The improvement of right ventricular function after adenotonsillectomy in children with obstructive sleep apnea

Role of automated functional imaging and myocardial work in assessment of cardiac function in children with obstructive sleep apnea

BACKGROUND

Early identification of abnormal left ventricular function in children with obstructive sleep apnea (OSA) is difficult using conventional echocardiographic indices and commonly used clinical markers of myocardial damage. We sought to investigate the value of automatic function imaging and myocardial work parameters in predicting early cardiac impairment in children having OSA with preserved left heart function and thereby identifying an optimal index for assessment.

PATIENTS AND METHODS

Fifty-two children who presented with symptoms of nocturnal sleep snoring and open-mouth breathing and 34 healthy controls were enrolled in this study. Clinical characteristics and conventional echocardiographic data were collected, and image analysis was performed using two-dimensional speckle-tracking echocardiography to obtain left ventricular global longitudinal strain (GLS), post-systolic index, peak strain dispersion, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency.

RESULTS

Children with OSA had significantly lower GLS, GWI, and GCW than those without (P < 0.05). Additionally, GWI (β = -32.87, 95% CI: -53.47 to -12.27), and GCW (β = -35.09, 95% CI: -55.35 to -14.84) were found to correlate with the disease severity in the multiple linear regression mode, with worsening values observed as the severity of the disease increased. ROC curve analysis revealed that GCW was the best predictor of myocardial dysfunction, with an AUC of 0.809 (P < 0.001), and the best cutoff point for diagnosing myocardial damage in children with OSA was 1965.5 mmHg%, with a sensitivity of 92.5% and a specificity of 58.7%.

CONCLUSIONS

GLS, GWI, and GCW were identified as predictors of myocardial dysfunction in children with OSA, with GCW being the best predictor.

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

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.

The effects of adeno/tonsillectomy on cardiopulmonary function based on echocardiography indices in children with primary snoring and mild obstructive sleep apnea

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.

Prevalence of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy: A meta-analysis

OBJECTIVE

Adenoid or adenotonsillar hypertrophy (AATH) adversely affects cardiovascular function, leading to pulmonary hypertension (PH). This meta-analysis of observational studies aimed to estimate the prevalence of PH in children with AATH.

METHODS

A meta-analysis was performed by searching the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases from their inception to 1 July 2021, for all studies that extracted data about PH prevalence in children with AATH. PH prevalence was calculated for each included study and as a pooled estimate with a 95% confidence interval.

RESULTS

A total of eight studies were included in this analysis. The pooled prevalence of PH in children with AATH was 35.0% (95% CI [18.0%, 52.0%]). The subgroup analysis demonstrated that the prevalence of PH in children with adenotonsillar hypertrophy was higher than that with adenoid hypertrophy with or without tonsillar hypertrophy (39.0%, 95% CI [14.0%, 65.0%] vs. 22.0%, 95% CI [17.0%, 28.0%], respectively). The prevalence derived from the prospective and cross-sectional studies were 45.0% (95% CI [13.0%, 76.0%]) and 20.0% (95% CI [14.0%, 25.0%]), respectively. America and Africa had lower prevalence rates than Asia (24.0%, 95% CI [1.0%, 46.0%], 27.0%, 95% CI [17.0%, 38.0%], and 48.0%, 95% CI [-2.0%, 98.0%]), respectively. The prevalence of studies with diagnostic criterion (a mean pulmonary artery pressure higher than 20 mmHg) was 50.0% (95% CI [6.0%, 94.0%]). The pooled prevalence of studies with diagnostic criterion (a mean pulmonary artery pressure higher than 25 mmHg) was 25.0% (95% CI [13.0%, 36.0%]).

CONCLUSION

The meta-analysis showed a prevalence of PH in children with AATH of 35.0%, demonstrating that this condition is a frequent complication of AATH. To better understand its clinical impact, more prospective evaluations are urgently needed.

Cardiac function and cognitive function in patients with obstructive sleep apnea

Objectives

This study was designed to evaluate echocardiographic findings in patients with obstructive sleep apnea (OSA) with cognitive impairment and compare it with the control group.

Methods

Sixty-seven OSA patients and 52 group of healthy controls were evaluated prospectively by Mini-Mental State Examination questionnaire and trans-thoracic echocardiography.

