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Obstructive Sleep Apnea in Childhood and its Cardiovascular Effects A. Kaditis, MD

Obstructive Sleep Apnea in Childhood and its Cardiovascular Effects A. Kaditis, MD. University of Thessaly School of Medicine and Larissa University Hospital Department of Pediatrics and Sleep Disorders Laboratory. Obstructive Sleep Apnea in Childhood. Clinical Presentation and Etiology.

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Obstructive Sleep Apnea in Childhood and its Cardiovascular Effects A. Kaditis, MD

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  1. Obstructive Sleep Apnea in Childhood and its Cardiovascular EffectsA. Kaditis, MD University of Thessaly School of Medicine and Larissa University Hospital Department of Pediatricsand Sleep Disorders Laboratory

  2. Obstructive Sleep Apnea in Childhood Clinical Presentation and Etiology

  3. Obstructive Sleep Apnea in Childhood Clinical Presentation • Snoring • Apnea • Mouth breathing • Restless sleep • Frequent arousals

  4. Obstructive Sleep Apnea in Childhood Adenoidal-Tonsillar Hypertrophy

  5. Obstructive Sleep Apnea in Childhood Pathogenesis

  6. Inspiration:The Thoracic Pump -5 0 cmH2O -10

  7. Airway Diameter and Respiratory Phase EXPIRATION INSPIRATION

  8. OSA: Airway-Adenoids-Tonsils (Arens R, et al. AJRCCM 2001;164:698)

  9. Obstructive Sleep Apnea in Childhood-Pathogenesis Model

  10. Obstructive Sleep Apnea in Childhood Pathophysiology

  11. Intermittent Upper Airway Obstruction and Gas Exchange Abnormalities Hypercapnia Hypoxia

  12. Cardio-Respiratory Interactions Respiratory Dysfunction ↕ Cardıac Dysfunction

  13. Upper Airway Obstruction and Cardiac Function OSA

  14. Defense of the Central Nervous System to Upper Airway Obstruction Arousal from Sleep And Increase in Tone of Pharyngeal Muscles

  15. Obstructive Sleep Apnea in Childhood OSA and Cardiovascular System

  16. Shahar et al.Sleep-Disordered Breathing and Cardiovascular Disease. AJRCCM 2001;163:19-25

  17. OSA-CV disease-Pathogenesis Quan and Gersh. Circulation 2004;109:951 Obstructive Apnea-Hypopnea ↓ Intrathoracic Pressure Hypoxia Arousals Oxidative stress ↑ Sympathetic tone Δ in cardiac structure-function Endothelial dysfunction-↓arterial distensibility Inflammation- metabolic disturbances BP abnormalities

  18. Obstructive Sleep Apnea in Childhood OSA and Inflammation

  19. Obstructive SDB and CRP Levels in Children CRP Log CRP AHI AHI AHI AHI Tauman et al. Pediatrics 2004;113:e564 Kaditis et al. AJRCCM 2005;171:282

  20. Larkin et al.CRP and AHI: Threshold EffectsCirculation 2005;111:1978

  21. Kaditis et al. Fibrinogen in Children with Sleep-Disordered Breathing.Eur Respir J 2004; 24:790 114 children 3-10 yo Kruskal-Wallis P = 0.002

  22. Obstructive Sleep Apnea in Childhood OSA and Insulin Resistance

  23. de la Eva R, et al. Metabolic Correlates with OSA in Obese Subjects. J Pediatr 2002; 140: 654-9

  24. Kaditis A, et al. Obstructive SDB and Fasting Insulin Levels in non-Obese Children. Pediatr Pulmonol 2005;40:515 110 children 2-13 yo • AHI ≥ 5 • AHI < 5

  25. Tauman R, et al. Obesity determines Insulin Resistance in Snoring Children. Pediatrics 2005; 116: e66 135 children 8.9 ± 3.5 yo

  26. Obstructive Sleep Apnea in Childhood OSA and Blood Pressure

  27. BP in Children with OSA Marcus et al. AJRCCM 1998;157:1098

  28. Kaditis et al. Morning BP in Children referred for Polysomnography.American Thoracic Society Meeting 2006 164 children 2.9-15 yo Diastolic BP Index (%) p < 0.01 p < 0.01 p < 0.01 Elevated Diast BP For AHI>5 OR 6.9 For 1<AHI<5 OR 3.3 AHI≥5 1≤AHI<5 AHI<1

  29. Kaditis et al. BP and Habitual SnoringPediatr Pulmonol 2005;39:408 760 children 4-14 yo

  30. Obstructive Sleep Apnea in Childhood OSA and Cardiac Function

  31. A. Tal, et al. Ventricular Dysfunction in Children with OSA. Pediatr Pulmonol 1988; 4: 139

  32. Amin et al. Left Ventricular Hypertrophy in Children with OSAAJRCCM 2002; 165:1395 • 28 subjects with OSA • 19 subjects with Primary Snoring • Left Ventricular Mass Index higher in OSA • AHI significant predictor of Left Ventricular Mass Index

  33. Amin et al. Left Ventricular Function in Children with SDBAm J Cardiol 2005; 95:801 • 25 children with AHI>5 • 23 children with AHI=1-5 • 15 children with AHI<1 • Left Ventricular Mass Index higher in OSA • AHI significant (negative) predictor of Left Ventricular Diastolic Function

  34. Kaditis et al. Nocturnal Cardiac Strain in Children with Obstructive SDB.American Thoracic Society Meeting 2006 R =0.29; p < 0.05 AHI ≥ 5 AHI < 5 Controls

  35. Conclusions-Research Questions Pediatric SDB is related with mechanisms predisposing to CV morbidity in adulthood Unknown threshold of SDB severity above which associated morbidity

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