The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

Background.The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA.Methods.Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale.Results.The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery.Conclusion.This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale.

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The impact of obstructive sleep apnea on endothelial function during weight loss in an obese pediatric population

Sleep Medicine ◽

10.1016/j.sleep.2021.08.002 ◽

2021 ◽

Author(s):

Sofie Jacobs ◽

Emilie Mylemans ◽

Marijke Ysebaert ◽

Eline Vermeiren ◽

Ann De Guchtenaere ◽

...

Keyword(s):

Weight Loss ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Endothelial Function ◽

Pediatric Population ◽

Obstructive Sleep ◽

The Impact

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Bone Mineral Density Attenuation in Obstructive Sleep Apnea by Derived Computed Tomography Screening

10.21203/rs.3.rs-1049040/v1 ◽

2021 ◽

Author(s):

Sharon Daniel ◽

Yafit Cohen-Freud ◽

Ilan Shelef ◽

Ariel Tarasiuk

Keyword(s):

Computed Tomography ◽

Bone Mineral Density ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Bone Mineral ◽

Clinical Information ◽

Mineral Density ◽

Peak Voltage ◽

Arousal Index ◽

Obstructive Sleep

Abstract The association between obstructive sleep apnea (OSA) and bone mineral density (BMD) is poorly elucidated with contradictory findings. We retrospectively explored the association between OSA and BMD by examining abdominal computed tomography (CT) vertebrae images using clinical information. We included 315 subjects (174 with OSA and 141 without OSA) who performed at least two CT scans (peak voltage of 120 kV). Bone mineral density was attenuated in those with OSA and increased age. BMD attenuation was not associated with the apnea–hypopnea score, nocturnal oxygen saturation, or arousal index. A multivariate linear regression indicated that OSA is associated with BMD attenuation after controlling for age, gender, and cardiovascular diseases. Here, we report that OSA is associated with BMD attenuation. Further studies are required to untangle the complex affect of OSA on BMD loss and possible clinical implication of vertebra depressed fracture or femoral neck fracture.

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Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

Children ◽

10.3390/children8111074 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1074

Author(s):

Erica Gastelum ◽

Marcus Cummins ◽

Amitoj Singh ◽

Michael Montoya ◽

Gino Luis Urbano ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Down Syndrome ◽

Sleep Apnea ◽

Treatment Guidelines ◽

Negative Impact ◽

Pediatric Population ◽

Healthy Children ◽

Obstructive Sleep ◽

Treatment Considerations ◽

Additional Therapy

Children with Down syndrome (DS) are at high risk for developing obstructive sleep apnea (OSA) compared to children without DS. The negative impact of OSA on health, behavior, and cognitive development in children with DS highlights the importance of timely and effective treatment. Due to the higher prevalence of craniofacial and airway abnormalities, obesity, and hypotonia in patients with DS, residual OSA can still occur after exhausting first-line options. While treatment commonly includes adenotonsillectomy (AT) and continuous positive airway pressure (CPAP) therapy, additional therapy such as medical management and/or adjuvant surgical procedures need to be considered in refractory OSA. Given the significant comorbidities secondary to untreated OSA in children with DS, such as cardiovascular and neurobehavioral consequences, more robust randomized trials in this patient population are needed to produce treatment guidelines separate from those for the general pediatric population of otherwise healthy children with OSA. Further studies are also needed to look at desensitization and optimization of CPAP use in patients with DS and OSA.

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Effect of Bariatric Surgery on Obstructive Sleep Apnea and Hypopnea Syndrome, Electrocardiogram, and Pulmonary Arterial Pressure

Obesity Surgery ◽

10.1381/0960892041590773 ◽

2004 ◽

Vol 14 (6) ◽

pp. 755-762 ◽

Cited By ~ 61

Author(s):

Matilde Valencia-Flores ◽

Arturo Orea ◽

Miguel Herrera ◽

Victoria Santiago ◽

Verónica Rebollar ◽

...

Keyword(s):

Bariatric Surgery ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Arterial Pressure ◽

Pulmonary Arterial Pressure ◽

Obstructive Sleep ◽

Pulmonary Arterial ◽

Hypopnea Syndrome

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846 Pulmonary Arterial Hypertension as a Sequela of Untreated Obstructive Sleep Apnea in a Patient with Prader-Willi Syndrome

SLEEP ◽

10.1093/sleep/zsab072.843 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A329-A329

Author(s):

Hina Emanuel ◽

Kevin Kaplan

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Systolic Dysfunction ◽

Morbidity And Mortality ◽

Prader Willi Syndrome ◽

Obstructive Sleep ◽

Pulmonary Arterial

Abstract Introduction Prader-Willi Syndrome (PWS) is a complex neurogenetic disorder characterized by hypotonia, behavioral problems, endocrinopathies, sleep and respiratory abnormalities. Morbidity and mortality in the PWS population is attributable to obesity, cardiovascular problems, and sleep apnea. We report a patient with PWS presenting with pulmonary arterial hypertension (PAH) due to untreated obstructive sleep apnea (OSA). Report of case(s) Our patient is a 17-year-old female with a past medical history of PWS, scoliosis, obesity (BMI 52.46), hypogonadotropic hypogonadism, and type II diabetes. Baseline echocardiogram (ECHO) performed at age 9 revealed an estimated right ventricular systolic pressure (eRVSP) of 32mmHg above right atrial pressure (RAP), tricuspid regurgitation (TR) at 2.8 m/sec with no interventricular septal flattening (IVSF) and right ventricle (RV) systolic dysfunction suggestive of mild PAH. Given significant scoliosis the patient did not qualify for growth hormone therapy. She underwent a polysomnogram (PSG) at age 14 showing severe obstructive sleep apnea; apnea-hypopnea index (AHI) of 22.6 (oAHI 22.6). Patient was subsequently lost to follow up until presenting in acute respiratory failure at age 17. She required endotracheal intubation and was extubated to bilevel PAP (BPAP) with inability to wean off BPAP. At that time an ECHO revealed eRVSP of 55 mmHg above RAP, IVSF, TR at 3.7 m/sec, and RV systolic dysfunction suggestive of moderate to severe PAH and developing right sided heart failure. A PAP titration PSG during this admission revealed hypoxemia with oxygen saturation less than 90% (O2 nadir 70%) 12.6% of total sleep time (TST) and hypoventilation (transcutaneous CO2 max of 57 mmHg with an elevation above 50 mmHg for 100% of TST). Using an inspiratory PAP (IPAP) of 24 cmH2O and expiratory PAP (EPAP) of 14 cmH20 with supplemental O2 of 4LPM the respiratory events and hypoxemia resolved but there was persistence of hypoventilation. Tadalafil was initiated for PAH and BPAP therapy for OSA. Follow up visits 4- and 8-weeks post discharge shows improving PAH (TR 3.6 m/sec, eRSVP 52 mmHg, and mild IVSF) due to BPAP and tadalafil therapies. Conclusion This case highlights the importance of treating OSA in patients with PWS to prevent cardiorespiratory complications and reduce morbidity and mortality. Support (if any) None

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