Does treatment of SDB in children improve cardiovascular outcome?

Available online 29 May 2012

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The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, AustraliaReceived 9 December 2011. Revised 20 April 2012. Accepted 20 April 2012. Available online 29 May 2012.View full text Sleep disordered breathing (SDB) is a common disorder in both adults and children and is caused by the obstruction of the upper airway during sleep. Unlike adults, most cases of paediatric SDB are due to the presence of enlarged tonsils and adenoids, thus the main treatment option is adenotonsillectomy (T&A). It is well known that obstructive sleep apnoea in adults increases the risk for hypertension, coronary artery disease and stroke, and there is now mounting evidence that SDB also has a significant impact on the cardiovascular system in children with reports of elevated blood pressure, endothelial dysfunction and altered autonomic cardiovascular control. As there is now substantial evidence that elevated blood pressure in childhood is carried on to adulthood it is important to know if treatment of SDB improves cardiovascular outcomes. Studies in adults have shown that treatment of SDB leads to improvements in cardiovascular function, including a reduction in pulmonary artery pressure, systemic blood pressure and endothelial dysfunction. However, studies exploring the outcomes of treatment of SDB in children on the cardiovascular system are limited and varied in their methodology and outcome measures. As a number of cardiovascular disturbances are sequelae of SDB, early detection and management could result in the reduction of elevated blood pressure in children, and consequently a reduction in cardiovascular morbidity in adulthood. The aim of this review is to summarise the findings of studies to date which have investigated the cardiovascular outcomes in children treated for SDB and to make recommendations for future management of this very common disease.

prs.rt("abs_end");Adenotonsillectomy; Blood pressure; Cardiovascular; Children; Hypoxaemia; Inflammation; Obstructive sleep apnoea; Sleep disordered breathing; Treatment

Figures and tables from this article:

Fig. 1. The effects of treatment on the cardiovascular consequences of obstructive sleep apnoea in children. The tick indicates studies that show improvement in the cardiovascular outcome with treatment, the question mark indicates study results are conflicting or that the treatment effects are unknown. OSA indicates obstructive sleep apnoea; RV, right ventricle; BP, blood pressure. Adapted from Bhattacharjee et al., 2009.49

View Within ArticleTable 1. Summary of studies investigating the effect of treatment on cardiovascular outcomes in children treated for SDB.

AHI – apnoea hypopnoea index; ApoB – apolipoprotein B; BP – blood pressure; BNP – brain natriuretic peptide; CRP – c-reactive protein; DBP – diastolic blood pressure; ET-1 – endothelin-1; HR – heart rate; IL-6 – interleukin 6; IL-10 – interleukin 10; LV – left ventricular; mo – month; N/A – not available; NIPPV – non-invasive positive ventilation; NOB – non-obese group; NT-proBNP – N-terminal pro-B-type natriuretic peptide; OB – obese group; ODI – oxygen desaturation index; OSA – obstructive sleep apnoea; P – prospective; PR – pulse rate; PRV – pulse rate variability; PS – primary snoring; R – retrospective; RV – right ventricular; S – primary snoring; SBP – systolic blood pressure; SD – standard deviation; SDP – sleep disordered breathing; T&A – adenotonsillectomy; w – week; y – year.

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