Solano-Pérez Esther, Coso Carlota, Romero-Peralta Sofía, Castillo-García María, López-Monzoni Sonia, Ortigado Alfonso, Mediano Olga
Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain.
Biomedicines. 2024 Feb 9;12(2):411. doi: 10.3390/biomedicines12020411.
Exposure to risk factors in youth can exacerbate the development of future cardiovascular disease (CVD). Obstructive sleep apnea (OSA), characterized by repetitive episodes of airway obstructions, could trigger said CVD acting as a modifiable risk factor. Measurements from echocardiography have shown impairments in the anatomy and function of the heart related to the severity of OSA. Therefore, the aim of this review was to propose a new clinical approach to the management of cardiovascular risk (CVR) in children based on treating OSA. The review includes studies assessing echocardiographic parameters for cardiac function and structure in pediatric OSA diagnosed using the apnea-hypopnea index (AHI) ≥ 1/h using polysomnography (PSG) and conducted within a year. Based on the reviewed evidence, in addition to PSG, echocardiography should be considered in OSA children in order to indicate the need for treatment and to reduce their future CVR. A follow-up echocardiography after treatment could be performed if impairments in the anatomy and function were found. Prioritizing parameters intimately connected to comorbidity could propel more effective patient-centered care. In conclusion, a reevaluation of pediatric OSA strategies should be considered, emphasizing comorbidity-related parameters in the cardiovascular field. Further studies are needed to assess this approach, potentially leading to enhanced protocols for more effective pediatric OSA treatment and CVR prevention.
年轻时暴露于风险因素会加剧未来心血管疾病（CVD）的发展。阻塞性睡眠呼吸暂停（OSA）以气道反复阻塞为特征，可作为一个可改变的风险因素引发上述心血管疾病。超声心动图测量结果显示，心脏的解剖结构和功能受损与阻塞性睡眠呼吸暂停的严重程度有关。因此，本综述的目的是提出一种基于治疗阻塞性睡眠呼吸暂停的儿童心血管风险（CVR）管理新临床方法。该综述纳入了在一年内进行的研究，这些研究使用多导睡眠图（PSG）诊断呼吸暂停低通气指数（AHI）≥1次/小时的小儿阻塞性睡眠呼吸暂停，并评估其心脏功能和结构的超声心动图参数。基于所审查的证据，除多导睡眠图外，对于阻塞性睡眠呼吸暂停儿童，应考虑进行超声心动图检查，以表明治疗的必要性并降低其未来的心血管风险。如果发现解剖结构和功能有损害，治疗后可进行超声心动图随访。优先考虑与合并症密切相关的参数可以推动更有效的以患者为中心的护理。总之，应考虑重新评估小儿阻塞性睡眠呼吸暂停策略，强调心血管领域中与合并症相关的参数。需要进一步研究来评估这种方法，这可能会导致制定更有效的小儿阻塞性睡眠呼吸暂停治疗和心血管风险预防方案。
