Right Ventricular Function and Pulmonary Arterial Coupling in Paediatric Obstructive Sleep Apnea

PURPOSE: Right ventricular (RV) dysfunction and increased pulmonary arterial (PA) pressure may occur in children with obstructive sleep apnea (OSA). Long-term data on RV-PA coupling in children with OSA with or without adenotonsillectomy are absent. METHODS: This prospective cohort study included children aged 5 to 12 years diagnosed with tonsillar hypertrophy and moderate-to-severe OSA. All subjects underwent echocardiographic assessment and sleep study at least 5 years since initial recruitment. Right atrial, RV function and indexed pulmonary artery acceleration time (PAATi) were evaluated. RV-PA coupling was assessed by tricuspid annular plane systolic excursion (TAPSE) / PAATi and RV global longitudinal strain (GLS) / PAATi. RESULTS: We evaluated 160 subjects, including 38 with OSA who declined adenotonsillectomy (Group I), 80 with OSA post-adenotonsillectomy (Group II), and 42 controls (Group III). Baseline demographics were similar across groups. At a mean follow-up of 7.2 ± 2.5 years, the latest OAHI did not differ significantly between the two OSA groups. Echocardiographic assessment revealed small intergroup differences in RA total strain, peak tricuspid annular systolic velocity, RVGLS and PAATi, whereas TAPSE, RV fractional area change and systolic strain rate were comparable across groups. Importantly, RV-PA coupling indices did not differ significantly among the three groups. Furthermore, within the OSA cohort, neither follow-up duration nor current OAHI severity correlated significantly with RV function or RV-PA coupling indices. CONCLUSIONS: RV function and RV-PA coupling are preserved in adolescents and young adults with a childhood diagnosis of OSA, irrespective of prior adenotonsillectomy.