International Journal of Pediatric Otorhinolaryngology
Effect of upper airway obstruction on pulmonary arterial pressure in children
Introduction
Upper airway obstruction (UAO) is known as the cause of various systemic abnormalities in children. It can have detrimental effects on the quality of life in children. There are some reports in the literature declaring these effects on somatic growth [1], [2], [3], poor school performance [4], [5], [6], [7], hyperactivity [8] and cardiopulmonary system [9], [10], [11], [12], [13], [14], [15]. Cardiovascular deterioration is the most important one among these disorders which may lead to cor pulmonale and congestive heart failure. Although cardiopulmonary sequelae of UAO had been mentioned by anecdotal reports [16], [17], [18] in the literature, importance of this problem is best understood when considering the incidence of adenotonsillar hypertrophy (ATH) which is the most common cause of upper airway obstruction and obstructive sleep apnea in children.
Elevation of the pulmonary arterial pressure is the first step of the sequelae leading to cor pulmonale and congestive heart failure. Because of the absence of cardiovascular system-related symptoms in this period, changes at the pulmonary arterial pressure do not draw attention. At clinical practice, Doppler echocardiographic examination is not employed routinely unless severe obstructive sleep apnea (OSA) disease settles down and cardiovascular deterioration becomes established. Therefore, the following question arises. Should echocardiographic examination be done to all children with ATH and do the children with ATH but having milder symptoms are also under risk of pulmonary hypertension? Accurate diagnosis of OSA is made with polysomnography (PSG) but it is not easily employed, expensive and usually not possible at office practice. Because of these disadvantages of PSG, decision of referring the child to a cardiologist for echocardiographic examination and the decision of adenotonsilectomy is commonly made according to symptom questionnaire and physical examination findings by otolaryngologists.
Purpose of this study is to examine the relationship between UAO-related symptoms and pulmonary hypertension in order to have an idea about the answers of the questions asked above. The effect of adenotonsilectomy on pulmonary arterial pressure in children with ATH is also examined.
Section snippets
Materials and methods
The study group was selected among children who were admitted to ENT outpatient clinic of Haydarpasa Numune Education and Research Hospital with the complaint of recurrent adenotonsillar infection between March 2005 and November 2007. After getting approval from the ethic committee of our hospital, we obtained a written informed consent from the parents of the children. All children underwent a complete otolaryngologic examination including oropharyngal examination, otoscopy, anterior
Results
The mean age of the children in the study group was 5.78 ± 1.98 years (3–10 years). Sixteen (41%) of them were female whereas 23 (59%) of the were male. The mean pulmonary arterial pressure levels and symptom scores of the children in the study group preoperatively and postoperatively are shown in Table 1.
Preoperative mPAP levels were found to be very significantly higher than the mPAP levels of the children postoperatively and the children in the control group (Student's t-test, p = 0.01). But,
Discussion
It is well known that ATH is the most common cause of upper airway obstruction in children. This obstruction becomes more pronounced during sleep when the oropharyngeal musculature is relaxed. Sleep-related UAO in children may manifest as obstructive apnea or obstructive hypoventilation. Obstructive hypoventilation results from continuous partial upper airway obstruction, which leads to paradoxical respiratory efforts, hypercarbia and often hypoxemia. Hypoxemia and hypercarbia induced
References (23)
- et al.
Determinants of growth in children with the obstructive apnea syndrome
J. Pediatr.
(1994) - et al.
The effect of adenotonsilectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea
J. Pediatr.
(1999) - et al.
The effect of tonsillectomy and adenoidectomy on inattention and impulsivity as measured by the test of variables of attention in children with obstructive apnea syndrome
Otolaryngology. Head Neck Surge.
(2004) - et al.
The effects of adenoidectomy and tonsilectomy on pulmonary arterial pressure in children
Am. J. Otolaryngol.
(2005) - et al.
Comparison of cardiac function and valvular damage in children with and without adenotonsillar hypertrophy
Int. J. Pediatr. Otorhinolaryngol.
(2005) - et al.
Preoperative and postoperative cardiac and clinical findings of patients with adenotonsillar hypertrophy
Int. J. Pediatr. Otorhinolaryngol.
(2001) - et al.
Doppler echocardiography in adenotonsillar hypertrophy
Int. J. Pediatr. Otorhinolaryngol.
(2000) - et al.
Reversible cardiopulmonary changes due to adenotonsillar hypertrophy
Int. J. Pediatr. Otorhinolaryngol.
(2000) Modern assessment of tonsils and adenoids
Pediatr. Clin. North Am.
(1989)- et al.
A diagnostic approach to suspected obstructive sleep apnea in children
J. Pediatr.
(1984)
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