Ian Milligan, Anna Kate Shaw, Roberta Leu, Usama Kanaan, Erik Michelfelder
Children’s Healthcare of Atlanta and Emory University
United States
Journal of Clinical Sleep Medicine
J Clin Sleep Med 2023;
DOI: 10.5664/jcsm.10952
Abstract
Study objectives: The purpose of this study is to examine the prevalence of pulmonary hypertension (PHTN) in children with obstructive sleep apnea (OSA) using echocardiographic (ECHO) parameters and to examine ECHO findings as they relate to severity of OSA.
Methods: A retrospective cohort study of subjects with OSA undergoing polysomnogram (PSG) and ECHO within 30 days of each other, between 01/01/15 – 12/31/20 was performed, excluding cardiac disease. ECHO evidence of PHTN was defined as ≥ 2 of the following: tricuspid regurgitation (TR) velocity > 3.0 m/sec, pulmonary acceleration/ejection time (AT/ET) ratio < 0.3, left ventricular eccentricity index (EI) > 1.5, right ventricular (RV) dysfunction or abnormal geometry. ECHO parameters were compared to OSA severity using obstructive apnea-hypopnea index (AHI), % time with oxygen saturation < 90%, and % time with end-tidal carbon dioxide > 50 mmHg. Odds ratios were calculated for each comorbidity to evaluate for risk factors.
Results: Of 509 subjects, 4.3% were found to have echocardiographic evidence of PHTN. Neither oAHI severity, nor worsening hypoxemia or hypercarbia correlated with worsening ECHO parameters. Comorbidities including bronchopulmonary dysplasia (OR 5.22, 2.01 – 13.53), prematurity (OR 3.10, 1.28 – 7.47), and autism (OR 3.69, 1.01 – 13.49) were associated with increased odds of PHTN.
Conclusions: Significant echocardiographic evidence of PHTN was seen in 4.3% of children with OSA. ECHO findings of PHTN did not correlate with PSG parameters. Comorbidities, particularly bronchopulmonary dysplasia, prematurity, and autism, appear to be a risk factor for developing PHTN in patients with OSA.
Category
Class III. Pulmonary Hypertension Associated with Airway Disease, Apnea or Hypoventilation
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes