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Type:	Artigo de Periódico
Title:	Prospective evaluation of obstructive sleep apnea syndrome, nasal flow and systolic pressure of the pulmonary artery in children with tonsillar hypertrophy
Authors:	C. P. Galvão M. Tinano Letícia Paiva Franco C. M. F. F. Nader A. E. Fernandes Helena Maria Gonçalves Becker
Abstract:	Introduction: Obstructive sleep apnea syndrome in childhood has aroused great interest due to its cardiovascular repercussions and its adverse effects on the quality of life of the affected individuals. However, fundamental aspects of the syndrome remain unknown. Objective: Herein we prospectively assessed pulmonary artery systolic pressure (PASP) and nasal flow in children with obstructive oral breathing with an indication for adenoidectomy and/or tonsillectomy and their relation- ship to the obstructive apnea and hypopnea index (OAHI). Materials and methods: Twenty-one children were evaluated at the time of the surgical indication (T0) and 18 months later (T1). Polysomnography, and rhinomanometry data were collected when we evaluated PASP. Results: Among the 21 children, 13 (61.9%) presented an altered OAHI at T0. Fourteen children (66.7%) un- derwent surgery. Of these, nine (64.3%) had an altered OAHI at T0 and seven (50.0%) at T1. Of the seven non- operated children, four (57.1%) had an altered OAHI at T0 and two (33.3%) at T1. Mean nasal flow increased in both groups independently of surgery (p<- 0.001). PASP exhibited a significant reduction between T0 and T1 in the operated group (p ,- 0.001). OAHI of the operated group did not show a significant decrease over time (p ¼ 0.074). In the non-operated children, the average nasal flow increased (p < 0.001), the PASP values did not reduce (p ¼ 0.99), and the OAHI increased and then decreased over time (p ¼ 0.025). Discussion: The present study stands out for the inclusion of a study group composed of children who did not undergo surgical treatment. It also included a lengthy follow-up (18 months) that allowed for a thorough investigation of OAHI changes over time. Indeed, the follow-up prac- ticed herein was much longer than those of previous studies (maximum of 7 months). The change in cardiovascular parameters after surgery indicates signs of early cardiovascular dysfunction in patients with OSA. It is not yet known whether these early alterations will be reflected in the future cardiovascular morbidity. We found that, in contrast to the findings regarding the operated patients, the OAHI of the non-operated group tended to normalize and PASP levels remain stable (p ¼ 0.99). These findings must be taken with caution given the small sample size of the non-operated group. It is not known whether elevated blood pressure levels in child- hood, even within normal limits, may contribute to future cardiovascular morbidity. Knowledge of the progression and the factors involved in the pathophysiology of OSA is important to identify the appropriate time to intervene and to determine which patients can benefit from the intervention. Isolated adenotonsillectomy, contrary to what was previously thought, is often insufficient to achieve complete resolution of sleep breathing problems and normalization of OAHI. Conclusion: PASP decreased significantly and OAHI did not normalize in the operated group. Mean nasal airflow increased in the operated and nonoperated groups.
Subject:	Apneia Obstrutiva do Sono Criança Adenoidectomia
language:	eng
metadata.dc.publisher.country:	Brasil
Publisher:	Universidade Federal de Minas Gerais
Publisher Initials:	UFMG
metadata.dc.publisher.department:	MED - DEPARTAMENTO DE OFTALMOLOGIA E OTORRINOLARINGOLOGIA
Rights:	Acesso Restrito
metadata.dc.identifier.doi:	10.1016/j.sleep.2019.11.338
URI:	http://hdl.handle.net/1843/53118
Issue Date:	2019
metadata.dc.url.externa:	https://www.sciencedirect.com/science/article/pii/S1389945719306999
metadata.dc.relation.ispartof:	Sleep Medicine
Appears in Collections:	Artigo de Periódico

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