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09.09.2023 | ENT • Original Article

Is there an OAHI or O₂ nadir that predicts the need for preoperative echocardiogram prior to adenotonsillectomy for children with severe obstructive sleep apnea?

verfasst von: Nicolas S. Poupore, Hussein Smaily, James D. Sullivan, Calvin W. Myint, John D. Prosser, William W. Carroll

Erschienen in: Sleep and Breathing | Ausgabe 1/2024

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Abstract

Purpose

To investigate threshold values for obstructive apnea–hypopnea index (OAHI) and nadir oxygen saturation (NspO₂) in children with severe obstructive sleep apnea (OSA) to identify children most appropriate for preoperative echocardiography.

Methods

A multi-institutional retrospective chart review was performed on children who underwent echocardiography and polysomnogram within a year. Children with severe OSA as defined by OAHI > 10 or NspO₂ < 80% were included. Receiver operator curves and Youden’s J index were used to assess the discriminatory ability and threshold values of OAHI and NspO₂ for right heart strain (RHS) on echocardiography.

Results

A total of 173 prepubertal (< 10 years) children and 71 postpubertal (≥ 10 years) children of age were included. RHS was seen in 9 (5%) prepubertal children and 4 (6%) postpubertal children. In prepubertal children, OAHI and NspO₂ were poor predictors of RHS (area under the curve [AUC] 0.53 [95%CI 0.45–0.61], p = 0.748; AUC 0.56 [95%CI 0.48–0.64], p = 0.609). In postpubertal children, threshold values of 55 events/hour and 69% were strong predictors for RHS (AUC 0.88 [95%CI 0.78–0.95], p < 0.001; AUC 0.92 [95%CI 0.83–0.97], p < 0.001).

Conclusion

In children with severe OSA, evidence of RHS is low. Postpubertal children with OAHI > 55 and NspO₂ < 69% appear most appropriate for echocardiography. Clinicians should weigh the risks and benefits of preoperative echocardiography for each child with these threshold values in mind.

Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS et al (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130:576–584. https://doi.org/10.1542/peds.2012-1671CrossRefPubMed

Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR et al (2019) Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg 160:S1-s42. https://doi.org/10.1177/0194599818801757CrossRefPubMed

Larrier DR, Huang ZJ, Wei Z, McHugh CH, Brock L, Reddy SC-B, Zhang W (2015) Is routine pre-operative cardiac evaluation necessary in obese children undergoing adenotonsillectomy for OSA? Am J Otolaryngol 36:744–747. https://doi.org/10.1016/j.amjoto.2015.05.007CrossRefPubMed

Katz SL, Monsour A, Barrowman N, Hoey L, Bromwich M, Momoli F, Chan T et al (2020) Predictors of postoperative respiratory complications in children undergoing adenotonsillectomy. J Clin Sleep Med 16:41–48. https://doi.org/10.5664/JCSM.8118CrossRefPubMedPubMedCentral

Blum RH, McGowan FX Jr (2004) Chronic upper airway obstruction and cardiac dysfunction: anatomy, pathophysiology and anesthetic implications. Paediatr Anaesth 14:75–83. https://doi.org/10.1046/j.1460-9592.2003.01193.xCrossRefPubMed

Revenaugh PC, Chmielewski LJ, Edwards T, Krishna J, Krakovitz P, Anne S (2011) Utility of preoperative cardiac evaluation in pediatric patients undergoing surgery for obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 137:1269–1275. https://doi.org/10.1001/archoto.2011.208CrossRefPubMed

Kalra M, Kimball TR, Daniels SR, LeMasters G, Willging PJ, Rutter M, Witt SA et al (2005) Structural cardiac changes as a predictor of respiratory complications after adenotonsillectomy for obstructive breathing during sleep in children. Sleep Med 6:241–245. https://doi.org/10.1016/j.sleep.2004.10.004CrossRefPubMed

Minai OA, Yared JP, Kaw R, Subramaniam K, Hill NS (2013) Perioperative risk and management in patients with pulmonary hypertension. Chest 144:329–340. https://doi.org/10.1378/chest.12-1752CrossRefPubMed

Pettitt-Schieber B, Tey CS, Hill R, Vaughn W, Pakanati V, Leu R, Raol N (2021) The utility of preoperative echocardiography in pediatric obstructive sleep apnea. Sleep and Breathing. https://doi.org/10.1007/s11325-021-02303-5CrossRefPubMed

10.

Teplitzky TB, Pereira KD, Isaiah A (2019) Echocardiographic screening in children with very severe obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 126:109626. https://doi.org/10.1016/j.ijporl.2019.109626

11.

Bitners AC, Arens R, Mahgerefteh J, Sutton NJ, Silver EJ, Sin S, Khan MA et al (2021) Prevalence of elevated right ventricular pressure in children with obstructive sleep apnea syndrome undergoing pulmonary hypertension screening. J Clin Sleep Med 17:2225–2232. https://doi.org/10.5664/jcsm.9412CrossRefPubMedPubMedCentral

12.

Clements AC, Walsh JM, Dai X, Skinner ML, Sterni LM, Tunkel DE, Boss EF et al (2021) Cardiopulmonary testing before pediatric adenotonsillectomy for severe and very severe obstructive sleep apnea syndrome. Laryngoscope. https://doi.org/10.1002/lary.29480CrossRefPubMed

13.

