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Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment
A Tal1, A Leiberman, G Margulis
1Pediatric Division, Soroka University Hospital, Beer-Sheva, Israel.
Insights
Obstructive sleep apnea in children can impair right ventricular function, even before clinical signs of heart problems appear. Treatment, like adenotonsillectomy, significantly improves cardiac function.
Area of Science:
- Pediatric Cardiology
- Sleep Medicine
- Cardiopulmonary Physiology
Background:
- Obstructive sleep apnea (OSA) in children is often linked to adenotonsillar hypertrophy.
- Cardiac involvement in pediatric OSA is not always clinically apparent.
- Ventricular dysfunction can be an early indicator of OSA-related complications.
Purpose of the Study:
- To evaluate ventricular function in children with oropharyngeal obstruction and OSA.
- To determine if OSA impacts right and left ventricular function.
- To assess the effect of adenotonsillectomy on ventricular function in these children.
Main Methods:
- Radionuclide ventriculography was used to assess ventricular function in 27 children with OSA.
- Ejection fraction and wall motion abnormalities were analyzed.
- Ventricular function was reassessed after adenotonsillectomy in a subset of patients.
Main Results:
- Reduced right ventricular ejection fraction (<35%) was found in 37% of patients.
- Wall motion abnormalities were detected in 18 patients.
- Adenotonsillectomy significantly improved right ventricular ejection fraction (24.4% to 46.7%) and wall motion.
Conclusions:
- Right ventricular function can be compromised in children with OSA due to adenotonsillar hypertrophy.
- Ventricular dysfunction may precede overt clinical signs of cardiac involvement.
- Surgical removal of obstruction (adenotonsillectomy) can reverse cardiac dysfunction in pediatric OSA.
Abstract:
Ventricular function was evaluated using radionuclide ventriculography in 27 children with oropharyngeal obstruction and clinical features of obstructive sleep apnea. Their mean age was 3.5 years (9 months to 7.5 years). Conventional clinical assessment did not detect cardiac involvement in 25 of 27 children; however, reduced right ventricular ejection fraction (less than 35%) was found in 10 (37%) patients (mean: 19.5 +/- 2.3% SE, range: 8-28%). In 18 patients wall motion abnormality was detected. In 11 children in whom radionuclide ventriculography was performed before and after adenotonsillectomy, right ventricular ejection fraction rose from 24.4 +/- 3.6% to 46.7 +/- 3.4% (P less than 0.005), and in all cases wall motion showed a definite improvement. In five children, left ventricular ejection fraction rose greater than 10% after removal of oropharyngeal obstruction. It is concluded that right ventricular function may be compromised in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy, even before clinical signs of cardiac involvement are present.