Results

The cognitive impairment and diastolic dysfunction were 19.6% (P = .002) and 18.4% (P = .016) more prevalent in OSA group compared to the control group. The mean tricuspid regurgitant gradient, pulmonary artery size, and transmitral A velocity were higher, but mean right ventricular peak systolic velocity, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), transmitral E/A ratio, and annular E’ velocity were lower in the OSA group than the control group. Comparing the patients with and without cognitive disorders, showed significant differences regarding the size of right atrium, TAPSE and FAC (P < .05).

Conclusions

OSA patients need accurate cardiac examinations, early diagnosis, and interventions to prevent the progression of cardiac dysfunction, especially older male patients with higher BMI and impaired cognition. Further studies are needed to determine the exact link between the OSA, obesity, and cardiac physiology.

Mean platelet volume levels in children with sleep-disordered breathing: a meta-analysis

BACKGROUND

Pediatric sleep-disordered breathing (SDB) correlated with respiratory conditions of snoring and hypopnea. Mean platelet volume (MPV) was an inflammatory marker, related to increased inflammatory condition of pediatric patients. Increase of MPV level may cause failure to thrive or increased upper airway infection rate. The aim of this study was to perform systematic review and meta-analysis to investigate the difference on MPV values for pediatric SDB, and compare the change on MPV after surgery in patients with pediatric SDB.

METHODS

A systemic review of the studies from PubMed, EMBASE, and Cochrane Library databases was conducted in March 2020, supported by reviewing of published articles for studies comparing MPV in pediatric SDB. Meta-analysis was used to compare the change of MPV in pediatric SDB, and sub-group analysis was also used to compare the MPV decrease after surgeries of adenoidectomy or adenotonsillectomy.

RESULTS

There were seven studies included in the review. Six of them including 963 subjects showed that a significant increase of MPV was noted in pediatric SDB compared to those in pediatric non-SDB (P < 0.05). Total standardized mean difference (SMD) in MPV between pediatric SDB and non-SDB was 0.51 (95% CI =0.30-0.72, P < 0.05). A significant decrease of MPV was found in pediatric SDB patients who underwent surgery (total SMD = - 0.36; 95% CI = - 0.70- -0.02, P < 0.05). Decreases of MPV after adenoidectomy and adenotonsillectomy were observed, but only the effect of adenotonsillectomy had a statistical significance (total SMD = - 0.72; 95% CI = - 1.18 - -0.26, P < 0.05).

CONCLUSION

The MPV was significantly higher in patients with pediatric SDB, indicating the presence of increased platelet activity in pediatric SDB patients. The level of MPV could be reduced by the two surgeries, especially adenotonsillectomy.

Effects of low-temperature plasma treatment on pulmonary function in children with obstructive sleep apnea-hypopnea syndrome

BACKGROUND

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep-related respiratory disease. Despite reports of low-temperature plasma radiofrequency ablation of tonsils and adenoids for the treatment of OSAHS, the effects on lung function and quality of life are unclear.

AIMS

This study aims to explore the effects of low-temperature plasma treatment on pulmonary function in children with OSAHS.

METHODS

A total of 110 children with OSAHS were included in this prospective study. Low-temperature plasma radiofrequency treatment and routine surgical treatment were performed in group A and group B, respectively. Maximal voluntary ventilation (MVV), forced vital capacity (FVC), and total lung capacity (TLC) were measured. OSA-18 survey was used to evaluate the quality of life 1 year after operation.

RESULTS

Group A had significantly higher effective treatment rate (P < 0.05) and lower operative period, bleeding volume, visual analog score, pseudomembrane detachment time, and time required to feed after operation than group B (all P < 0.001). There were no significant difference in the incidence of postoperative complications between the groups and MVV, FVC, and TLC between the groups before and after operation (all P > 0.05), and the above indexes in both groups were significantly increased after operation (all P < 0.05). OSA-18 scores in group A were significantly lower than group B after operation (P < 0.001).

CONCLUSIONS

Low-temperature plasma technique performed in OSAHS children has a good clinical effect, which can reduce the operation time, intraoperative blood loss, postoperative pain, pseudomembrane detachment time, hospitalization time, and improve pulmonary function and quality of life.