAcT) was found to be significantly lower in preoperative group compared to postoperative and control group (109.68±18.03, 118.93±17.46, 120.0±14.07; p=0.010, respectively). Mean pulmonary artery pressure (mPAP) was significantly higher in preoperative group than control group (29.64±8.11, 24.95±6.33; p=0.010, respectively). In postoperative group mPAP was found to be similar to control group (25.48±7.85, 24.95±6.33; p=0.740, respectively). CONCLUSIONS TAPSE, PAcT, MPI and TIVA are useful markers for evaluation of preoperative and postoperative ventricular function in children with ATH who have findings of upper airway obstruction. We think that using these practical and easy-to perform parameters may be relevant for evaluation and postoperative follow-up of patients with ATH who have findings of upper airway obstruction. Besides adenotonsillectomy is a beneficial treatment option for these patients.
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Affiliation(s)
- Mecnun Çetin
- Division of Pediatric Cardiology, Department of Pediatrics, Van İpekyolu State Hospital, Van, Turkey.
| | - Münevver Yılmaz
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Serkan Özen
- Department of Pediatrics, Ağrı State Hospital, Ağrı, Turkey
| | - Nazım Bozan
- Department of Otolaryngology, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey
| | - Şenol Coşkun
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Selcuk M, Sayar N, Demir S, Rodi Tosua A, Aslan V. The value of isovolumic acceleration for the assessment of right ventricular function in acute pulmonary embolism. Rev Port Cardiol 2014; 33:591-6. [PMID: 25300858 DOI: 10.1016/j.repc.2014.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/16/2014] [Accepted: 01/27/2014] [Indexed: 10/24/2022] Open
Abstract
AIM The aim of this study was to assess the value of tricuspid annulus myocardial isovolumic acceleration (IVA) in the assessment of right ventricular function in patients with acute pulmonary embolism (PE). METHODS Fifteen patients (mean age 60.6±11.3 years) with acute PE were enrolled and a control group was formed of 15 patients with a similar mean age (60.3±11.5). Patients who were diagnosed with acute PE by thoracic computed tomography angiography underwent transthoracic echocardiography at the time of diagnosis and at one month after diagnosis. RESULTS In the control group IVA was 2.8±0.2 m/s(2), while in the acute PE group, it was 2.0±0.1 m/s(2) at the time of diagnosis and 2.9±0.1 m/s(2) at the end of the first month. When IVA values of acute PE patients at the end of the first month were compared with their initial values and those of the control group, they had normalized (control and acute PE p<0.0001; control and PE at one-month follow-up p=0.983). CONCLUSION In our study, IVA was shown to be a reliable marker of right ventricular systolic function in patients with acute PE.
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Affiliation(s)
- Murat Selcuk
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
| | - Nurten Sayar
- Department of Cadiology, Siyami Ersek Education and Research Hospital, Istambul, Turkey
| | | | - Aydın Rodi Tosua
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
| | - Vedat Aslan
- Department of Cadiology, Siyami Ersek Education and Research Hospital, Istambul, Turkey
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Proença-Módena JL, Buzatto GP, Paula FE, Saturno TH, Delcaro LS, Prates MC, Tamashiro E, Valera FC, Arruda E, Anselmo-Lima WT. Respiratory viruses are continuously detected in children with chronic tonsillitis throughout the year. Int J Pediatr Otorhinolaryngol 2014; 78:1655-61. [PMID: 25128448 PMCID: PMC7112801 DOI: 10.1016/j.ijporl.2014.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/10/2014] [Accepted: 07/12/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the oscillations on the viral detection in adenotonsillar tissues from patients with chronic adenotonsillar diseases as an indicia of the presence of persistent viral infections or acute subclinical infections. STUDY DESIGN Cross-sectional prospective study. SETTING Tertiary hospital. METHODS The fluctuations of respiratory virus detection were compared to the major climatic variables during a two-year period using adenoids and palatine tonsils from 172 children with adenotonsillar hypertrophy and clinical evidence of obstructive sleep apnoea syndrome or recurrent adenotonsillitis, without symptoms of acute respiratory infection (ARI), by TaqMan real-time PCR. RESULTS The rate of detection of at least one respiratory virus in adenotonsillar tissue was 87%. The most frequently detected viruses were human adenovirus in 52.8%, human enterovirus in 47.2%, human rhinovirus in 33.8%, human bocavirus in 31.1%, human metapneumovirus in 18.3% and human respiratory syncytial virus in 17.2%. Although increased detection of human enterovirus occurred in summer/autumn months, and there were summer nadirs of human respiratory syncytial virus in both years of the study, there was no obvious viral seasonality in contrast to reports with ARI patients in many regions of the world. CONCLUSION Respiratory viruses are continuously highly detected during whole year, and without any clinical symptomatology, indicating that viral genome of some virus can persist in lymphoepithelial tissues of the upper respiratory tract.
