Prevalence of pulmonary hypertension in children with obstructive sleep apnea living at high altitude

Abstract

Introduction

The prevalence of obstructive sleep apnea (OSA) is 1–4 %. Some reports describe its association with pulmonary hypertension (PH), but its prevalence is unknown. No studies at high altitude have determined the relationship between OSA and PH. The aim of this study was to establish the prevalence of PH in children diagnosed with OSA living in a high-altitude city at 2640 m above sea level.

Methods

Children between 2 and 16 years of age referred to the Sleep Laboratory of the Fundación Neumológica Colombiana in Bogotá with a positive polysomnogram for OSA were included, and a two-dimensional transthoracic echocardiogram (TTE) was performed to evaluate PH. Statistical analysis was performed using median, interquartile range, chi-squared test, and Kruskall-Wallis test.

Results

Of the 55 patients (n: 55), 63.6 % were male, with a median age of 6 years, 14 children (25.5 %) were overweight; 12 children (21.8 %) had mild OSA, 12 (21.8 %) had moderate OSA and 31 (56.4 %) severe OSA. In patients with severe OSA, the minimum saturation during events was 78 % with a desaturation index (DI) of 33.8/hour (p < 0.01). T90 and T85 increased proportionally with OSA severity (p < 0.05). Of the 55 patients with OSA, none had PH according to echocardiography; 4 patients (7.2 %) had pulmonary artery systolic pressure (PASP) at the upper limit of normal (ULN), and it was not related to a higher body mass index (BMI).

Conclusions

We found no association between OSA and PH in children with OSA at high altitude.

Highlights

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  The prevalence of pulmonary hypertension in children with OSA living at high altitude is unknown.

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  It is not known whether living at high altitude is an additional risk factor for the development of PH in children with OSA.

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  None of the children with sleep apnea in this study who lived in a high-altitude city had a PASP that was higher than normal.

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  Intermittent desaturation and OSA severity at high altitude do not correlate with development of pulmonary hypertension.

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  It is important to identify the subgroups of children with sleep apnea who need to be screened for pulmonary hypertension.