Burns AT, Hansen SL, Turner ZS, Aden JK, Black AB, Hsu DP (2019) Prevalence of pulmonary hypertension in pediatric patients with obstructive sleep apnea and a cardiology evaluation: a retrospective analysis. J Clin Sleep Med 15:1081–1087. https://doi.org/10.5664/jcsm.7794CrossRefPubMedPubMedCentral

14.

Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD et al (2015) Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation 132:2037–2099. https://doi.org/10.1161/cir.0000000000000329CrossRefPubMed

15.

Pettitt-Schieber B, Tey CS, Nemeth J, Raol N (2021) Echocardiographic findings in children with obstructive sleep apnea: a systematic review. Int J Pediatr Otorhinolaryngol 145:110721. https://doi.org/10.1016/j.ijporl.2021.110721

16.

Zhang J, Chan NY, Lam SP, Li SX, Liu Y, Chan JW, Kong AP et al (2016) Emergence of sex differences in insomnia symptoms in adolescents: a large-scale school-based study. Sleep 39:1563–1570. https://doi.org/10.5665/sleep.6022CrossRefPubMedPubMedCentral

17.

Berry RB, Albertario CL, Harding SM, Al E (2018) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.5. Am Acad Sleep Med 1–32

18.

Wali SO, Abaalkhail B, AlQassas I, Alhejaili F, Spence DW, Pandi-Perumal SR (2020) The correlation between oxygen saturation indices and the standard obstructive sleep apnea severity. Ann Thorac Med 15:70–75. https://doi.org/10.4103/atm.ATM_215_19CrossRefPubMedPubMedCentral

19.

Hsu WC, Kang KT, Chiu SN, Weng WC, Lee PL, Lin CY (2018) 24-hour ambulatory blood pressure after adenotonsillectomy in childhood sleep apnea. J Pediatr 199:112-117.e6. https://doi.org/10.1016/j.jpeds.2018.03.072CrossRefPubMed

20.

Kavanaugh-McHugh A, Tobias JD, Doyle T, Heitmiller ES, Meagher C (2000) Transesophageal echocardiography in pediatric congenital heart disease. Cardiol Rev 8:288–306. https://doi.org/10.1097/00045415-200008050-00008CrossRefPubMed

21.

Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35. https://doi.org/10.1002/1097-0142(1950)3:1%3c32::aid-cncr2820030106%3e3.0.co;2-3CrossRefPubMed

22.

Abd El-Moneim ES, Badawy BS, Atya M (2009) The effect of adenoidectomy on right ventricular performance in children. Int J Pediatr Otorhinolaryngol 73:1584–1588. https://doi.org/10.1016/j.ijporl.2009.08.013CrossRefPubMed

23.

Sofer S, Weinhouse E, Tal A, Wanderman KL, Margulis G, Leiberman A, Gueron M (1988) Cor pulmonale due to adenoidal or tonsillar hypertrophy or both in children. Noninvasive Diagnosis Follow-up Chest 93:119–122. https://doi.org/10.1378/chest.93.1.119CrossRefPubMed

24.

Chan JY, Li AM, Au CT, Lo AF, Ng SK, Abdullah VJ, Ho C et al (2009) Cardiac remodelling and dysfunction in children with obstructive sleep apnoea: a community based study. Thorax 64:233–239. https://doi.org/10.1136/thx.2007.094904CrossRefPubMed

25.

Poupore NS, Gudipudi R, Nguyen SA, Pecha PP, Pecha TJ, Carroll WW (2022) Tissue Doppler echocardiography in children with OSA before and after tonsillectomy and adenoidectomy: a systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 152:111002. https://doi.org/10.1016/j.ijporl.2021.111002CrossRefPubMed

26.

Sun YL, Yuan B, Kong F, Li XM (2021) Effects of adenoidectomy or adenotonsillectomy on the cardiovascular system in children: a meta-analysis. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-021-06986-0CrossRefPubMedPubMedCentral

27.

Teo DT, Mitchell RB (2013) Systematic review of effects of adenotonsillectomy on cardiovascular parameters in children with obstructive sleep apnea. Otolaryngol - Head Neck Surg (United States) 148:21–28. https://doi.org/10.1177/0194599812463193CrossRef

28.

Spilsbury JC, Storfer-Isser A, Rosen CL, Redline S (2015) Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence. Sleep 38:23–29. https://doi.org/10.5665/sleep.4318CrossRefPubMedPubMedCentral

29.

Chan KC, Au CT, Hui LL, Ng SK, Wing YK, Li AM (2019) How OSA evolves from childhood to young adulthood: natural history from a 10-year follow-up study. Chest 156:120–130. https://doi.org/10.1016/j.chest.2019.03.007CrossRefPubMed

30.

Mokdad AH, Ballestros K, Echko M, Glenn S, Olsen HE, Mullany E, Lee A et al (2018) The state of US health, 1990–2016: burden of diseases, injuries, and risk factors among US states. JAMA 319:1444–1472. https://doi.org/10.1001/jama.2018.0158CrossRefPubMedPubMedCentral

Titel: Is there an OAHI or O2 nadir that predicts the need for preoperative echocardiogram prior to adenotonsillectomy for children with severe obstructive sleep apnea?
verfasst von: Nicolas S. Poupore
Hussein Smaily
James D. Sullivan
Calvin W. Myint
John D. Prosser
William W. Carroll
Publikationsdatum: 09.09.2023
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 1/2024
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-023-02910-4

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Is there an OAHI or O₂ nadir that predicts the need for preoperative echocardiogram prior to adenotonsillectomy for children with severe obstructive sleep apnea?