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Affiliation(s)
- José Luiz Proença-Módena
- Department of Cell Biology, School of Medicine of Ribeirão Preto of University of São Paulo, Ribeirão Preto, Brazil,Virology Research Center, School of Medicine of Ribeirão Preto of University of São Paulo, Ribeirão Preto, Brazil,Department of Genetics, Evolution and Bioagents, Institute of Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Guilherme P. Buzatto
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirao Preto of University of São Paulo, Ribeirao Preto, Brazil
| | - Flávia E. Paula
- Department of Cell Biology, School of Medicine of Ribeirão Preto of University of São Paulo, Ribeirão Preto, Brazil,Virology Research Center, School of Medicine of Ribeirão Preto of University of São Paulo, Ribeirão Preto, Brazil
| | - Tamara H. Saturno
- Virology Research Center, School of Medicine of Ribeirão Preto of University of São Paulo, Ribeirão Preto, Brazil,Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirao Preto of University of São Paulo, Ribeirao Preto, Brazil
| | - Luana S. Delcaro
- Department of Internal Medicine, School of Medicine of Ribeirão Preto of University of São Paulo, Ribeirão Preto, Brazil
| | - Mirela C. Prates
- Virology Research Center, School of Medicine of Ribeirão Preto of University of São Paulo, Ribeirão Preto, Brazil,Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirao Preto of University of São Paulo, Ribeirao Preto, Brazil
| | - Edwin Tamashiro
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirao Preto of University of São Paulo, Ribeirao Preto, Brazil
| | - Fabiana C.P. Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirao Preto of University of São Paulo, Ribeirao Preto, Brazil
| | - Eurico Arruda
- Department of Cell Biology, School of Medicine of Ribeirão Preto of University of São Paulo, Ribeirão Preto, Brazil,Virology Research Center, School of Medicine of Ribeirão Preto of University of São Paulo, Ribeirão Preto, Brazil
| | - Wilma T. Anselmo-Lima
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirao Preto of University of São Paulo, Ribeirao Preto, Brazil,Corresponding author at: Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, FMRP-USP, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP 14049-900, Brazil. Tel.: +55 16 36022862; fax: +55 16 36022860
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Selcuk M, Sayar N, Demir S, Rodi Tosua A, Aslan V. The value of isovolumic acceleration for the assessment of right ventricular function in acute pulmonary embolism. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cincin A, Sakalli E, Bakirci EM, Dizman R. Relationship between obstructive sleep apnea-specific symptoms and cardiac function before and after adenotonsillectomy in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2014; 78:1281-7. [PMID: 24880923 DOI: 10.1016/j.ijporl.2014.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of our study was to investigate subclinical cardiac disturbances in patients with symptoms due to adenotonsillar hypertrophy (ATH) and the impact of adenotonsillectomy (AT) using conventional and novel echocardiographic measures. MATERIAL AND METHODS Thirty patients with grade 3 or 4 ATH (mean age: 7.86 ± 3.83 years; 10 females) and 30 healthy, age- and sex-matched volunteers (mean age, 8 ± 2.77; 14 females) were enrolled in the study. In addition to conventional two-dimensional and Doppler echocardiographic parameters, tissue Doppler parameters, including myocardial performance indices (MPIs) of both the right (RV) and left ventricle (LV), were studied. The severity of obstructive sleep apnea (OSA) was determined using the OSA-18 health quality questionnaire. The OSA-18 questionnaire and echocardiographic examination were repeated after AT in patients with ATH. RESULTS The total OSA-18 scores for the control, preoperative, and postoperative groups were 39.56 ± 19.98, 80.63 ± 22.32, and 44.10 ± 20.31, respectively. Conventional parameters were not different among the groups. The mean pulmonary artery pressure estimated using the Mahan formula was increased in the ATH group compared with that in the control group (21.72 ± 4.25 vs. 12.43 ± 3.83, respectively; p<0.001) and significantly improved after AT (21.72 ± 4.25 vs. 16.09 ± 4.53; p<0.001). The RV MPI was significantly different between the control and ATH groups (0.322 ± 0.052 vs. 0.383 ± 0.079, respectively; p=0.001). Both the LV and RV MPI significantly improved (0.515 ± 0.066 vs. 0.434 ± 0.052, p<0.001; and 0.383 ± 0.079 vs. 0.316 ± 0.058, p=0.018, respectively) after surgery for ATH. CONCLUSIONS Our study revealed that the patients with OSA-specific symptoms due to ATH had higher pulmonary artery pressure and impaired RV function according to novel echocardiographic parameters. Surgery for ATH seems to have an important effect on both LV and RV function.
