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. 2022 Jun 1;18(6):1629-1637.
doi: 10.5664/jcsm.9944.

Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea

Melissa A Maloney  1 , Sally L Davidson Ward  1   2 , Jennifer A Su  2   3 , Ramon A Durazo-Arvizu  2   4 , Jacqueline M Breunig  5 , Daniel U Okpara  5 , Emily S Gillett  1   2
Affiliations

Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea

Melissa A Maloney et al. J Clin Sleep Med. .

Abstract

Study objectives: 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.

Methods: 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.

Results: 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 CO2 > 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).

Conclusions: 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.

Citation: Maloney MA, Davidson Ward SL, Su JA, et al. Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea. J Clin Sleep Med. 2022;18(6):1629-1637.

Keywords: echocardiogram; obstructive sleep apnea; pediatrics; pulmonary hypertension.

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Conflict of interest statement

All authors have reviewed and approved this manuscript. Work for this study was performed at Children’s Hospital Los Angeles. Dr. Maloney received grant support through the Skirball Research Fellowship Award. Dr. Durazo-Arvizu assisted in statistical analysis with support from National Institutes of Health/National Center for Research Resources (NIH/NCRR) Southern California Clinical and Translational Science Institute (SC-CTSI) grant number UL1 TR000130. The authors report no conflicts of interest.

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