Imaging Detects Preoperative Cardiac Changes in Children With OSA

Tissue Doppler Imaging Echocardiography (TDI) identified subclinical changes in cardiac function in children with obstructive sleep apnea prior to tonsillectomy and adenoidectomy, based on data from 560 children.

Identifying cardiac abnormalities before surgery could help reduce the risk of perioperative or postoperative complications, but data from previous studies have not shown reliable predictors of cardiac changes in children with obstructive sleep apnea (OSA), writes Nicolas S. Poupore, MD, of the Medical University of South Carolina, Charleston, and colleagues.

TDI is an additional imaging study that measures a positive systolic peak and two negative diastolic peaks and has shown increased sensitivity to subclinical changes in asymptomatic or mildly symptomatic patients, although data on use in pediatric patients are limited, the researchers said.

In a study published in the International Journal of Pediatric OtorhinolaryngologyThe researchers analyzed data from four studies involving 295 children with OSA and 265 controls without OSA who underwent tonsillectomy and adenoidectomy (T&A) and TDI. They checked TDI measurements for the S ‘, E’ and A ‘waves and then for the E’ / A ‘ratio at the tricuspid annulus (S’ RV) and mitral annulus (E ‘/ A’ LV) before and after T&A.

In patients prior to T&A, both TDI measures of interest, S′ RV and E′/A′ LV, were significantly lower compared to controls, with mean differences of -1.04 and -0.74, respectively (P. < 0.001 for both). However, these T&A measured variables did not differ statistically from the controls, the researchers found.

The study was constrained by several factors, including the lack of TDI echocardiography data, which was confirmed by polysomnograms in many studies, meaning only four were eligible for meta-analysis, the researchers noted. Other limitations included the lack of stratification by OSA severity, the potential for bias in patient selection, and the lack of data on how long OSA took before T&A, they said. “Since untreated OSA has been shown to worsen cardiac effects, it makes sense that different lengths of untreated OSA can affect heart function differently,” they explain.

Although TDI can provide more accurate information on assessing cardiac risk factors in children with OSA, the current study results do not answer the question of which patients need preoperative echocardiography and whether the study should include TDI, the researchers wrote.

“Doctors should assess each child individually for their comorbidities and the resources available to determine the benefit of cardiac imaging prior to T&A for that child,” the researchers emphasize. “With the safety of a child under anesthesia and post-op is paramount, we need powerful, prospective studies to further clarify which children should receive cardiac imaging prior to T&A to reduce perioperative complications.”

The study did not receive any third-party funding. The researchers have not disclosed any relevant financial relationships.

Int J Pediatric Otorhinolaryngology. Edition published January 2022. abstract

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