Echocardiographic findings in children with obstructive sleep apnea: A systematic review

To systematically review the incidence of cardiac abnormalities in pediatric patients with obstructive sleep apnea (OSA) in order to assess the utility of preoperative echocardiographic evaluation for patients undergoing surgery.

A systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Data sources were searched from January 1, 1980 to March 25, 2020. Studies that examined echocardiographic findings and polysomnographic data for patients between birth and 18 years of age with polysomnogram-confirmed OSA were included. Studies that included patients with preexisting cardiac, metabolic, or hematologic disorders that could affect hemodynamic parameters were excluded. Included studies were assessed for quality and risk of bias using the U.S. National Institute of Health's Quality Assessment Tools.

Thirteen studies met inclusion criteria. Five studies were categorized as high risk of bias, three were categorized as medium risk, and five were categorized as low risk. Study design varied considerably between studies, including heterogeneous classifications of OSA severity, discrepant reporting of echocardiographic parameters, and differing estimations of pulmonary hemodynamics. Significant disagreement regarding the effect of OSA on cardiac function was found between all included studies.

Data demonstrating significant associations between OSA and cardiac abnormalities in children is inconsistent. Echocardiographic abnormalities are inconsistently found and, when present, their clinical significance remains poorly understood. Assessing the utility of preoperative echocardiography in children with OSA requires further investigation with prospective studies utilizing standardized classifications of OSA severity, reporting of echocardiographic parameters, and estimations of pulmonary hemodynamics.