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Published on: December 6, 2016
Tonsil size as a predictor of cardiac complications in children with sleep-disordered breathing
Eduardo Homrich Granzotto1, Flavio Veras Aquino, José Antônio Flores
1Medical Sciences Postgraduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. eduardo@granzotto.com.br
Insights
Tonsil size measured by radiography strongly correlates with pulmonary artery pressure in children with enlarged tonsils and sleep-disordered breathing. Larger tonsil size may indicate a higher risk for pulmonary artery hypertension, suggesting further cardiac evaluation.
Area of Science:
- Pediatric Cardiology
- Otolaryngology
- Sleep Medicine
Background:
- Adenotonsillar hypertrophy is a common cause of sleep-disordered breathing in children.
- Enlarged tonsils can lead to increased pulmonary artery pressure (PAP) and potentially pulmonary artery hypertension (PAH).
- Radiographic measurement of tonsil size offers a non-invasive assessment method.
Purpose of the Study:
- To evaluate the association between palatine (T/P) tonsil size and PAP in children requiring adenotonsillectomy.
- To determine if tonsil size can identify children at higher risk for PAH.
Main Methods:
- A cross-sectional study involving 45 children with surgical indications for adenotonsillar hypertrophy.
- Palatine tonsil (T/P) size measured via lateral neck radiography.
- Pulmonary artery pressure (PAP) assessed using Doppler echocardiography; symptoms evaluated with the OSA-18 questionnaire.
Main Results:
- A strong correlation (r = 0.624) was found between systolic PAP and T/P.
- Children with PAH had significantly larger T/P measurements (P < .001).
- A T/P cut-off of 0.66 identified children with significantly higher mean systolic PAP.
Conclusions:
- Palatine tonsil size correlates well with PAP in children with adenotonsillar hypertrophy and sleep-disordered breathing.
- A T/P ratio >0.66 suggests a higher risk for cardiac complications, warranting further echocardiographic study or surgical prioritization.
Objectives/Hypothesis:
The primary objective was to evaluate the association of palatine (T/P) tonsil size determined by radiography with pulmonary artery pressure (PAP) measured by Doppler echocardiography in children with surgical indication for adenotonsillar hypertrophy. The secondary objective was to evaluate if tonsil size could help to identify children at higher risk of pulmonary artery hypertension (PAH).
Study Design:
Cross-sectional study.
Methods:
The study was conducted with a consecutive sample of children with indication of adenotonsillectomy for sleep-disordered breathing. T/P was measured by lateral neck radiography, PAP by echodopplercardiography, and symptoms and quality of life by the Obstructive Sleep Apnea (OSA)-18 questionnaire. T/P was plotted in a receiver operating characteristic (ROC) curve to determine the best cut-off point to identify children with PAH.
Results:
A total of 45 children participated in the study. The mean age was 72.0 +/- 32.3 months, and six (13%) patients had PAH. Correlation between systolic PAP and T/P was strong (r = 0.624; P < .0001). T/P was significantly higher in patients with PAH (P < .001). OSA-18 score did not significantly correlate with the variables. The cut-off point identified in the ROC was 0.66, which was the minimum T/P where sensitivity was still 100%. Mean systolic pulmonary artery pressure in children with T/P >0.66 was significantly higher than in those with T/P <0.66 (P < .001).
Conclusions:
T/P showed a good correlation with PAP in children with adenotonsillar hypertrophy and surgical indication for sleep-disordered breathing. Children with T/P >0.66 can be at greater risk for cardiac complications and should be submitted to complementary studies with echodopplercardiography or given preference for surgery.
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