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Published on: December 6, 2016
Prevalence of Pulmonary Hypertension in Pediatric Patients With Obstructive Sleep Apnea and a Cardiology Evaluation:
Antoinette T Burns1, Shana L Hansen2, Zachary S Turner3
1Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.
Insights
Pulmonary hypertension (PH) is uncommon in children with obstructive sleep apnea (OSA), affecting only 1.8%. OSA severity did not predict PH risk, suggesting current screening guidelines may need revision for pediatric patients.
Area of Science:
- Pediatric Cardiology
- Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) is linked to pulmonary hypertension (PH) in children, but prevalence estimates vary widely.
- Accurate PH prevalence and risk factors in pediatric OSA patients are not well-established.
Purpose of the Study:
- To determine the prevalence of PH in children diagnosed with OSA.
- To identify potential predictors of increased PH risk in this pediatric population.
Main Methods:
- Retrospective review of 88,058 pediatric beneficiaries with OSA diagnosis.
- Analysis of overnight polysomnography data for OSA severity and oxygen saturation.
- Inclusion of 163 pediatric patients with OSA undergoing cardiology evaluation.
Main Results:
- PH was diagnosed in 3 of 163 pediatric OSA patients (1.8% prevalence).
- None of the PH patients had severe OSA.
- Obesity and comorbid cardiac disorders were present in PH patients.
Conclusions:
- The prevalence of PH in pediatric OSA patients evaluated by cardiology is low.
- OSA severity did not correlate with PH risk in this cohort.
- Further research is needed to refine PH screening strategies for children with OSA.
Study Objectives:
Pulmonary hypertension (PH) has been reported as a serious complication of obstructive sleep apnea (OSA) in children; however, estimated prevalence rates vary widely (zero to 85%). The purpose of this study is to determine the prevalence of PH in children with OSA and identify factors that may predict an increased PH risk in children with OSA.
Methods:
A retrospective review of all pediatric beneficiaries (88,058) in the San Antonio Military Health System with a diagnosis of OSA and a clinical evaluation by a pediatric cardiologist. OSA severity and nadir oxygen saturation were recorded from overnight polysomnography. Reason for referral, comorbid disorders, echocardiogram results, and cardiac diagnoses were obtained from cardiology records.
Results:
OSA was identified in 2,020 pediatric patients (2.3%). A pediatric cardiology consultation was reported for 296 patients with OSA. After excluding 95 patients for incorrect OSA diagnoses, incomplete data, or OSA treatment before cardiology evaluation, 163 patients were included in the final analysis. A diagnosis of PH was found in 3 patients with OSA (1.8%). Two of these patients had obesity, and all three had comorbid cardiac disorders.
Conclusions:
Prevalence of PH in pediatric patients with OSA is low and none of the patients with PH had severe OSA. Current guidelines recommend PH screening in patients with severe OSA, yet OSA severity may not accurately predict risk. Factors evaluated in this study did not demonstrate an increased PH risk; additional research is necessary to improve screening in pediatric patients with OSA.
Citation:
Burns AT, Hansen SL, Turner ZS, Aden JK, Black AB, Hsu DP. Prevalence of pulmonary hypertension in pediatric patients with obstructive sleep apnea and a cardiology evaluation: a retrospective analysis. J Clin Sleep Med. 2019;15(8):1081-1087.
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