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Affiliation(s)
- Altug Cincin
- Marmara University Medical Faculty, Department of Cardiology, Istanbul, Turkey
| | - Erdal Sakalli
- Safa Private Hospital, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Eftal Murat Bakirci
- Erzincan University Medical Faculty, Department of Cardiology, Erzincan, Turkey
| | - Rafet Dizman
- Yunus Emre State Hospital, Department of Cardiology, Eskisehir, Turkey
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Ghazipour A, Noori SM, Madjidi S, Nikakhlagh S, Saki N, Rekabi H. Determination of the Effect of Nasal Septoplasty on Pulmonary Artery Pressure in Patients with Deviated Nasal Septum. ACTA ACUST UNITED AC 2014. [DOI: 10.17795/jjhr-21890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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King MS, Xanthopoulos MS, Marcus CL. Improving Positive Airway Pressure Adherence in Children. Sleep Med Clin 2014; 9:219-234. [PMID: 24910579 DOI: 10.1016/j.jsmc.2014.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michelle S King
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Melissa S Xanthopoulos
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Carole L Marcus
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
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Kocabaş A, Salman N, Ekici F, Cetin I, Akcan FA. Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy. Pediatr Cardiol 2014; 35:785-92. [PMID: 24343731 DOI: 10.1007/s00246-013-0853-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/28/2013] [Indexed: 11/26/2022]
Abstract
Deterioration of the right ventricular (RV) functions and the increase in the pulmonary arterial pressure (PAP) of children with moderate to severe adenotonsillar hypertrophy (ATH) have been well described. In addition to these complications, this study aimed to investigate the influence of ATH on the conduction system. The study investigated 46 patients with a diagnosis of ATH and 46 healthy control subjects. Conventional echocardiography, P-wave dispersion (Pd), tissue Doppler imaging (TDI) findings, and atrial electromechanical delay (AED) were compared between the patients and the control subjects before and after adenotonsillectomy. The maximum P-wave duration and Pd were significantly higher in the patients than in the control subjects (p < 0.001). The patient group showed significantly greater RV end-diastolic dimension (p = 0.01), right atrial area (p < 0.001), and mean PAP (p = 0.03) but lower E/A ratios for the mitral (p = 0.04) and tricuspid (p = 0.01) valves and a shorter pulmonary flow trace acceleration time (p = 0.03). The tricuspid annular-plane systolic excursion was similar between these groups (p = 0.21). In the patient group, TDI studies showed significantly lower E'/A' ratios for the tricuspid lateral (p = 0.006) and mitral septal (p = 0.003) segments than in the control group. The myocardial performance index was lower for the mitral lateral, mitral septal, and tricuspid lateral segments in patient group (p < 0.001). Similarly, AED was prolonged in the patient group at all three segments (p < 0.001). Also, the patient group showed a significantly longer interatrial (p = 0.03) and intraatrial (p = 0.04) electromechanical delay. However, all the electro- and echocardiographic parameters were similar between the patients and the control subjects after adenotonsillectomy (p > 0.05). The prolongations in P-wave duration, Pd, and inter- and intraatrial electromechanical delays were first shown in this population. The cardiac changes induced by ATH-associated hypoxia may facilitate arrhythmias during the long term.
