Medline ® Abstracts for References 57,66
of 'Evaluation of suspected obstructive sleep apnea in children'
Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment.
Tal A, Leiberman A, Margulis G, Sofer S
Pediatr Pulmonol. 1988;4(3):139.
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.
Pediatric Division, Soroka University Hospital, Beer-Sheva, Israel.
Impaired right ventricular function in adenotonsillar hypertrophy.
Duman D, Naiboglu B, Esen HS, Toros SZ, Demirtunc R
Int J Cardiovasc Imaging. 2008;24(3):261. Epub 2007 Sep 6.
OBJECTIVE: Adenotonsillar hypertrophy (ATH) causing upper airway obstruction and obstructive sleep apnea (OSA) syndrome and may lead to the pulmonary hypertension and cor pulmonale. This study was designed to determine the clinical value of right ventricular (RV) myocardial performance index (MPI) in ATH. The effects of adenotonsillectomy on MPI were also assessed.
METHODS: Twenty-one children with grade 3 and grade 4 ATH and 21 age-and-sex matched healthy children were enrolled. MPI, defined as the sum of isovolumetric contraction and relaxation time divided by ejection time, was measured by using Doppler echocardiography preoperatively and postoperatively in all subjects. The quality of life in children was also assessed with obstructive sleep disorder questionnaire (OSA-18).
RESULTS: The RV MPI in patients with ATH was significantly higher than the control group (0.41 +/- 0.06 vs. 0.29 +/- 0.07; P<.001). It showed a strong correlation with mean pulmonary artery pressure and OSA-18 survey score (r = 0.71; P<.005 and (r = 0.64; P<.01, respectively). The RV MPI and OSA-18 survey score decreased significantly after the relief of upper airway obstruction by adenotonsillectomy (from 0.41 +/- 0.06 to 0.31 +/- 0.03; P<.001 and from 83 +/- 27 to 36 +/- 12; P<.0001, respectively). The RV MPI in postoperative group was similar to control group.
CONCLUSION: Our findings support that advanced stage of ATH is associated with impaired RV functions, which were recovered postoperatively.
Department of Cardiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey. firstname.lastname@example.org