Correlação entre resistência nasal e pressão arterial pulmonar em crianças e adolescentes respiradores orais usando métodos objetivos de avaliação do fluxo nasal e achados ecocardiográficos

Abstract

Introduction: Adenotonsillar hypertrophy (ATH) and allergic rhinitis (AR) are the most common causes of upper airway obstruction in children. It may result in chronic alveolar hypoventilation, hypoxemic pulmonary vasoconstriction and pulmonary hypertension. Objective: Evaluate the prevalence of pulmonary hypertension in chronic oral breathers agedfrom 2 to 12 years old with ATH and AR through doppler echocardiographic parameters and the relation between the nasal resistance and pulmonary arterial pressure. Method: 54 patientswith ATH and adeno and/or tonsilectomy indication and 24 pacients with persistent allergic rhinitis were selected and underwent Doppler echocardiogram and rhinomanometrics measures. The determination of the systolic pulmonary artery pressure (SPAP) was done through the tricuspid regurgitation and the mean pulmonary artery pressure (MPAP) wascalculated from the SPAP. Similar determinations were performed in 25 nasal breathers. Results: The PMAP and SPAP means were significantly higher in oral breathers than in the nasal breathers group (17,62 ± 2,06 [ATH] and 17,45 ± 1,25 [AR] versus 15,20 ±2,36 mmHg,p< 0,005; and 25,61 ± 3,38 [ATH] e 25,33 ± 2,06 [AR] versus 21,64 ± 3,87 mmHg, p< 0,005, respectively) and the acceleration time of the pulmonary flow trace (ACT) mean was higher in the nasal breathers group (127,24 ± 12,81 versus 114,06 ± 10,63 ms [ATH] and 117,96 ± 10,28 ms [AR], p<0,005). SPAP presented a negative association with nasal flow (rho ofSpearman = -0,34; p<0,001). Conclusion: Oral breathers presented evidence of increased pulmonary arterial pressure by doppler ecocardiography and the increase of the systolic pulmonary artery pressure correlated to the increase of the nasal resistance, but there was anabsence of pulmonary hypertension diagnose.