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Affiliation(s)
- Abdullah Kocabaş
- Department of Pediatric Cardiology, Ankara Children's Hematology and Oncology Research and Training Hospital, Ankara, Turkey,
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Borgström A, Nerfeldt P, Friberg D. Questionnaire OSA-18 has poor validity compared to polysomnography in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2013; 77:1864-8. [PMID: 24055180 DOI: 10.1016/j.ijporl.2013.08.030] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/23/2013] [Accepted: 08/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of the quality-of-life instrument OSA-18 by comparing it with objective data from polysomnography in children with sleep-disordered breathing. STUDY DESIGN Cross-sectional. PATIENTS AND METHODS Full-night polysomnographic data were obtained from 225 subjects, 139 boys and 86 girls, median age 4.5 years (1-12) in our sleep laboratory. Their caregivers answered the OSA-18 quality-of-life instrument (range 18-126). The polysomnographic parameter, the apnea-hypopnea index (AHI) was compared with the total symptom score (TSS) and with the subscale of sleep disturbance (SD) from the OSA-18 questionnaire. Receiver operating characteristic (ROC) curves were created to test the predictive value of OSA-18. RESULTS With the TSS of the OSA-18 at ≥60, compared with AHI levels of >1 and ≥5, the sensitivity was 55.2% and 59.3% respectively, and the specificity 40.9% and 48.4%, respectively. With the TSS>80 and AHI levels of ≥5 and ≥10, the sensitivity was 24.6% and 32.1%, respectively. For the subscale of SD, the majority of the subjects showed poor correlation with the AHI values. The ROC area under the curve for different levels of the AHI (>1, ≥5, and ≥10) was 0.49, 0.57, and 0.56, respectively. CONCLUSIONS The OSA-18 questionnaire showed poor validity in detecting and predicting pediatric OSA. The majority of the children with severe OSA would not be correctly diagnosed if the OSA-18 were used as a dominant diagnostic tool.
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Affiliation(s)
- Anna Borgström
- Department of Otorhinolaryngology, Karolinska University Hospital and CLINTEC, Karolinska Institute, Stockholm, Sweden.
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Martha VF, Moreira JDS, Martha AS, Velho FJ, Eick RG, Goncalves SC. Reversal of pulmonary hypertension in children after adenoidectomy or adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2013; 77:237-40. [PMID: 23245625 DOI: 10.1016/j.ijporl.2012.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 11/04/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Adenotonsillar hypertrophy is a common condition in pediatric patients with upper respiratory airways complaints, and pulmonary arterial hypertension (PAH) may be one complication of that condition. OBJECTIVES To study the occurrence of PAH (mean pulmonary artery pressure higher than or equal to 25 mmHg) in a group of children with adenotonsillar hypertrophy and upper respiratory complaints (snoring or oral breathing), and to verify the pulmonary arterial pressure (PAP) changes after adenotonsillectomy. STUDY DESIGN Case-control prospective study. SETTINGS Study conducted at São Lucas Hospital, approaching both public and private sector. SUBJECT AND METHODS Thirty-three pediatric patients with adenotonsillar hypertrophy and evidence of obstructive upper airways complaints were treated with adenotonsillectomy. All 33 patients underwent echocardiogram before and after the surgery with determination of the pulmonary arterial pressure (PAP), through either the tricuspid regurgitation or artery linear flow acceleration time estimation. Similar determinations were performed in 10 normal non operated controls. RESULTS Pulmonary hypertension was verified 12 (36%) of the 33 patients with adenotonsillar hypertrophy. Adenoidectomy or adenotonsillectomy was associated to a significant 27% decrease in mean PAP (27 ± 2.8 to 20 ± 5.1 mmHg, p<0.001) and to a non significant 26% decrease in systolic PAP (35 ± 6.2 mmHg to 25 ± 0.5 mmHg, p=0.243). The PAP values in children with no pulmonary hypertension were not changed after the surgery. CONCLUSIONS In children with pulmonary hypertension associated to adenotonsillar hypertrophy, the adenotonsillectomy decreased PAP to normal values in all patients.
