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The utility of preoperative echocardiography in pediatric obstructive sleep apnea
Brian Pettitt-Schieber1, Ching Siong Tey2, Robert Hill3
1School of Medicine, Emory University, Atlanta, GA, USA.
Insights
In pediatric obstructive sleep apnea (OSA) patients, preoperative echocardiogram abnormalities do not predict postoperative adverse events. However, the lowest oxygen saturation (O2) nadir during sleep studies is a significant predictor of these complications.
Area of Science:
- Pediatric Cardiology
- Sleep Medicine
- Critical Care Medicine
Background:
- Obstructive sleep apnea (OSA) is increasingly recognized in children, often associated with cardiovascular comorbidities.
- Understanding predictors of postoperative adverse events in pediatric OSA patients is crucial for optimizing perioperative management.
- Cardiac function assessment through echocardiography is commonly performed in this population.
Purpose of the Study:
- To investigate the association between cardiac function, assessed via echocardiography, and postoperative adverse events in pediatric patients with OSA.
- To identify potential predictors of adverse outcomes in children with varying degrees of OSA severity.
Main Methods:
- A retrospective study evaluated 110 pediatric patients (birth to 18 years) with OSA who underwent echocardiography within six months of surgery.
- Patients were categorized by OSA severity based on polysomnography (PSG) findings.
- Chi-squared analysis and logistic regression were used to determine associations between demographic factors, OSA severity, echocardiographic findings, and postoperative adverse events.
Main Results:
- Of 110 children, 22 had mild, 22 moderate, and 66 severe OSA. Race and congenital heart disease (CHD) correlated with OSA severity.
- Echocardiographic abnormalities were present in 45 patients, but not significantly associated with OSA severity after excluding patients with CHD.
- Postoperative adverse events occurred in 16% of patients; only the lowest oxygen saturation (O2) nadir during PSG was a significant predictor.
Conclusions:
- Preoperative echocardiographic abnormalities are uncommon in pediatric OSA patients and do not reliably predict postoperative adverse events.
- The O2 saturation nadir during preoperative PSG is a significant predictor of postoperative complications.
- O2 saturation nadir should be considered a valuable clinical indicator for assessing OSA severity and risk in pediatric surgical patients.
Purpose:
The purpose of this study was to determine the associations between cardiac function and postoperative adverse events in pediatric patients with obstructive sleep apnea (OSA).
Methods:
Patients between birth and 18 years of age diagnosed with OSA between January 1, 2015, and December 31, 2018, who underwent echocardiographic evaluation within 6 months of surgery at a tertiary care children's hospital were evaluated. Exclusion criteria included history of neuromuscular disorders, tracheostomy placement, or a predominance of central apneic events recorded during polysomnography (PSG). Patients were grouped by OSA severity. Chi-squared analysis and logistic regression were utilized to determine associations between demographic characteristics, OSA severity, preoperative echocardiographic abnormalities, and postoperative adverse events.
Results:
One hundred ten children met inclusion criteria for the study, including 22 with mild OSA, 22 with moderate OSA, and 66 with severe OSA. Race and the presence of congenital heart disease (CHD) were significantly associated with differences in OSA severity. Echocardiographic abnormalities were found in 45 patients, but exclusion of patients with CHD revealed no significant associations with differences in OSA severity. Postoperative adverse events were identified in 18 (16%) patients, and only O2 saturation nadir was found to be a significant predictor of these complications.
Conclusion:
Preoperative echocardiogram abnormalities are not commonly found in children with OSA and presence of abnormalities does not predict postoperative adverse events. O2 saturation nadir measured on preoperative PSG is a significant predictor of postoperative adverse events and should be examined as a clinical indicator of OSA severity.
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