A systematic review and meta-analysis of cohort studies of echocardiographic findings in OSA children after adenotonsilectomy

ContextThere is evidence that OSA in children can be associated with acute and chronic effects on the cardiovascular system due to repetitive episodes of apnea and hypoxemia.ObjectiveTo assess whether there is an association between OSA and echocardiographic findings in children and whether that association persists after adenotonsillectomy.Data sourcesA literature search was conducted based on PUBMED, EMBASE and LILACS.Study selectionChildren with OSA and children who did not have OSA, who were aged ≤12 years.Data extractionTwo reviewers extracted data independently; the risk of bias was assessed by examining the selected sample, the recruitment method, completeness of follow up, and blinding.ResultsSeven studies met all the inclusion criteria and methodological requirements. There was a significant difference with elevated mean pulmonary arterial pressure levels in OSA participants compared to those without OSA at preoperative assessment [mean difference (MD) 8.67; confidential interval (CI) 95% 6.09, 11.25]. OSA participants showed a statistically significant increased interventricular septum (IVS) thickness (mm) [MD 0.60; CI 95% 0.09, 1.11]; and right ventricular (RV) dimension (cm/m) [MD 0.19; CI 95% 0.10, 0.28]. There was also a significant increase in right ventricular (RV) dimension (cm/m) [MD 0.10; CI 95% 0.05, 0.14] in OSA children.ConclusionThere is moderate quality evidence regarding possible association between OSA and right heart repercussions. More prognosis studies are needed, to allow the combination of results in a meta-analysis.