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Affiliation(s)
- Viviane Feller Martha
- Department of Otorhinolaryngology, Sao Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Teo DT, Mitchell RB. Systematic Review of Effects of Adenotonsillectomy on Cardiovascular Parameters in Children with Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2012; 148:21-8. [DOI: 10.1177/0194599812463193] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To systematically review current studies on the effects of adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) on cardiovascular parameters in children. Data Sources PubMed database. Review Methods A comprehensive PubMed MeSH search was done between 1970 and 2012. Results Fourteen articles were included. The total number of children was 418. The mean sample size was 30 (range, 1-62), and the mean age of the sample population was 6 years (range, 2-10 years). Criteria used for the diagnosis of OSA ranged from full-night polysomnography (PSG) to clinical parameters. Three studies had results from preoperative and postoperative PSG. Cardiovascular parameters studied included blood pressure, heart rate, cardiac morphology, and cardiac function. All studies reported an improvement in cardiovascular parameters and OSA symptoms after surgery. Three studies reported improvement in blood pressure, 6 reported improvement in mean pulmonary artery pressures, 7 reported improvement in echocardiographic findings, and 1 reported a decrease in pulse rate and pulse rate variability after T&A for OSA. Conclusion There is evidence that cardiovascular morbidities associated with OSA are potentially reversible. T&A may have a significant role in reversing the cardiovascular sequelae of OSA. However, there is a paucity of well-designed and powered studies to address this issue.
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Affiliation(s)
- Dawn T. Teo
- Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern Medical Center, Children’s Medical Center Dallas, Texas, USA
| | - Ron B. Mitchell
- Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern Medical Center, Children’s Medical Center Dallas, Texas, USA
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Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130:e714-55. [PMID: 22926176 DOI: 10.1542/peds.2012-1672] [Citation(s) in RCA: 968] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.
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Gozal D, Hakim F, Kheirandish-Gozal L. Chemoreceptors, baroreceptors, and autonomic deregulation in children with obstructive sleep apnea. Respir Physiol Neurobiol 2012; 185:177-85. [PMID: 22954503 DOI: 10.1016/j.resp.2012.08.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 08/21/2012] [Accepted: 08/23/2012] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is highly prevalent sleep disorder of breathing in both adults and children that is fraught with substantial cardiovascular morbidities, the latter being attributable to a complex interplay between intermittent hypoxia (IH), episodic hypercapnia, recurrent large intra-thoracic pressure swings, and sleep disruption. Alterations in autonomic nervous system function could underlie the perturbations in cardiovascular, neurocognitive, immune, endocrine and metabolic functions that affect many of the patients suffering from OSA. Although these issues have received substantial attention in adults, the same has thus far failed to occur in children, creating a quasi misperception that children are protected. Here, we provide a critical overview of the evidence supporting the presence of autonomic nervous system (ANS) perturbations in children with OSA, draw some parallel assessments to known mechanisms in rodents and adult humans, particularly, peripheral and central chemoreceptor and baroreceptor pathways, and suggest future research directions.
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Affiliation(s)
- David Gozal
- Department of Pediatrics, Comer Children's Hospital, The University of Chicago, Chicago, IL, USA.
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Childhood obesity and obstructive sleep apnea. J Nutr Metab 2012; 2012:134202. [PMID: 22957216 PMCID: PMC3432382 DOI: 10.1155/2012/134202] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/31/2012] [Indexed: 11/18/2022] Open
Abstract
The global epidemic of childhood and adolescent obesity and its immediate as well as long-term consequences for obese individuals and society as a whole cannot be overemphasized. Obesity in childhood and adolescence is associated with an increased risk of adult obesity and clinically significant consequences affecting the cardiovascular and metabolic systems. Importantly, obesity is additionally complicated by obstructive sleep apnea (OSA), occurring in up to 60% of obese children. OSA, which is diagnosed using the gold standard polysomnogram (PSG), is characterised by snoring, recurrent partial (hypopneas) or complete (apneas) obstruction of the upper airway. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation. There is emerging data that OSA is associated with cardiovascular burden including systemic hypertension, changes in ventricular structure and function, arterial stiffness, and metabolic syndromes. Thus, OSA in the context of obesity may independently or synergistically magnify the underlying cardiovascular and metabolic burden. This is of importance as early recognition and treatment of OSA in obese children are likely to result in the reduction of cardiometabolic burden in obese children. This paper summarizes the current state of understanding of obesity-related OSA. Specifically, this paper will discuss epidemiology, pathophysiology, cardiometabolic burden, and management of obese children and adolescents with OSA.
