Children with obstructive sleep apnea appear to gain moderate cardiac benefits based on echocardiographic findings following an adenotonsillectomy, according to a recent meta-analysis.
“This review showed cardiovascular repercussions mostly on pulmonary circulation, right heart dimensions and diastolic function, with improvement after treatment,” Dr. Silke Anna Theresa Weber of Universidade Estadual Paulisita–UNESP in Botucatu, Brazil, and her colleagues reported (Int. J. Pediatr. Otorhinolaryngol. 2014;78:1571-8).
From a search of PUBMED, Embase, and LILACS in studies of cohorts ranging from 55 to 110 subjects, the researchers identified seven cohort studies meeting their criteria. Each study included children 12 years old or younger with obstructive sleep apnea (OSA) who received an adenotonsillectomy, and a comparison group of children without OSA.
Before the surgery, children with OSA had 8.67 greater mean pulmonary arterial pressure levels, compared with those without OSA, according to data in two studies. After surgery, the groups’ levels did not differ with statistical significance. Preoperatively, children with OSA had a mean 0.60-mm thicker increased interventricular septum and a mean 0.19-cm/m right ventricular dimension, compared with children with OSA in those two studies.
After the operation through 6 months’ follow-up, two studies “showed improvement of the mean arterial pulmonary blood pressure” in OSA children, and three other studies “showed improvement of cardiac structure and heart functions, mostly on the right heart, as right ventricle dimensions, tricuspid E/A ratio, and estimated pulmonary pressure,” the authors wrote.
Yet, the evidence for postoperative positive cardiovascular outcomes were limited, the authors wrote. None of the studies mentioned confounding factors for cardiovascular disease, such as obesity, and many did not use polysomnography for sleep apnea diagnoses.
The study was supported by FAPESP – Fundação de Amparo á Pesquisa do Estado de São Paulo. The authors reported no disclosures.