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Prevalence of pulmonary hypertension in obstructive sleep apnea and its relation to disease severity
Ian Milligan1,2, Anna Kate Shaw1,2, Roberta Leu1,3
1Children's Healthcare of Atlanta, Atlanta, Georgia.
Insights
Pulmonary hypertension (PHTN) was found in 4.3% of children with obstructive sleep apnea (OSA). PHTN in children with OSA was linked to comorbidities like bronchopulmonary dysplasia, not OSA severity.
Area of Science:
- Pediatric Cardiology
- Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) is a common condition in children.
- Pulmonary hypertension (PHTN) is a serious complication that can arise from various conditions.
- The relationship between OSA severity and PHTN in pediatric populations requires further investigation.
Purpose of the Study:
- To determine the prevalence of PHTN in children diagnosed with OSA.
- To assess echocardiographic (ECHO) findings indicative of PHTN in this cohort.
- To explore the correlation between PHTN and the severity of OSA, including hypoxemia and hypercarbia.
Main Methods:
- Retrospective cohort study of pediatric patients with OSA.
- Inclusion criteria: polysomnogram and ECHO within 30 days, absence of cardiac disease.
- PHTN definition based on specific ECHO parameters; comparison with OSA severity metrics (apnea-hypopnea index, oxygen saturation, end-tidal carbon dioxide).
Main Results:
- Echocardiographic evidence of PHTN was identified in 4.3% of the 509 patients studied.
- No significant correlation was found between OSA severity (apnea-hypopnea index, hypoxemia, hypercarbia) and ECHO parameters of PHTN.
- Comorbidities such as bronchopulmonary dysplasia (OR 5.22), prematurity (OR 3.10), and autism (OR 3.69) were associated with increased odds of PHTN.
Conclusions:
- A notable percentage of children with OSA exhibit echocardiographic signs of PHTN.
- OSA severity, based on polysomnogram data, does not appear to be a direct predictor of PHTN in this population.
- Bronchopulmonary dysplasia, prematurity, and autism are identified as significant risk factors for developing PHTN in children with OSA.
Study Objectives:
The purpose of this study is to examine the prevalence of pulmonary hypertension (PHTN) in children with obstructive sleep apnea (OSA) using echocardiographic (ECHO) parameters and to examine ECHO findings as they relate to severity of OSA.
Methods:
A retrospective cohort study of patients with OSA undergoing polysomnogram and ECHO within 30 days of each other, between January 1, 2015, and December 31, 2020, was performed, excluding cardiac disease. ECHO evidence of PHTN was defined as ≥ 2 of the following: tricuspid regurgitation velocity > 3.0 m/s, pulmonary acceleration/ejection time ratio < 0.3, left ventricular eccentricity index > 1.5, and right ventricular dysfunction or abnormal geometry. ECHO parameters were compared to OSA severity using obstructive apnea-hypopnea index, percent of time with oxygen saturation < 90%, and percent of time with end-tidal carbon dioxide > 50 mmHg. Odds ratios were calculated for each comorbidity to evaluate for risk factors.
Results:
Of 509 patients, 4.3% were found to have echocardiographic evidence of PHTN. Neither obstructive apnea-hypopnea index severity nor worsening hypoxemia or hypercarbia correlated with worsening ECHO parameters. Comorbidities including bronchopulmonary dysplasia (odds ratio, 5.22, 2.01-13.53), prematurity (odds ratio, 3.10, 1.28-7.47), and autism (odds ratio, 3.69, 1.01-13.49) were associated with increased odds of PHTN.
Conclusions:
Significant echocardiographic evidence of PHTN was seen in 4.3% of children with OSA. ECHO findings of PHTN did not correlate with polysomnogram parameters. Comorbidities, particularly bronchopulmonary dysplasia, prematurity, and autism, appear to be a risk factor for developing PHTN in patients with OSA.
Citation:
Milligan I, Shaw AK, Leu R, Kanaan U, Michelfelder E. Prevalence of pulmonary hypertension in obstructive sleep apnea and its relation to disease severity. J Clin Sleep Med. 2024;20(5):675-680.
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