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Tatlıpınar A, Biteker M, Meriç K, Bayraktar Gİ, Tekkeşin Aİ, Gökçeer T. Adenotonsillar hypertrophy: Correlation between obstruction types and cardiopulmonary complications. Laryngoscope 2012; 122:676-80. [DOI: 10.1002/lary.22508] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/04/2011] [Accepted: 11/29/2011] [Indexed: 11/08/2022]
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Koc S, Aytekin M, Kalay N, Ozcetin M, Burucu T, Ozbek K, Celik A, Kadi H, Gulturk S, Koc F. The effect of adenotonsillectomy on right ventricle function and pulmonary artery pressure in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2012; 76:45-8. [PMID: 22000211 DOI: 10.1016/j.ijporl.2011.09.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/20/2011] [Accepted: 09/24/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Severe upper airway obstruction may have an effect on chronic alveolar hypoventilation, which consequently may lead to right ventricle (RV) dysfunction induced by hypoxemic pulmonary vasoconstriction. The investigators aimed to study RV function and mean pulmonary artery pressure (mPAP) in patients with ATH who were undergoing adenotonsillectomy by using tissue Doppler echocardiography (TDE). METHODS The study examined 27 children with ATH who had a mean age of 8 ± 2 years. The subjects were comprised 17 (63%) males and 10 (37%) females. Hypertrophy of the tonsils was graded according to the Brodsky scale. Children having either grade 3 or 4 hypertrophied adenotonsils were recruited for the study. Adenotonsillectomy was performed on all subjects in the study group and echocardiographic examination was repeated 3 months postoperatively. RESULTS Tricuspid Em significantly increased after adenotonsillectomy (17.7 ± 3.6 vs. 19.1 ± 5.5, p=0.04). The RV myocardial performance index (MPI) and mPAP significantly decreased after adenotonsillectomy (RV MPI: 0.57 ± 0.13 vs. 0.40 ± 0.12, p<0.001 and mPAP (mmHg): 31 ± 9 vs. 25 ± 7, p=0.001). CONCLUSION The results of this study, evaluated with the results of previous studies, demonstrated that adenotonsillectomy improved RV performance and reduced mPAP in children with ATH.
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Affiliation(s)
- Sema Koc
- Gaziosmanpasa University, Medical Faculty, Otolaryngology Department, Tokat, Turkey
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Impact of septoplasty on pulmonary artery pressure in patients with markedly deviated septum. J Craniofac Surg 2011; 22:1591-3. [PMID: 21959393 DOI: 10.1097/scs.0b013e31822e5e21] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM The nasal septal deviation (NSD) increases upper airway obstruction. This study aimed to measure the mean pulmonary arterial pressure (mPAP) of the patients with markedly deviated nasal septum and to determine the effect of septoplasty on the pulmonary arterial pressure. METHODS Fifty-one patients with NSD (mean age, 37.1 [SD, 8.6] years; 27 men and 24 women) were included in the study. Thirty-five of the patients (22 men, 13 women) aged between 21 and 55 years (mean, 35.1 [SD, 8.9] years) comprised the control group. Mean pulmonary arterial pressure was measured in the preoperative period and postoperative third month. RESULTS The mean preoperative mPAP value (25.4 [SD, 5.3]) of the study group was statistically significantly higher than that of the control group (20.5 [SD, 2.8]) (P = 0.000). There was a significant decrease in mPAP after the operation (20.6 [SD, 3.8]) (P = 0.000). Twenty-two of 51 patients had pulmonary arterial hypertension. CONCLUSION Markedly deviated nasal septum significantly affected mPAP. Septoplasty was efficient in the treatment of patients with NSD.
