title: Utility of preoperative cardiac evaluation in pediatric patients undergoing surgery for obstructive sleep apnea.
abstract: OBJECTIVE
  To identify the prevalence of clinically relevant findings during cardiac evaluations of pediatric patients with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (TA), and to determine the association between cardiac findings and postoperative respiratory complications.
  
  
  METHODS
  Retrospective medical chart review.
  
  
  METHODS
  Pediatric patients aged 10 months to 15 years who underwent both echocardiography and polysomnography (PSG) within 6 months prior to TA for OSA from April 2007 through April 2011.
  
  
  METHODS
  Two pediatric cardiologists independently reviewed echocardiographic studies for evidence of cardiovascular disease. Patients were stratified based on apnea-hypopnea index (AHI) severity (1-5, >5-10, and >10). These groups were compared according to demographic, electrocardiographic (ECG), and echocardiographic values, and postoperative respiratory complications.
  
  
  RESULTS
  The medical charts of 57 of 900 patients identified were reviewed following exclusion of those with congenital cardiac abnormalities. The AHI groupings did not differ demographically. No clinically relevant abnormalities were identified on the echocardiogram of any patient. There was a statistically significant association between increased AHI and the appearance of postoperative respiratory complications (P < .05). Indicators of myocardial hypertrophy, such as left ventricular mass index, were not significantly related to AHI in contrast to previously published studies. No echocardiographic or ECG findings were identified that were associated with increased number of postoperative respiratory complications or OSA severity based on AHI.
  
  
  CONCLUSIONS
  The lack of clinically relevant findings during preoperative cardiac evaluations suggests that aggressive cardiac workup in pediatric patients with OSA may not be indicated unless dictated by comorbidities. Consistent with results in prior studies, preoperative AHI can identify patients at risk for respiratory complications following TA.
authors.affiliation: Head and Neck Institute, Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Revenaugh
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Chmielewski
authors.forename: Thomas
authors.initials: T
authors.lastname: Edwards
authors.forename: Jyoti
authors.initials: J
authors.lastname: Krishna
authors.forename: Paul
authors.initials: P
authors.lastname: Krakovitz
authors.forename: Samantha
authors.initials: S
authors.lastname: Anne
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003299:Cooperative Behavior; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010348:Patient Care Team; D017286:Polysomnography; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000601:surgery*; D014068:Tonsillectomy; D019564:Unnecessary Procedures