Maloney Melissa A, Ward Sally L Davidson, Su Jennifer A, Durazo-Arvizu Ramon A, Breunig Jacqueline M, Okpara Daniel U, Gillett Emily S
Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.
Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California.
J Clin Sleep Med. 2022 Jun 1;18(6):1629-1637. doi: 10.5664/jcsm.9944.
Pulmonary hypertension (PH) is a rare yet serious complication of obstructive sleep apnea (OSA). Echocardiographic screening for PH is recommended in children with severe OSA, but the health care burden of universal screening is high. We sought to determine the prevalence of PH on echocardiogram among children with severe OSA and identify variables associated with a positive PH screen.
Retrospective study of 318 children with severe OSA (obstructive apnea-hypopnea index ≥ 10 events/h) and echocardiogram within 1 year of polysomnogram. PH-positive echocardiogram was defined by peak tricuspid regurgitation velocity ≥ 2.5 m/s and/or 2 or more right-heart abnormalities suggestive of elevated pulmonary artery pressure. Patient characteristics and polysomnogram data were compared to identify factors associated with PH.
Twenty-six children (8.2%; 95% confidence interval [CI] 5.4-11.8%) had echocardiographic evidence of PH. There was no difference in age, sex, body mass index, obstructive apnea-hypopnea index, or oxygenation indices between patients with and without PH. Sleep-related hypoventilation (end-tidal CO > 50 mmHg for > 25% of total sleep time) was present in 25% of children with PH compared with 6.3% of children without PH (adjusted prevalence ratio = 2.73; 95% CI 1.18-6.35). Forty-six percent of children (12/26) with PH had Down syndrome vs 14% (41/292) without PH (adjusted prevalence ratio = 3.11; 95% CI 1.46-6.65).
There was a relatively high prevalence of PH on echocardiogram in our cohort of children with severe OSA. The findings of increased PH prevalence among children with sleep-related hypoventilation or Down syndrome may help inform the development of targeted screening recommendations for specific pediatric OSA populations.
Maloney MA, Davidson Ward SL, Su JA, et al. Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea. . 2022;18(6):1629-1637.
肺动脉高压（PH）是阻塞性睡眠呼吸暂停（OSA）一种罕见但严重的并发症。建议对重度OSA患儿进行超声心动图筛查以诊断PH，但普遍筛查的医疗负担较高。我们试图确定重度OSA患儿超声心动图检查中PH的患病率，并识别与PH筛查阳性相关的变量。
对318例重度OSA患儿（阻塞性呼吸暂停低通气指数≥10次/小时）进行回顾性研究，这些患儿在多导睡眠图检查后1年内接受了超声心动图检查。超声心动图PH阳性定义为三尖瓣反流峰值速度≥2.5米/秒和/或2种或更多提示肺动脉压升高的右心异常。比较患者特征和多导睡眠图数据，以确定与PH相关的因素。
26例患儿（8.2%；95%置信区间[CI]5.4 - 11.8%）有超声心动图证据显示存在PH。有PH和无PH的患者在年龄、性别、体重指数、阻塞性呼吸暂停低通气指数或氧合指数方面无差异。25%的PH患儿存在与睡眠相关的通气不足（呼气末二氧化碳分压>50 mmHg持续时间超过总睡眠时间的25%），而无PH患儿中这一比例为6.3%（调整患病率比 = 2.73；95% CI 1.18 - 6.35）。46%的PH患儿（12/26）患有唐氏综合征，而无PH患儿中这一比例为14%（41/292）（调整患病率比 = 3.11；95% CI 1.46 - 6.65）。
在我们的重度OSA患儿队列中，超声心动图检查显示PH的患病率相对较高。睡眠相关通气不足或唐氏综合征患儿中PH患病率增加的发现可能有助于为特定儿科OSA人群制定有针对性的筛查建议提供依据。
Maloney MA, Davidson Ward SL, Su JA,等。重度阻塞性睡眠呼吸暂停患儿超声心动图检查中肺动脉高压的患病率。. 2022；18(6):1629 - 1637。