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Effects of endoscopic sinus surgery on pulmonary artery pressure in patients with extensive nasal polyposis. J Craniofac Surg 2011; 22:592-3. [PMID: 21403550 DOI: 10.1097/scs.0b013e318207f430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM Extensive nasal polyposis (ENP) increases upper airway obstruction. This study aimed to measure the mean pulmonary arterial pressure (mPAP) of the patients with ENP and to determine the effect of endoscopic sinus surgery on the pulmonary arterial pressure. METHODS Forty-seven patients with ENP (mean age, 37.3 [SD, 8.7] years; 29 male patients and 18 female patients) were included in the study. Thirty-two of the patients (19 male patients, 13 female patients) aged between 21 and 55 years (mean, 36.1 [SD, 8.5] years) comprised the control group. Mean pulmonary arterial pressure was measured in the preoperative period and postoperative third month. RESULTS The mean preoperative mPAP value (26.1 [SD, 5.2]) of the study group was statistically significantly higher than that of the control group (20.6 [SD, 2.8]) (P=0.000). There was a significant decrease in the mPAP after the operation (20.9 [SD, 3.8]) (P=0.000). Twenty-six of 47 patients had pulmonary arterial hypertension. CONCLUSIONS Extensive nasal polyposis significantly affected mPAP. Endoscopic surgery was efficient in the treatment of the patients with ENP.
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Routine Electrocardiography Request in Adenoidectomy: Is it necessary? Indian J Otolaryngol Head Neck Surg 2011; 63:330-5. [PMID: 23024937 DOI: 10.1007/s12070-011-0264-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 04/27/2011] [Indexed: 10/18/2022] Open
Abstract
To evaluate the relevance of routine electrocardiographic request in pre-operative work-up of children undergoing adenoidectomy. This is a two year prospective study of children with obstructive adenoid that had adenoidectomy. This is a tertiary hospital based study at the Otorhinolaryngology Department of University College Hospital, Ibadan. Children (≤12 years) with clinical and radiological evidence of an obstructive adenoid were investigated. Information obtained with an interviewer assisted questionnaire included the biodata, clinical presentation of the patients, ECG findings, echocardiographic findings, cardiothoracic ratio, palatal airway and ratio of adenoid diameter to the nasopharyngeal diameter. The adenoid volume was measured after adenoidectomy. The results were analyzed using SPSS version 14 and level of statistical significance was P < 0.05. There were seventy four patients; 45 (60.8%) males and 29 (39.2%) females with a mean age of 38.35 months, S.D ± 30.32 (range 5-144 months). All the patients presented with mouth breathing and recurrent mucopurulent rhinorrhea. Mild snoring was detected in 18 (25%) patients, moderate snoring in 39 (54.17%) patients and severe snoring in 15 (20.83%) patients. Mild apnea was observed in 55 (74.32%) patients and moderate in 19 (25.68%) patients. Only seven (9.46%) patients had abnormal electrocardiographic findings but their ejection fraction on echocardiography ranged from 63 to 72% with a mean value of 68.17%, S.D ± 3.22. Cardiac complications of enlarged obstructive adenoid appear not to be common. Routine preoperative electrocardiography should therefore be restricted to only the high risk patients.
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Moghaddam YJ, Bavil SG, Abavisani K. Do pre-adenotonsillectomy echocardiographic findings change postoperatively in children with severe adenotonsillar hypertrophy. J Saudi Heart Assoc 2011; 23:31-5. [PMID: 23960632 PMCID: PMC3727552 DOI: 10.1016/j.jsha.2010.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 09/25/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Hypertrophy of adenotonsillar tissue is one of the most common problems in childhood age and causes upper airway obstruction and even obstructive sleep apnea symptoms in severe forms. The aim of this study is to evaluate the changes of pre-adentonsillectomy echocardiographic findings after operation. MATERIAL AND METHODS From August 2007 to November 2008, 55 children with adenotonsillar hypertrophy and obstructive-sleep symptoms (aged 3-11 years old of which 35 were males and 20 females) were randomly selected. Preoperatively echocardiography was performed for all patients by the pediatric cardiologist. In control group 55 children who referred to otolaryngology clinic because of non adenotonsillar related disease evaluated. One month and six months after operation, patients with positive findings were followed up and again echocardiography was performed separately. RESULTS No complaints of apnea were reported. Tonsillar grades of all cases were type III or IV. The preoperative mean pulmonary arterial pressure levels of the 4 (7.3%) children were higher than normal range (25 mm Hg) and it decreased significantly after operation (P < 0.000) (Preoperative MPAP = 32 ± 3 mm Hg, and six months postoperative follow up, MPAP = 11 ± 5 mm Hg). All the patients' parents complained about severe open mouth snoring, agitated sleep and hyperpnoea of their children. The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation (P < 0.000 preoperative TR = 34 ± 8 mm Hg postoperative TR = 19 ± 6 mm Hg). AC/ET in these seven patients were lower than 0.4. In control group echocardiography findings are normal. CONCLUSION Severe chronic hypertrophic adenotonsillar tissue caused higher tricuspid regurgitation pressure and mean pulmonary arterial pressure.
