PURPOSE: Children with cyanotic congenital heart disease live with baseline oxygen saturations in the mid 70's, so hence they exist on the steep part of the oxyhemoglobin dissociation curve. These patients are at increased risk for the hemodynamic variations occurring during apneas/ hypopneas. Long-term outcomes for children with congenital heart disease could be adversely affected since the etiology of pulmonary hypertension is believed to be secondary to the hypoxia and hypercarbia seen in chronic airway obstruction paired with the sympathetic overstimulation caused by frequent sleep arousals. This study determine the prevalence and identify risk factors associated with sleep disorder breathing (SDB) among pediatric patient with congenital heart disease.
METHODS: A two part questionnaire for the screening of SDB for pediatric patients was performed. Part one consists 22 item validated Pediatric Sleep Questionnaire (PSQ). Part two consisted of subjective assessment of the subject's cardiovascular and respiratory symptom. All odd ratios of greater than 1 with p-values less than .05 were considered significant covariates.
RESULTS: A total of 206 children met the inclusion criteria and were included in the final analysis. The prevalence of sleep disordered breathing (SDB) was high at 63.1%. Among the factors analyzed, an increased frequency of pulmonary diseases (greater than 7 times/year) was statistically correlated with increased PSQ scores (p=.002). Likewise, early palliative repair (p=.001) was statistically associated. A high total cardiac score is almost four times associated with increased PSQ ratings (p=.018).
CONCLUSION: Increased frequency of pulmonary diseases and early palliative repair was statistically correlated with increased Pediatric Sleep Questioner scores. A high total cardiac score is almost four times associated with increased PSQ ratings. Hence patients with congenital heart disease and Sleep Disordered Breathing are more likely to have worse cardiac symptoms.
CLINICAL IMPLICATIONS: This an important issue for the clinician in identifying patients with congenital heart disease at high risk for development of sleep disordered breathing thereby proper and adequate measures can be instituted early to decrease morbidity and mortality and improve their quality of life.
DISCLOSURE: Beverly Delacruz, No Financial Disclosure Information; No Product/Research Disclosure Information