Obstructive sleep apnea in children with congestive heart failure

Abstract

Purpose: To study OSA and its effects on cardiac indices in children with congestive heart failure (CHF) Methods: This case controlled prospective study was carried on 45 children Group Ia included 15 children (mean age 4.7+5.33 years) with CHF (patients with OSA due to genetic causes and upper airway obstruction were excluded), Group Ib: Group Ia patients after control of CHF. Group II: included 30 age and sex matched healthy controls. Children were subjected to history taking for CHF and OSA, sleep screening study using non invasive apnea link system, ECG, chest x-ray, echocardiographic: 2D, M mode, Doppler imaging, assessment of right ventricular end systolic pressure (RVESP), LV and RV myocardial performance (Tei) indices, systolic, diastolic functions and cardiac mass index. Results: A significant increase in OSA symptoms, apneahypopnea index (AHI), apnea index (AI) and hypopnea index (HI) values were found in group I compared to group II. Group Ib showed a statistically significant decrease in AHI, HI, oxygen desaturation index (ODI), RVESP, LV and RV Tei indices when compared to group Ia. A statistically significant negative correlation was noted between baseline oxygen saturation and LVPWD (p<0.05). A significant positive correlation was found between AHI and QTc, RV Tei index before and after control of CHF (P= 0.03, 0.042 and 0.037) respectively. Conclusions: Children with CHF were found to have OSA. Antifailure measures improved both conditions. Alleviation of OSA associated improved myocardial contractility and decrease in both pulmonary pressure and QTc thus decreasing the risk for CVS morbidity.