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Affiliation(s)
- Yalda Jabbari Moghaddam
- Department of Otolaryngology-Head and Neck Surgery, Tabriz University of Medical Sciences, Iran
| | | | - Khosrou Abavisani
- Department of Otolaryngology-Head and Neck Surgery, Tabriz University of Medical Sciences, Iran
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Sans Capdevila Ó, Wienberg P, Haag O, Cols M. Comorbilidades de los trastornos respiratorios del sueño en los niños. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61 Suppl 1:26-32. [DOI: 10.1016/s0001-6519(10)71242-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Attia G, Ahmad MA, Saleh AB, Elsharkawy A. Impact of obstructive sleep apnea on global myocardial performance in children assessed by tissue Doppler imaging. Pediatr Cardiol 2010; 31:1025-36. [PMID: 20694555 DOI: 10.1007/s00246-010-9755-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 07/14/2010] [Indexed: 12/18/2022]
Abstract
This study aimed to assess the impact of obstructive sleep apnea (OSA) due to adenotonsillar hypertrophy (ATH) on the global myocardial performance in children using tissue Doppler imaging (TDI) and to evaluate the reversibility of the disorder after adenotonsillectomy (AT). The study included 42 children with OSA due to ATH (mean age, 5 ± 3.14 years) as the study group and 45 age- and sex-matched healthy children (mean age, 5.2 ± 3.08 years) as the control group. Polysomnography and echocardiography were performed. Indexed left ventricular mass (LVMi), pulmonary artery systolic pressure, mean pulmonary artery pressure (mPAP), and pulmonary vascular resistance (PVR) were calculated by echocardiography. Tissue Doppler imaging was used to determine the left ventricular and right ventricular myocardial performance index (MPI) of patients and control subjects before and after AT. The patients were classified into mild OSA (apnea-hypopnea index [AHI] 1-5; n = 18)] and moderate to severe OSA (AHI >5; n = 24) according to polysomnography findings. All the children in the control group had an AHI less than 1. They were treated using AT, then reevaluated by polysomnography and echocardiographic examination 6 to 8 months after surgery. Results are described as mean ± standard deviation. The patients with OSA had higher pulmonary artery systolic pressure, mPAP, PVR, LVMi, and right ventricular diastolic diameter than the control subjects. The patients with moderate to severe OSA showed more prominent changes than the patients with mild OSA, but the latter still differed significantly from the control subjects. The TDI-derived right ventricular MPI and left ventricular MPI measurements of the patients with OSA were higher (mean, 0.40 ± 0.08 vs 0.28 ± 0.01; p < 0.001) than those of the control subjects and (0.45 ± 0.05 vs 0.32 ± 0.05; p < 0.001) and correlated well with AHI and mPAP. In addition, mPAP was significantly correlated with AHI. Postoperatively, relief of OSA was validated by polysomnography, and a repeat of the echocardiographic parameters showed no significant differences between the patients and the control subjects. Tissue Doppler imaging can detect the subtle, subclinical changes in cardiac performance that occur in OSA due to adenotonsillar hypertrophy. Such changes generally are reversible after surgical treatment.
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Affiliation(s)
- Gehan Attia
- Pediatrics Department (Pediatric Cardiology Unit), Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
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Granzotto EH, Aquino FV, Flores JA, Neto JFL. Tonsil size as a predictor of cardiac complications in children with sleep-disordered breathing. Laryngoscope 2010; 120:1246-51. [DOI: 10.1002/lary.20870] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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