Left ventricular dysfunction in pediatric sleep apnea

Background: Sleep-disordered breathing (SDB) is a syndrome of upper airway narrowing during sleep secondary to greater upper airway resistance and pharyngeal collapsibility. Obstructive sleep apnea (OSA) is the most common cause of sleep disordered breathing and its long term effects on cardiovascular outcomes is well studied in adults. Adult OSA can result in pulmonary hypertension, right ventricle dysfunction, left ventricular hypertrophy and dysfunction, systemic hypertension, coronary artery disease and arrhythmias. Studies looking at OSA in children and ventricular dysfunction are limited. Aim of review: The purpose of this review article is to describe the current evidence on the development of left ventricular dysfunction secondary to OSA in children. Key scientific concepts of review: Early signs of diastolic dysfunction have been reported in moderate to severe OSA patients, and non-invasive imaging like echocardiography is being used to identify diastolic dysfunction. Increased left ventricular mass is usually present in OSA patients, which can be multifactorial and systemic hypertension can amplify the effects. Long term outcomes in OSA patients after adenotonsillectomy or continuous positive airway pressure treatment are promising, and left ventricular diastolic function returns to baseline after treatment. Heart failure has been reported in adults but is not a common feature in pediatric patients.